Chest
Volume 134, Issue 4, Supplement, October 2008, Pages 43S-56S
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Anxiety and Depression in COPD
Anxiety and Depression in COPD: Current Understanding, Unanswered Questions, and Research Needs

https://doi.org/10.1378/chest.08-0342Get rights and content

Background

Approximately 60 million people in the United States live with one of four chronic conditions: heart disease, diabetes, chronic respiratory disease, and major depression. Anxiety and depression are very common comorbidities in COPD and have significant impact on patients, their families, society, and the course of the disease.

Methods

We report the proceedings of a multidisciplinary workshop on anxiety and depression in COPD that aimed to shed light on the current understanding of these comorbidities, and outline unanswered questions and areas of future research needs.

Results

Estimates of prevalence of anxiety and depression in COPD vary widely but are generally higher than those reported in some other advanced chronic diseases. Untreated and undetected anxiety and depressive symptoms may increase physical disability, morbidity, and health-care utilization. Several patient, physician, and system barriers contribute to the underdiagnosis of these disorders in patients with COPD. While few published studies demonstrate that these disorders associated with COPD respond well to appropriate pharmacologic and nonpharmacologic therapy, only a small proportion of COPD patients with these disorders receive effective treatment.

Conclusion

Future research is needed to address the impact, early detection, and management of anxiety and depression in COPD.

Section snippets

Burden of COPD

COPD is a largely preventable and treatable disease responsible for a substantial human and economic burden throughout the world.1 It is currently the fourth-leading cause of death in the United States and is expected to surpass stroke within the next decade to become the third-leading cause of death.2 The diagnosis of COPD is based on the documentation of a postbronchodilator FEV1/FVC < 70%.3, 4 Using this definition, 23.6 million adults (13.9%) in the United States have COPD and 2.4 million

Screening for Anxiety and Depression

Many of the somatic symptoms of a major depression overlap with symptoms caused by severe COPD, although sustained depressed mood and marked loss of pleasure in life should not be attributed to lung disease alone. The Global Initiative for Chronic Obstructive Lung Disease guidelines3 recommend that new COPD patients should have a detailed medical history including an “assessment of feelings of depression or anxiety.” Similarly, primary care guidelines63 recommend screening for mental health

Efficacy of Different Treatment Models in COPD

Managing depression and anxiety in primary and specialty medical settings starts with an accurate diagnosis. Many COPD patients have transitory mood symptoms during respiratory exacerbations that improve spontaneously as their physical status improves. There is no evidence that these time-limited minor depressive symptoms require specific treatment. By contrast, major depression is likely to require antidepressant medication or other specific mood-focused therapy79 to improve functioning and

Summary

Symptoms of anxiety and depression are common in patients with COPD, but they are rarely diagnosed and treated appropriately because there are few published data to guide health-care professionals in the management of these symptoms. Furthermore, physician attitudes and patient beliefs both mitigate against optimal patient care. We have summarized the current state of knowledge, outlined some unanswered questions, and suggested areas for ongoing and future clinical and research priorities. We

Appendix

This report was developed from the proceedings of a workshop organized by the ACCP in Chicago, in September 2006. Workshop Chair: Janet Maurer, MD, Phoeniz, AZ; Co-Chair: Nicola A. Hanania, MBBS, MS, Houston, TX.

Acknowledgment

The authors acknowledge the assistance of Ms. Lee Ann Fulton, Sydney Parker, PhD, and the staff and members of the Steering Committee of the Clinical Pulmonary Network of the ACCP for their assistance and input in organizing this workshop.

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    This workshop was supported by grant R13-MH073228-01A1 from the National Institute of Mental Health and the Alpha-1 Foundation.

    The authors disclose that no financial or other potential conflicts of interest exist.

    A list of speakers is given in the Appendix.

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