An Important Comorbidity in COPD

Nicholas Gross, MD, PhD


June 10, 2014

Depression and Anxiety Predict Health-Related Quality of Life in Chronic Obstructive Pulmonary Disease

Blakemore A, Dickens C, Guthrie E, et al
Int J Chron Obstruct Pulmon Dis. 2014;9:501-512.

Chronic obstructive pulmonary disease (COPD) has long been known to have several comorbidities,[1] but psychiatric disorders have not figured prominently among them. A recent meta-analysis looks at 2 measures of psychiatric health in relation to health-related quality of life (HRQoL) in patients with COPD. Patients with spirometry-confirmed COPD and in whom a validated HRQoL (including measures of depression and anxiety) had been performed were included. The studies were longitudinal in order to determine whether depression and anxiety predicted the risk for subsequent HRQoL in COPD patients. Six studies encompassing 895 COPD patients formed the basis of the study. The authors found a strong positive correlation between tests for depression and subsequent impairment of HRQoL (r = 0.48, P < .001). Similarly, they found a correlation between tests for anxiety and respiratory-specific HRQoL (r = 0.36, P < .001).


One drawback of the study is that it was a retrospective analysis of previously published data, the quality of which is uncertain. This is common to retrospective studies.

A similar meta-analysis also found that depression and anxiety were correlated with HRQoL. Moreover, the correlation with HRQoL[2] was stronger than that with FEV1. Likewise, panic disorder has been associated with impaired health in patients with COPD,[3] as has suicidality.[4] It seems clear, therefore, that psychiatric problems are not uncommon in COPD and that HRQoL may be adversely affected by them. Not stated by the authors of the present study, but clearly implicated, is that one should be aware of these disabilities and be prepared to treat them when found.

Other comorbidities that commonly occur and that complicate the course and management of COPD are acute exacerbations of COPD, coronary artery and peripheral vascular disorders, lung and other organ malignancies associated with cigarette smoking, osteoporosis, muscle weakness and wasting, respiratory infections, and metabolic syndrome, as described in the Global Initiative for Chronic Obstructive Lung Disease. Management of COPD and its many comorbidities is outlined in that reference.



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