What's Keeping COPD Patients Down?

Depression risk in COPD higher in female patients and patients with higher levels of dyspnea

/ Author:  / Reviewed by: Chris Galloway, M.D.

(RxWiki News) People with chronic obstructive pulmonary disease (COPD) suffer from depression more often than others. As depression can worsen the health status of COPD patients, it's important to know which patients are most at risk.

One study recently presented at a conference showed that female COPD patients and patients with more severe shortness of breath had a higher risk of depression than other COPD patients.

Fortunately, the study's results also showed that being physically active may protect against depression in these patients.

"Stay active if you have COPD."

This study was led by Orlando Lopez Jove, MD, chief of the pulmonary laboratory at the Hospital Cetrangolo in Buenos Aires, Argentina.

According to Dr. Lopez Jove, "About 10 percent of the general population suffers from depression, and studies have shown that rate to be significantly higher in patients with COPD."

Depression in patients with COPD has been linked to higher levels of disability, secondary illnesses and health care burden.

"Not every COPD patient will suffer from depression," said Dr. Lopez Jove, "and being able to identify which patients are most at risk could be a valuable tool in ensuring those patients receive counseling and other treatment that could help improve their quality of life."

So Dr. Lopez Jove and his colleagues set out to examine rates of depression in COPD patients and which factors might affect their risk of depression.

"In this study, we wanted to learn if factors including gender, lifestyle habits, COPD severity, shortness of breath and overall quality of life were related to the frequency of depression in COPD patients, and if they were related, to try to determine the extent of that relationship," said Dr. Lopez Jove.

The study included 113 patients with COPD at varying stages of the disease (stages I to IV). None of these patients had COPD exacerbations (episodes of worsening symptoms) within the previous month.

The researchers measured patients' lung function, shortness of breath and other physical characteristics such as body mass index, or BMI (ratio of weight to height).

Depression was determined using the Beck Depression Inventory (BDI) and previous diagnoses of depression. Quality of life was measured using the Saint George's Respiratory Questionnaire (SGRQ). The researchers also studied participants' physical activity, smoking habits and family history of depression.

Participants were considered physically active if they did 150 minutes of physical activity each week.

More than 18 percent of study participants were current smokers. About 11 percent (13 patients) had a family history of depression.

Depression was found in a total of 51 patients (45.3 percent) and in seven (13.7 percent) of the patients who had a previous diagnosis for depression. A total of 44 patients (86.3 percent) were diagnosed by BDI.

The researchers found that the severity of COPD and patients' smoking habits did not affect whether patients had depression nor the level of their depression.

The odds of depression were 5.37 times higher among female COPD patients compared to male patients and 5.73 times higher among patients with more severe dyspnea, or shortness of breath, compared to those with less severe dyspnea.

The researchers also found that physical activity was a protective factor against depression.

In addition, depression appeared to have a direct impact on patients' quality of life.

"Depression is a disorder which remains easily undiagnosed due to underpresentation and because the symptoms are not very specific," said Dr. Lopez Jove. "Therefore, it is important to consider this disorder in patients with COPD, especially in female patients and patients who experience significant shortness of breath."

According to Dawn Fielding, BS, RCP, AE-C, Pulmonary Rehabilitation Clinical Specialist and founder of the Chronic Lung Alliance, "In order to successfully manage COPD it is very important to address depression and anxiety in patients who suffer from it.

"It is very common to find depression in patients with chronic lung disease, especially those patients who have not gained proper education about management of their disease, and those who suffer from a more severe stage of the disease where breathing is more difficult. Learning to manage the disease through proper lifestyle modification is vital to the patients success and their physical, mental, and emotional well being." 

Fielding added, "Becoming or remaining active is of utmost importance, as exercise not only improves our ability to perform tasks and activities, but increases circulation, decreases chance of accident or injury, and elicits the release of hormones that improve mood and feeling well being."

Dr. Lopez Jove said there are already plans for further research into the impact of depression treatment on COPD patients and their quality of life.

"COPD patients have to deal not only with the physical consequences of the disease, but they also must deal with the psychological consequences of COPD," said Dr. Lopez Jove. "Patients with depression often suffer from low self-confidence or self-efficacy, and early diagnosis and treatment of depression is very important for improving a patient’s quality of life, maximizing healthcare utilization and improving treatment outcomes."

The results of this study were presented at the American Thoracic Society's international conference. As such, the research has yet to be published in a peer-reviewed journal.

Information on funding and author disclosures was unavailable.

Reviewed by: 
Review Date: 
May 17, 2013
Last Updated:
September 12, 2013