Nurse respiratory specialist Karen Heslop-Marshall explains why patients with COPD are vulnerable to anxiety and depression , and how addressing these problems can help them manage their condition |
Chronic obstructive pulmonary disease ( COPD ) is a common , largely preventable lung condition characterised by airflow obstruction and respiratory symptoms such as breathlessness , persistent cough and frequent chest infections .
It results from long-term exposure to harmful gases and particulates ( including tobacco smoke , air pollution and occupational dusts and fumes ) in combination with factors such as childhood lung development and genetics .
COPD is incurable and its trajectory is one of progressive decline punctuated by acute exacerbations ( symptom ‘ flare-ups ’). 1 However , early diagnosis and treatment can help slow progression and reduce the risk of exacerbations . People with COPD often have other conditions , with depression and anxiety being common comorbidities . 2
Management centres on evidence-based medical therapy to control symptoms and slow lung-function decline . There are also a number of recommended self-management interventions that allow patients to monitor symptoms and optimise health-related quality of life . 1 Research has found such interventions reduce respiratory-related A & E visits and admissions 1 , 3 , 4 , which is why it is important to get self-management right .
What are the important elements of self-management ? Self-management in COPD includes : 1
• Treatment adherence and the ability to recognise deterioration .
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• Maintaining physical activity .
• Attending to mental health . Interventions that incorporate mental health are significantly more effective than those targeting physical symptoms alone . 1 There is also increasing evidence that integrating mental and physical care for people with long-term conditions can reduce healthcare costs . 5
Why are mental health issues a consideration in COPD ? Breathlessness is a common symptom for people with respiratory problems such as COPD . 4 Even with optimal treatment , breathlessness can persist and is highly distressing for those affected .
Understandably , breathlessness can trigger anxiety . Indeed , panic attacks are common in COPD ; the prevalence of panic disorder is at least 10 times higher than in the general population . 6
A natural way of coping with breathlessness is to avoid doing activities that provoke it . While in the short term this may help alleviate the anxiety , in the longer term it can be counterproductive because it means patients become deconditioned and muscle strength declines , making them even more prone to breathlessness and less able to stay physically active .
Furthermore , as patients become less able to do things they used to do , they can develop symptoms of depression . Patients can experience dysthymia ( persistent mild depression ) or develop moderate-tosevere depression . 7
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