Q. I am a Director of Nursing at an acute care hospital. We are searching for an anxiety scale that will assist nursing and medical staff in more objectively rating anxiety level in patients with respiratory disorders. We are most interested in a scale that has been validated for guiding when medication with anti-anxiety drugs may be helpful under these circumstances.

A. I'm not aware of any studies showing that a specific anxiety rating scale can successfully guide medication treatment for patients with respiratory disorders. However, several studies have utilized various rating scales to measure either anxiety or depression in patients with chronic obstructive pulmonary disease (COPD).

For example, Janson et al (Am J Respir Crit Care Med 1994; 149:930-4) used the hospital anxiety and depression (HAD) scale questionnaire. They found a significant correlation between anxiety and depression and the report of asthma-related symptoms. The HAD scale was also used in a study by Gore et al (Thorax 2000;55:1000-06), who found that 90% of patients with COPD suffered clinically relevant anxiety or depression, compared with 52% of patients with lung cancer. Gift & Cahill (Heart Lung 1990;19:252-7) used the Spielberger State Anxiety Inventory to assess patients with COPD.

However, I personally see no reason why other anxiety scales, such as the Hamilton, Zung, or Sheehan scales, could not be used to guide treatment in such cases. These are all standardized to non-medically ill patients, so far as I know, but I don't necessarily think that renders them invalid for COPD patients. Nevertheless, it appears that most of the studies done in this population have used the HAD scale. Also see Hajiro et al, Respir Med 2000 Sep;94(9):841-6 for more on the HADS in COPD patients.

April 2001

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