The impact of chronic obstructive pulmonary disease-related fears on disease-specific disability

Anxiety is frequently observed in persons with chronic obstructive pulmonary disease (COPD). Although anxiety in persons with COPD is multifaceted, it is mostly assessed as a general psychopathological condition. Consequently, the objectives of this study were to revise an existing questionnaire assessing relevant anxieties for use in clinical practice and research, to examine the association between COPD-related fears and disability, and finally to develop norms for COPD-related fears. Disease severity (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, use of long-term oxygen), sociodemographic characteristics, COPD-specific disability (COPD assessment test), and psychopathology (depression, general anxiety, somatoform symptoms, and disease-related fears) were obtained from a sample of 1025 individuals with COPD via the Internet. We used the COPD Anxiety Questionnaire (German: CAF) for the assessment of different fears that have been found to be relevant in COPD: fear of dyspnea, fear of physical activity, fear of progression, fear of social exclusion, and sleep-related worries. Mean COPD-specific disability was high (22.87). After explanatory and confirmatory factor analyses, a revised version of the CAF was constructed. The economical and user-friendly CAF-R showed adequate reliability and expected correlations with convergent and discriminant constructs. Gender-specific norms are provided for use in clinical practice and research. Even after controlling for GOLD stage, sociodemographic variables, and psychopathology, COPD-related fears contributed incrementally to disease-specific disability. The CAF-R is an economical and reliable tool to assess different specific fears in COPD. Results indicate that disease-specific fears have an impact on disability, supporting the assumption that detailed assessment of anxiety in COPD should be included in clinical practice.