A mindful breathing intervention in chronic obstructive pulmonary disease: A mixed methods feasibility study

Background: The psychological and physiological impacts of chronic obstructive pulmonary disease (COPD) may exacerbate the anxiety-breathlessness cycle, reduce self-efficacy and impede self-management. The integrative literature included in this current study, highlighted evidence to suggest mindfulness-based interventions may increase self-awareness and self-efficacy and reduce symptom burden. However, more research is needed to optimise uptake, adherence, acceptability, delivery, components and efficacy of these interventions for people with COPD. The current study evaluated the clinical feasibility of a mindful breathing intervention in COPD. The secondary aim was to obtain preliminary estimates regarding change in the participants’ self-efficacy in managing their COPD.

Methods: This mixed method pre-post study with three-month follow-up assessed the feasibility of recruitment, acceptability, and reported preliminary descriptive data regarding this novel mindful breathing intervention for 18 adults with mild to very severe COPD (age range 56-92 years; 69% female). Self-report measures assessed mindfulness, self-efficacy, psychological and physiological symptom burden, and overall health related quality of life. A qualitative interview exploring ten participants’ experiences of the mindful breathing intervention was undertaken at the three- month follow-up point. A case study of the first trial participant was used to test feasibility of the study processes

Findings: Twenty-nine adults participated in the current study and adherence to the mindful breathing intervention was 62% based on completer analysis (n = 18). The case study identified some practical issues with the technological aspects of the delivery and research which were addressed. Statistically significant changes included three of the five factors, and the total score of the COPD Self-Efficacy Scale: The Hospital Anxiety and Depression scores: The anxiety/depression dimension of the EQ-5D-5L: The St George’s Respiratory Questionnaire for COPD demonstrated improved activity levels and overall less COPD related burdens. The Five Facet Mindfulness Questionnaire-Short Form findings demonstrated change on the non-reactivity facet and the total score. The EQ-5D-5L demonstrated improvements in mobility and usual activities. The participants’ qualitative findings resulted in three overarching topics which highlighted an ability to be more self-aware and motivated to search out, and to continue to participate in, effective self-management practices (including the mindful breathing intervention) to improve their overall psychological and physical wellbeing.

Discussion: This current study demonstrated feasibility supporting further evaluation of the mindful breathing intervention in a larger trial. The results are consistent with the wider literature which suggests mindfulness-based interventions may be an effective non-pharmacological treatment to increase mindfulness and self-efficacy in managing the problematic psychological and physical symptoms commonly associated with COPD. To this researcher’s knowledge this current study is the first to assess feasibility of a self-managed, home-based mindful breathing intervention for those with COPD in New Zealand. To detect larger effect sizes between the mindful breathing intervention and an active control, a much larger participant sample would be necessary.

Conclusion: The mindful breathing intervention is a brief, no to low cost, easily accessible individual centric intervention which has the potential to improve the psychological and physiological wellness of people with COPD. Further research is needed to establish whether these preliminary findings can be replicated and maintained over a longer period.