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What is TANDEM?

Living with COPD - Chris' story

Depression makes you feel down and you don’t enjoy life. Anxiety can make you feel nervous, on edge, or keep you worrying about things. Longstanding health problems can lead to depression and anxiety.

Chronic obstructive pulmonary disease (COPD), causes breathlessness with intermittent flare ups (attacks). About 25% of people with COPD have depression and up to 50% of outpatients have anxiety. Many have both depression and anxiety. Recent research tells us that psychological and lifestyle treatments which include exercise may be most effective in relieving depression and anxiety. Our study aims to test the effect of psychological treatment linked to physical activity for people with mild or moderate anxiety or depression (or both) and moderate or severe COPD.

Psychological (talking) treatments are very effective for anxiety and depression. CBT (cognitive behaviour therapy) targets how people think about their problems and promotes positive changes.

Pulmonary rehabilitation (PR), a group course run by physiotherapists, is the cornerstone physical treatment for COPD. It increases most people’s ability to exercise, reduces breathlessness and improves wellbeing reducing anxiety and depression. However many COPD sufferers are not keen on joining PR, even though many want to know more about their condition and how to manage it better. Because breathlessness can be so troubling in COPD sufferers may be anxious about exercise. Currently only around 40% of those who might benefit from PR complete the course.

We propose to link the psychological (proven) CBT with the practical (proven) PR. Our new intervention involves up to 8 home visits by a trained respiratory nurse (or physiotherapist) to COPD patients with mild/moderate anxiety or depression. After this they will be supported in taking up an offer of PR with their local service, during which the nurse will continue to support them through phone calls. The intervention will be tailored to the needs of patients. We will train the nurses to deliver the principles of CBT and they will also be able to support patients around the many practical aspects of living with COPD. The intervention will be designed and refined in close consultation with groups of COPD sufferers and their carers. Questions that we hope to answer about the new intervention are: Can it reduce anxiety and depression? Does it encourage sufferers to start (and finish) a PR course? Will it lead to reduced breathlessness, increased exercise capacity and wellbeing, reduced days spent in hospital? How much would it cost the NHS?

The study is in two parts - a small study followed by a second, much larger, study which will show decisively if the new treatment works. The second study will only go ahead if the small study proves it can be done. Patients will be recruited from hospital clinics, GP surgeries and referrals to PR. Those who agree to join the study will be screened for anxiety and depression with a simple questionnaire. Those with anxiety or depression will then be offered the new treatment or standard PR with allocation to either treatment entirely by chance so we can measure the effect of the new intervention. All participants will get a £5 voucher for their contribution in completing their follow up questionnaires.

Baseline and follow-up information (at 6 and 12 months) will be collected in person by a researcher, or by post, and with permission we will collect information from medical records.