Inside Duke Medicine

Coping with COPD’s emotional toll

At 49 years old, William Lambeth, M.D., saw his life as a busy OB/GYN come to a sudden halt. He had chronic obstructive pulmonary disease (COPD).

A new Duke Medicine research program aims at help those with COPD and their loved ones cope with this disease, particularly its emotional toll.

“You go into an instant fight-or-flight response only you can’t fight or flight,” said Lambeth. “You become immobilized. To say its frightening is an understatement.”

Click below to read more of this story by Inside’s Melissa Schwarting.

Lambeth is describing daily episodes associated with his chronic obstructive pulmonary disease (COPD), a lung disease that restricts air flow and is the fourth leading cause of preventable death for men and women.

“People with COPD experience a drastic change in their ability to complete everyday tasks and commonly develop anxiety and depression,” said James Blumenthal, Ph.D., clinical psychologist and the lead investigator of the new study.

More than 15 million Americans are living with COPD and more than a million North Carolinians have a chronic lung disease. Some research has reported depressive symptoms or major depression to be as high as 80 percent and elevated symptoms of anxiety to exceed 90 percent. These rates are much higher than other chronic illnesses.

“Anxiety can trigger shortness of breath, which can become severe. Over time, people adopt a sedentary lifestyle to avoid these episodes, which a can worsen their overall health,” Blumenthal said. “We’d like to break this cycle.”

COPD, which encompasses emphysema and chronic bronchitis, causes irreversible loss of lung function that can require lung transplantation in later stages. Symptoms include shortness of breath, chronic cough, wheezing and weight loss. COPD is commonly caused by smoking.

For Lambeth, it all started one busy week in December 1997.

“I went upstairs to shower and return to the hospital, but by the time I got to the top I could not breathe,” said Lambeth. Eight months later he decided he could no longer continue to work. Even minimal physical activity became too taxing. “It’s like breathing through a straw all of the time.”

“Everyone with COPD has some level of anxiety, but their emotional needs often go unmet,” said Scott Palmer, M.D., M.H.S., scientific director of the lung transplant program. “Medical interventions to treat anxiety can reduce respiratory function and potentially adversely affect breathing, so psychological interventions, such as coping skills training, can help empower patients to manage their own health and provide a better long-term solution.”

The new research program is designed to explore more effective ways to help patients with lung disease cope with problematic symptoms, improve their quality of life, improve their physical functioning and increase their survival. The five–year, $3.6 million study is funded by the National Institutes of Health.

The Duke team also includes Tereza Martinu, M.D.; Neil MacIntyre, Frank Keefe, Michael Babyak, and Virginia Fenwick. Researchers at the Ohio State University are led by Charles Emery, Ph.D., and Philip Diaz. Scientists from the University of North Carolina at Chapel Hill also will participate, including Alan Hinderliter, M.D., and Diane Catellier, D.P.H.

The team is looking for people with COPD and their partners or caregivers to participate in a unique coping skills training program delivered over a series of weekly, 30-minute telephone calls that will provide tools designed to enhance their ability to manage the disease symptoms. Participants also will receive the latest educational materials about optimal ways to manage COPD.

Lambeth reiterates the value of addressing the often overlooked psychological aspects of COPD.

“This is a disease that is hard to grasp. You go through a grieving process. It’s really helpful to have someone to talk to.”

For more information about the Duke COPD research program, contact Julie Johnson, study coordinator at (919) 684-5487 or email James Blumenthal at Blume003@mc.duke.edu.