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Wednesday, September 24, 2014

Depression and anxiety in COPD increases morbidity and mortality, study shows

Many patients with chronic obstructive pulmonary disease (COPD) feel depressed or anxious due to their disease.  It is important for physicians to recognize and treat this, because studies sow COPD patients who are anxious or depressed have a 1.25% greater risk of dying compared to COPD patients who are not depressed.

It makes sense that so many patients with COPD become depressed, considering the disease affects so many different areas of their lives.  For instance, according to Peian et al:
  • They feel useless
  • Experience reduced sexual activity
  • Depend on others for their personal care
  • Lose interest in future projects
Peain also reports:
Tobacco may provide psychological relief for some individuals.  Continuing smokers with COPD are more at risk of depression than those who quit.  A longitudinal cohort study showed that continuous smokers had a much steeper decline in lung function than those who stopped smoking.  We also found that with an increasing duration of smoking and the amount of smoking, the number of deaths was increased.  These results may be attributed to the interaction between depression and smoking.  Furthermore, there was an interaction between former smoking and depression, which may be due to short duration of quitting.  Most of te former smokers quit only when they suffered from a serious condition.  In addition, smoking cessation was reported to be associated with an increased rate of depression.  These results suggest that COPD patients should stop smoking as soon as possible.
Likewise, the study reported on anxiety.
Elevated anxiety in cOPD patietns is more common in current smokers than in nonsmokers.  Smoking is a common reason to explain the high association of anxiety with COPD.  Tobacco use is widely acknowledged as the single most important environmental risk factor for the development of COPD, and a high level of anxiety is a risk factor for starting to smoke.  A roportion of patients who develop COPD as a consequence of smoking show higher levels of anxiety than in the general population.  Taken together, it is likely that there is an interaction between current smoking and anxiety.   In fact, our study shows that this interaction is increased with a long duration of smoking and a large number of pack-years. 
The study further concluded that 48-60% of th deaths in COPD subjects were explained by an interaction between smoking and depression symptoms, and 49-55% of the deaths of COPD subjects were explained by an interaction between smoking and anxiety symptoms."

Bottom line, the researchers suggest that "quitting smoking may help depressed or anxious patients with COPD forestall death.  Given the difficulty in the treatment of depression or anxiety in certain COPD patients, a recommendation to quit smoking may be an inexpensive and practical means of delaying death from COPD."

  1. Lou, Peian, Peipei Chen, Pan Zhang, Jiaxi Yu, Yong Wang, Na Chen, Lei Zhang, Hongmin Wu, and Jing Zhao, “Effects of Smoking, Depression and Anxiety on Mortality of COPD Patients: A Prospective Study,” Respiratory Care, January, 2014, Volume 59, Number 1, pages 54-61
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