Anxiety and Depression are Related to the Outcome of Emergency Treatment in Patients with Obstructive Pulmonary Disease

doi:10.1378/chest.122.5.1633

Chest

Volume 122, Issue 5, November 2002, Pages 1633-1637

https://doi.org/10.1378/chest.122.5.1633 Get rights and content

Study objectives

To investigate whether psychological factors predict outcome after emergency treatment for obstructive pulmonary disease.

Setting

Emergency department at a university hospital.

Patients

Forty-three patients presenting with exacerbation of asthma or COPD.

Intervention

The patients received emergency treatment and were followed up for 4 weeks.

Measurement

Spirometry, blood sampling, pulse oximetry, breathing rate, pulse rate, and dyspnea score was measured before and during emergency treatment. The psychological status was assessed using the hospital anxiety and depression (HAD) scale questionnaire at the end of the follow-up period.

Results

Anxiety and/or depression was found in 17 patients (40%). Of these patients, nine patients (53%) were admitted to hospital or had a relapse within 1 month, compared with five patients (19%) in the group without anxiety and/or depression (p < 0.05). Among patients who relapsed within 1 month (n = 14), the HAD total score was 12.4 ŷ 5.9 compared with 8.6 ŷ 5.1 (mean ŷ SD) among the patients without a relapse (p < 0.05). After making adjustments for age, gender, atopic status, treatment, and pack-years, the significant association between treatment failure and anxiety and/or depression still remained.

Conclusion

Our study indicates that anxiety and depression are related to the outcome of emergency treatment in patients with obstructive pulmonary disease. Further studies should be conducted evaluating the effect of treatment of anxiety and depression in patients with recurrent exacerbations of asthma and COPD.

Section snippets

Materials and Methods

The study comprised adult patients (> 18 years old) with acute exacerbations of obstructive pulmonary disease, both asthma and COPD, presenting during the day at our emergency department. They were all assessed as being in need of emergency treatment. They were excluded if immediate hospital admission was deemed necessary or if they were unable to perform lung function tests. All participation was voluntary, and the study was approved by the Ethics Committee at the Medical Faculty at Uppsala

Results

Fifty patients were included in the investigation. We obtained full records from 43 patients who were evaluated in this study. The mean age was 65.3 years (range, 22 to 87 years). Nineteen patients were men (mean age, 65.8 years), and 24 were women (mean age, 64.8 years). Sixteen patients (37%) had an anxiety score of ≥ 8 (probable anxiety), 5 patients (12%) had a depression score of ≥ 8 (probable depression), 4 patients (9%) had both an anxiety and a depression score of ≥ 8, and 17 patients

Discussion

The main finding of this study is that patients who had a relapse after emergency treatment of obstructive pulmonary disease are more likely to report signs of anxiety and/or depression. We have not found similar studies for comparison, but our results are in accordance with those of some other studies. In the study by Stehr et al⁵ involving male patients with COPD, psychosocial factors such as experiencing the loss of a first-order relative and being more pessimistic about the prognosis, were

ACKNOWLEDGMENT

The assistance of Elisabeth Rydéhn, RN, is greatly appreciated.

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: This study was supported by the Bror Hjerpstedt Foundation, Sweden, the Swedish Heart and Lung Foundation, and Astra, Sweden.

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Chest

Clinical Investigations: Emergency RoomAnxiety and Depression are Related to the Outcome of Emergency Treatment in Patients with Obstructive Pulmonary Disease

Study objectives

Setting

Patients

Intervention

Measurement

Results

Conclusion

Section snippets

Materials and Methods

Results

Discussion

ACKNOWLEDGMENT

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Chest

Respir Med

Lancet

Chest

Respir Med

J Psychosom Res

J Psychosom Res

Br J Dis Chest

J Psychosom Res

Risk factors for recurrent emergency department visits for asthma

Thorax

Predictors of treatment adherence among asthma patients in the emergency department

J Asthma

The perception of breathlessness in asthma

Am Rev Respir Dis

Relationship between the ability to detect added resistance at rest and breathlessness during bronchoconstriction in asthmatics

Respiration

Comparison of clinical dyspnea ratings and psychophysical measurements of respiratory sensation in obstructive airway disease

Am Rev Respir Dis

Variability of the perceived sense of effort in breathing during exercise in patients with chronic obstructive pulmonary disease

Am Rev Respir Dis

Standardized lung function testing

Clin Respir Physiol

Clinical Investigations: Emergency Room
Anxiety and Depression are Related to the Outcome of Emergency Treatment in Patients with Obstructive Pulmonary Disease