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

Authors Usmani ZA, Carson-Chahhoud KV, Esterman AJ, Smith BJ

Received 20 February 2018

Accepted for publication 11 April 2018

Published 27 June 2018 Volume 2018:11 Pages 287—293


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Zafar A Usmani,1,2 Kristin V Carson-Chahhoud,1,3 Adrian J Esterman,4,5 Brian J Smith1,2

1School of Medicine, The University of Adelaide, Adelaide, SA, Australia; 2Department of Respiratory Medicine, The Queen Elizabeth Hospital, Adelaide, SA, Australia; 3School of Health Sciences, The University of South Australia, Adelaide, SA, Australia; 4School of Nursing and Midwifery, The University of South Australia, Adelaide, SA, Australia; 5Australian Institute of Tropical Health Medicine, James Cook University, Cairns, QLD, Australia

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.
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

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