The relationship between coping styles and clinical outcomes in patients with COPD entering pulmonary rehabilitation

Symptoms of anxiety, depression and exercise intolerance contribute to an impaired health status in patients with Chronic Obstructive Pulmonary Disease (COPD). Coping styles may also be related to symptoms and health status. Objectives of this study were to assess the distribution of coping styles in patients entering pulmonary rehabilitation (PR) with and without anxiety and/or depression; and to assess whether coping styles contribute to exercise intolerance and reduced health status.

Coping styles were studied in 698 patients using the Utrecht Coping List (UCL). Disease-specific health status (St. George's Respiratory Questionnaire, SGRQ), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), exercise tolerance (6-minute walking distance, 6MWD) and clinical characteristics were assessed.

High levels (16.5%) of active confronting coping style were rarely reported. A minority of patients used low levels (17.5%) of passive reaction pattern coping style. Differences in coping profiles were present between patients with and without anxiety and/or depression. A higher level of active confronting coping style was associated with a higher 6MWD (Beta 0.092, p < 0.01), while a higher level of avoidance coping style was associated with a lower 6MWD (Beta -0.074, p = 0.017). The UCL subscales were not related to SGRQ total score (p > 0.05).

In COPD patients entering PR, coping styles were associated with symptoms of anxiety, depression and exercise intolerance, but not associated with disease-specific health status. Future studies should examine whether interventions aiming at optimizing coping styles during PR can improve outcomes for patients with COPD.