A randomized placebo-controlled trial of paroxetine for the management of anxiety in chronic obstructive pulmonary disease (PAC Study)

Abstract

Background

Despite the high prevalence of anxiety in COPD patients and its impact on quality of life, evidence to support the effectiveness of various anxiety treatment options is insufficient, leading to the need for further research in this field.

Aim

The aim of this study was to assess the efficacy and safety of paroxetine for the management of anxiety in COPD and the impact of treatment on patients’ quality of life and rate of hospitalization.

Patients and methods

In a double-blind, randomized, controlled trial, COPD patients were allocated into groups that either received paroxetine 20 mg or placebo pills daily, for four months. Differences in outcomes were assessed based on an intention-to-treat analysis using linear mixed effects models. A chi-square test was used to compare the number of COPD-related admissions.

Results

Thirty-eight participants were recruited. Twenty-two of these completed the trial. A clinically and statistically significant reduction was noted in anxiety symptoms after four months of treatment compared to the placebo. Clinically important improvement was noted in depression symptoms, with no statistically significant differences in walking distance or quality-of-life measure outcomes. The intervention group had less COPD-related admissions compared to the placebo group but experienced medication-related side effects.

Conclusion

Treatment with paroxetine significantly improved anxiety levels, but this difference did not translate into improved quality of life at four months follow-up.

Keywords:

• anxiety
• COPD
• pharmacotherapy
• paroxetine
• BAI
• emphysema

Acknowledgments

The authors wish to acknowledge Harshani Jayasinghe and Malcolm Brinn for their assistance with patient recruitment and data collection and Zoe Kopsaftis for assistance with manuscript editing. They also wish to thank June Challen from the Clinical Trials Unit at TQEH pharmacy for assistance with blinding and randomization along with Pamela Kidd and Donna Keatley from the Pulmonary Function Laboratory at TQEH Respiratory Medicine for assistance with performing various tests. They wish to thank Dr Paul Cafarella (RGH), Dr Jeff Bowden (FMC), Dr Ral Antic (RAH), Prof Mark Holmes (RAH), Mrs Karen Royals (TQEH), and Mrs Mary Young (RAH) for their assistance with recruitment at various sites. This study was funded by the Department of Respiratory Medicine, The Queen Elizabeth Hospital, Adelaide, SA, Australia.

Disclosure

The authors report no conflicts of interest in this work.