Chronic Obstructive pulmonary Disease (COPD) is a common progressive disorder characterized by persistent airflow limitation. It is usually caused by exposure to tobacco smoke, toxic particles, or toxic gases. COPD is characterized by cough, sputum production, and dyspnea, which is the cardinal symptom and is included in the criteria for severity. Dyspnea is a major source of suffering and disability, especially when it persists at rest.
Despite proper medical treatment, many patients continue to suffer from persistent dyspnea that significantly impairs their daily functioning and quality of life. Complementary approaches such as yoga and relaxation techniques are therefore recommended by some experts. Hypnosis is one of these practices. It has been shown to be effective in the management of both acute and chronic pain and it can abolish several types of experimentally induced dyspnea in healthy volunteers. In adults with COPD, a single hypnosis session has been shown to reduce anxiety immediately, though only temporarily. However, according to a recent retrospective study, a median of three hypnosis sessions increases the distance covered in the 6-minute walk test in COPD patients.
The investigators therefore hypothesize that several hypnosis sessions will improve the quality of life of adult outpatients with COPD who suffer from persistent dyspnea. The study plans to recruit 154 patients with severe dyspnea (mMRC(modified Medical Research Council Dyspnea Scale) 3 or 4). They will be randomly assigned to either the experimental group or the control group. Patients in the experimental group will participate in 5 sessions of medical hypnosis spaced 7 ± 2 days apart. The first hypnosis session will take place at the end of the enrollment visit. The final session will be held via teleconsultation. Four standardized telephone calls, spaced 7 ± 2 days apart, will replace the hypnosis sessions in the control group. The primary outcome of the study will be the evolution of quality of life, assessed 6 weeks after the start of the study as compared to baseline. Secondary outcomes will focus on changes in exercise capacity, dyspnea, anxiety, depression, dyspnea-related catastrophizing, self-efficacy, and pleasure in life.
Age >18 years
COPD (any etiology), referred by a pulmonologist and managed according to GOLD 2024 guidelines except for pulmonary rehabilitation that is not required
Outpatient follow-up
Residing in Paris or the inner suburbs for centers located within the city limits, or within a 30-minute drive for centers located outside the city limits of Paris.
Vulnerable individuals (under legal guardianship or curatorship) or deprived of liberty
Pregnant or breastfeeding women
Absolute or relative contraindication to the 6 minutes walk test, spirometry or body plethysmography
Current COPD exacerbation or exacerbation resolved less than one week ago
Parallel
Hypnosis
BehavioralFive medical hypnosis sessions, each scheduled 7 ± 2 days apart
standardized telephone calls
Other interventionFour standardized telephone calls, made at 7 ± 2 day intervals
Change in quality of life assessed using the total score of the St George's Respiratory Questionnaire (SGRQ)
Change in the total score of the St. George's Respiratory Questionnaire (SGRQ), which assesses respiration-related quality of life, at 6 weeks after randomization and baseline. The SGRQ is a self-administered questionnaire that assesses three domains: symptoms, activity, and impact on daily life. It permits calculation of a total score from these three domains, reflecting respiration-related quality of life. Study participants will complete this questionnaire at the first visit, the randomization visit (V1), and the final visit (V6). The two visits will take place 6 weeks apart (with an extra week's buffer in case of unexpected delays regarding one of the visits or hypnosis sessions). (Total score ranges from 0 to 100, 0 = no impact of the disease on quality of life, 100 = maximum impact on quality of life.
Change in the three component scores of the SGRQ that assess the quality of life in COPD in terms of symptoms, activity and impact on daily life
The SGRQ permits the calculation of 3 scores related to the quality of life in COPD patients : symptoms, activity and impact on daily life (Total score ranges from 0 to 100, 0 = no impact of the disease on quality of life, 100 = maximum impact on quality of life.).
Change in ability to engage in physical activity
Distance covered during the 6-minute walk test
Change in dyspnea and its affective, sensory, and emotional dimensions
Dyspnea will be assessed using the Multidimensional Dyspnea Profile (MDP) questionnaire (Scores range from 0 to 10-50 for each item with higher scores indicating more severe sensory or emotional dyspnea; 0 = no impact of breathlessness.).
Change in dyspnea in activities of daily living
Dyspnea will be assessed using the London Chest Activity of Daily Living (LCADL) scale (Scores range from 0 to 75, 0 = no limitation of daily activities due to breathlessness. 75 = maximum limitation of daily activities due to breathlessness.).
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