Interoceptive abnormalities in COPD patients: Their predictive role in anxiety and acute exacerbation of COPD

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, significantly impacting both physical and psychological health. Anxiety, a prevalent comorbidity in COPD, exacerbates respiratory symptoms, impairs disease management, and increases healthcare utilization. Interoceptive sensitivity, the ability to perceive and interpret internal bodily signals, plays a critical role in managing chronic conditions, yet its influence on healthcare utilization in COPD remains underexplored. This study investigates the relationship between interoceptive sensitivity, anxiety sensitivity, and acute exacerbation hospitalization rates in COPD patients, aiming to identify potential therapeutic targets to improve patient outcomes. A cross-sectional study was conducted among 73 COPD patients recruitedboth outpatients and inpatients of respiratory department. Interoceptive sensitivity was assessed using a body perception questionnaire-very short form scale, and autonomic nervous system (ANS) reactivity was assessed through body perception questionnaire 20-autonomic nervous system. Anxiety sensitivity was measured with the anxiety sensitivity index-3 physical concerns subscale. Depression and anxiety were evaluated by PHQ-9 and GAD-7 seperately. Acute exacerbation of COPD (AECOPD) was identified by self-reported hospitalizations and verified via medical records over the preceding year, according to GOLD 2023 criteria. Logistic regression models were used to analyze the associations between interoceptive sensitivity, anxiety sensitivity, and its correlation with AECOPD. Higher interoceptive sensitivity was associated with a 28.4% reduction in the likelihood of AECOPD (odds ratios = 0.716, 95% confidence intervals: 0.58-0.88, P = .002), suggesting a protective effect. Conversely, elevated anxiety sensitivity increased AECOPD by 126.6% (odds ratios = 2.266, 95% confidence intervals: 1.32-3.89, P = .003). Other demographic and clinical factors, including age, body mass index, and COPD duration, were not significant predictors of AECOPD. The findings reveal the dual role of interoceptive sensitivity and anxiety sensitivity in influencing healthcare utilization among COPD patients. Interventions targeting interoceptive skills and anxiety sensitivity, such as mindfulness-based therapy, may improve symptom management, reduce emergency healthcare utilization and hospital admission, and enhance overall quality of life in this population. Future research should explore longitudinal and interventional studies to further elucidate these relationships.