Stress management alone does not significantly alter the course or prognosis of COPD; however, as a component of the management program in a rehabilitation setting, it can improve a patient's function, possibly by allowing better coping with their disease (39,40). In a meta-analysis of psychosocial interventions in COPD, the effect of relaxation training was confirmed to be most notable in the areas of subjective dyspnea and psychological well being (41). There was also a trend toward less utilization of hospital services and toward a greater sense of independence in these studies. This is not necessarily surprising, as the patients who can remain calm and are able to relax are less likely to unnecessarily utilize emergency services. The effect of stress relaxation techniques on the utilization of sedative hypnotic medications in COPD has not been studied, but in our clinical experience, the need for these agents does seem to decline with the learning of appropriate relaxation maneuvers.
Because the comprehensive care of the patient with COPD in the pulmonary rehabilitation setting aims for achievement of the highest function possible, the psychosocial aspects of the program should not be neglected. The best form of relaxation technique is still a matter of controversy, and there is no clear recommendation to be made from a review of the literature. In reality, the availability of practitioners experienced in relaxation techniques will often limit the options at any one center, and each individual patient will respond differently to different treatment regimens. Techniques that are commonly used include hypnosis and autohypnosis, meditation, visualization, timed breathing, and relaxation audiotapes and videos. The goal is to allow the individual to find a tool that helps them to relax, and that can be used during exacerbations or periods of anxiety. Once the training has been achieved, the maintenance of the skill must be emphasized, as it is with all aspects of pulmonary rehabilitation.
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