A99-04 Coping Strategies, Anxiety Status, and Functional Outcomes in IPF and COPD During Pulmonary Rehabilitation - A Prospective Observational Study

Abstract Background Psychological factors such as anxiety and coping strategies may influence the effectiveness of pulmonary rehabilitation (PR). While some data exist in chronic obstructive pulmonary disease (COPD), evidence in idiopathic pulmonary fibrosis (IPF) is scarce. Therefore, the primary aim of this study was to examine coping strategies in anxious vs. non-anxious patients with IPF. As a secondary objective, we compared coping profiles and functional outcomes with patients with COPD to provide clinical relevance. Methods In this prospective observational study, patients with IPF (n = 90) and COPD (n = 90) participating in a 3-week inpatient PR-program were included. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS); a score ≥8 on the anxiety subscale defined the anxious group. Coping strategies were evaluated with the Essener Coping Questionnaire (EFK). Functional outcomes were the 6-minute walk distance (6MWD) measured at baseline and post-PR and daily physical activity (steps/day) assessed by accelerometry post-PR and at 3-month follow-up. Results Among IPF patients (67±8 years), anxious individuals (n = 37 45%) showed a less adaptive coping profile at baseline than non-anxious patients (n = 46 55%): lower problem-focused coping (2.0±0.7 vs. 2.6±0.7, p 0.001), lower inner stability, and higher depressive and avoidance strategies (all p 0.05). Compared to COPD (68±8 years; anxious: n = 55 64%, non-anxious: n = 31 36%), IPF patients demonstrated more adaptive coping overall, including higher problem-focused coping (2.4±0.8 vs. 2.1±0.8, p = 0.04), greater social inclusion, and inner stability (all p 0.05). Baseline 6MWD was higher in IPF than in COPD (391±116m vs. 312±126m). Both groups improved significantly after PR (IPF: +28m 95% CI 16-40, COPD: +32m 23-42, each p 0.05). In contrast, daily physical activity diverged during follow-up: IPF patients reduced their step count by 2100 steps/day 95% CI -3075 to -1123, whereas COPD patients increased activity by + 1600 steps/day 95% CI 696 to 2505. Conclusions Coping strategies differed by anxiety status within IPF and between IPF and COPD, with IPF patients showing higher problem-focused coping, social inclusion, and inner stability at PR-start. The higher prevalence of anxiety in COPD may partly explain these between-group differences. Short-term functional improvements (6MWD) were comparable in both groups, but long-term physical activity patterns diverged, with a decline in IPF and an increase in COPD. These findings highlight disease- and anxiety-related differences in coping profiles. However, the decline in physical activity despite more adaptive coping in IPF suggest that disease-related factors, such as progression, may outweigh psychological factors in determining functional outcomes. This abstract is funded by: This study was funded by Boehringer Ingelheim. The sponsor had no influence on study design, data collection, analysis, or interpretation.