A Significant Unmet Mental Health Care Need Exists for Patients With COPD

Chronic obstructive pulmonary disease (COPD) is understood to be linked with both physical and mental distress, and recent research also suggests that, among current and former smokers with COPD, there exists a significant unmet need in terms of patients’ anxiety and depressive symptoms.

Researchers from the University of Alabama at Birmingham’s Division of Pulmonary, Allergy and Critical Care Medicine, and colleagues recently reported on a cross-sectional analysis of current and former smokers with 10 or more pack years of smoking history who were enrolled in the COPDGene study, which is being conducted at 20 sites in the United States and which has enrolled more than 10,000 patients to date.

In an effort to compare the frequency of anxiety and depressive symptoms—as well as the use of anxiolytic-hypnotics and antidepressants—in smokers with and without COPD, the investigators, led by Anand S. Iyer, MD, used the Hospital Anxiety and Depression Scale, recorded medication use, and used regression analysis to identify characteristics associated with unmedicated symptoms.

In total, they identified 5331 current and former smokers, 45% of whom had COPD and 55% of whom who did not, who experienced anxiety or depressive symptoms. Overall, 19.7% had anxiety symptoms, and the frequency of these symptoms was similar between those who did and did not have COPD. However, depressive symptoms were more frequent in those with severe to very severe COPD, at 20.7% (versus 13.1% overall).

Across the cohort, 21.2% were receiving medications, with anxiolytic-hypnotic use being highest in smokers with severe to very severe COPD, though antidepressant use did not significantly vary in those with and without COPD.

Overall, 66% of those who had anxiety or depressive symptoms were unmedicated. Having unmedicated symptoms was associated with the following:

• African American race (adjusted odds ratio [OR], 2.95; 95% CI, 2.25-3.87)
• Male gender (adjusted OR, 1.93; 95% CI, 1.57-2.36)
• No health insurance (adjusted OR, 2.38; 95% CI, 1.30-4.35)
• Severe to very severe COPD (adjusted OR, 1.48; 95% CI, 1.04-2.11)
• Higher level of respiratory symptoms or exacerbation history (adjusted OR, 2.21; 95% CI, 1.62-3.02).

"We have previously found that depression predicts hospital readmissions in COPD, and others have found associations with exacerbations and poor adherence to medications," Iyer said in a statement. "Clinically, we treat many COPD patients and smokers who have borderline COPD and also have clinically important emotional symptoms that would warrant treatment."

Iyer said that the next steps for research include assessing how symptoms of anxiety and depression influence outcomes, particularly with respect to exacerbation of COPD, and suggested that untreated emotional symptoms represent a major gap in COPD care that may warrant earlier palliative care.

Reference

Iyer AS, Holm KE, Bhatt SP, et al. Symptoms of anxiety and depression and use of anxiolytic-hypnotics and antidepressants in current and former smokers with and without COPD—a cross sectional analysis of the COPDGene cohort. J Psychosom Res. 2019;118:18-26. doi: 10.1016/j.jpsychores.2019.01.002.