Spirituality in people with advanced chronic obstructive pulmonary disease - challenge for more effective interventions, support, and healthcare education: Mini-review

Recent advances in understanding the role of antidepressants to manage breathlessness in supportive and palliative care

PURPOSE OF REVIEW

Breathlessness is a prevalent and distressing symptom in palliative and supportive care, with limited licensed pharmacological options once disease-directed therapies are no longer effective. Antidepressants have been proposed as a potential treatment, even in the absence of comorbid mood disorders, due to their modulation of neural circuits and serotonin pathways involved in breathlessness perception. Despite their off-label use in clinical practice for managing refractory or chronic breathlessness, robust evidence supporting their efficacy is needed. This review critically evaluates the latest evidence on their potential benefits and safety in breathlessness management.

RECENT FINDINGS

Breathlessness is influenced by at least three interrelated axes: lung-brain, behavioural-functional, and psycho-social-spiritual. These mechanisms operate across diseases, making them relevant in palliative and supportive care. Despite promise from early case reports and small trials, two recent large, randomised studies of mirtazapine and sertraline found no benefit in alleviating breathlessness or improving other outcomes. The mirtazapine trial also reported more adverse events than placebo. Earlier trials were small with design limitations, reducing reliability. A 2016 trial of sertraline found benefits for depression in stable COPD. Recent concerns over increased morbidity associated with antidepressant use in respiratory disease highlight the need for early detection of people at risk of worsening breathlessness or depression and a holistic, individualised approach.

SUMMARY

Current evidence does not support antidepressants for breathlessness in respiratory disease. Non-pharmacological approaches should be first line, given their proven benefits and low risk. Off-label medicine use requires caution and should ideally be offered within a trial or evaluation. Given the complex nature of breathlessness, future research should focus on innovating and then testing treatments and therapies in well-designed trials with appropriate outcome measures and reporting of adverse events, health care use and informal carer effects.

Identification of Psychosocial and Sociodemographic Factors Associated with Low Medication Awareness in COPD Subjects: A Cross-Sectional Study, Findings from the Indonesian Family Life Survey 5

Purpose

To identify psychosocial and sociodemographic factors influencing low medication awareness among patients with Chronic obstructive pulmonary disease (COPD) based on Indonesian Family Life Survey 5 (IFLS-5).

Methods

This study used a cross-sectional design, with data from IFLS-5 (2014/2015). Inclusion criteria were subjects with a self-reported diagnosis of COPD and aged at least 15 years. Two main factors were identified as modifiable psychosocial factors (eg, insomnia, depressive symptoms, happiness status, general health check status, smoking status, and health service satisfaction) and as non-modifiable sociodemographic factors (eg, gender, age, education level, marital status, economic status, insurance ownership, religiosity, comorbidity, and place of residence). Multivariate logistic regression analysis was used to explore the relationship between these factors and the awareness of COPD medication, by observing the adjusted odds ratio (aOR) within a 95% Confidence Interval.

Results

There were 618 subjects identified with COPD, of which 53.40% were male. 84.30% of subjects have low medication awareness. Non-modifiable sociodemographic factors such as age 15-25 years (aOR: 2.531; 95% CI 1.024-6.253; p-value 0.044), age 26-35 years (aOR: 3.418; 95% CI 1.444-8.091; p-value 0.005), high school education level (aOR: 4.870; 95% CI 1.685-14.078; p-value 0.003), and modifiable psychosocial factors such as satisfaction with health services with the category "sufficient" (aOR: 2.510; 95% CI 510; 95% CI 1.508-4.176; p-value 0.000), and subjects who smoked (aOR: 1.894; 95% CI 1.147-3.127; p-value 0.013), were significantly associated with low COPD medication awareness.

Conclusion

This study shows that most subjects with COPD had low medication awareness, which is influenced by factors such as age, education level, smoking habits, and satisfaction with health services. This highlights the need for targeted interventions for high-risk groups. Limitations of this study include reliance on self-reported data, which may lead to recall bias. In addition, this study was unable to provide evidence of a causal relationship.

The Relationship Between Spiritual Care Needs and Death Anxiety in Turkish Patients with Chronic Obstructive Pulmonary Disease

This study aimed to determine the levels of spiritual care needs and death anxiety, as well as the relationship between them, in Turkish patients with chronic obstructive pulmonary disease (COPD). This descriptive and correlational study included 480 patients who were admitted to the pulmonology outpatient clinics of a public hospital with a diagnosis of COPD between November 1, 2023, and April 31, 2024. The study data were collected using the Patient Diagnosis Form, Dyspnea Fear Level Assessment Form, Spiritual Care Needs Inventory, and Templer Death Anxiety Scale. It was determined that 60.8% of the patients had high death anxiety and moderate spiritual care needs. A positive correlation (r = 0.327; p < 0.01) was found between the mean scores of the Spiritual Care Needs Inventory and the Templer Death Anxiety Scale. Patients with high death anxiety also had high spiritual care needs (p < 0.01). It was determined that the gender of the patients, fear of dyspnea, and death anxiety predicted 20% of the need for spiritual care (R = 0.457, R2 = 0.209, F = 17.800, p < 0.001). Considering the study findings, it can be stated that death anxiety may decrease as the spiritual needs of the patients are met. Within the framework of holistic care, it is essential for health professionals to identify patients' spiritual needs in addition to their physical and psychological needs and to implement interventions to meet these needs.

Spirituality, Organizational Gratefulness, and Well-Being Among Polish Workers

The relationship between spirituality at work and occupational and subjective well-being is not a well-recognized area of research. Many studies have indicated the beneficial effects of spiritual activities on employees' flourishing, but the mechanisms of this influence are still not sufficiently explained. This study aimed to verify the proposed mechanisms that underlie employees' spirituality, stress at work, and life satisfaction, and the role of gratitude toward the organization in these relationships. It was assumed that employees' spirituality is indirectly related to stress at work via gratitude toward the organization. In turn, gratitude toward the organization is directly and indirectly related to life satisfaction through stress at work. The study encompassed 754 individuals working in different companies in Poland. In a sample of women, both spirituality dimensions were indirectly related to stress at work and life satisfaction. Among men, only the secular dimension of spirituality, such as attitude toward coworkers, was indirectly related to stress at work and life satisfaction. Gratitude toward the organization was negatively directly related to stress at work and, through this variable, indirectly positively related to life satisfaction. The benefits of employees' spirituality for their well-being were confirmed, emphasizing a grateful attitude toward the organization as a significant factor in this relationship.

Unveiling the burden of COPD: perspectives on a patient-reported outcome measure to support communication in outpatient consultations-an interview study among patients

Introduction

Chronic Obstructive Pulmonary Disease (COPD) profoundly affects physical, psychological, and social aspects of life, yet these issues often remain unaddressed. Patient-Reported Outcomes Measures (PROM) have the potential to address these issues by promoting person-centered communication. However, their impact in COPD practice remains uncertain. This study aimed to investigate how patients with COPD perceive the usefulness of a new holistic PROM for general palliative care (PRO-Pall) before and during outpatient consultations.

Methods

Semi-structured telephone interviews were conducted with patients diagnosed with moderate to very severe COPD, 2-5 days after consultation at a respiratory outpatient clinic in Denmark. Interviews were transcribed verbatim and analyzed inductively using qualitative content analysis.

Results

Nine patients (five males; mean age: 66 years) participated in the study with four themes emerging: (1) Unlocking thoughts: Completing PRO-Pall stimulated patients' self-reflection, which revealed previously overlooked COPD-related issues, particularly psychosocial challenges. (2) Unmasking concerns: Patients felt encouraged to be honest, rather than concealing their concerns. (3) Breaking the ice: PRO-Pall responses enabled direct questioning by healthcare professionals during consultations, initiating discussions on patients' sensitive yet vital COPD-related matters. (4) Deepening the dialogue: Healthcare professionals' targeted and attentive approach fostered more holistic and meaningful discussions, providing most patients with a deeper understanding of psychosocial issues affecting their well-being.

Conclusion

Completing PRO-Pall prior to outpatient consultations prompted most patients with COPD to unveil previously unacknowledged psychosocial challenges. During consultations, addressing these challenges initiated open discussions on individual concerns, enhancing most patients' understanding of the multifaceted burden of COPD.