Overview of the Impact of Depression and Anxiety in Chronic Obstructive Pulmonary Disease

Background Anxiety and depression are common entities in patients diagnosed with COPD. However, the impact that they have on the exacerbation of illness is scarcely studied. Objective To determine if the presence of anxiety and depression is associated with a greater risk of frequent exacerbation (≥2 per year) in patients diagnosed with COPD. Patients and Methods A cohort study that analysed frequent exacerbation and associated factors in 512 patients monitored during 2 years. Exacerbations were defined as events that required antibiotic/s and/or systemic corticosteroids (moderate) or hospitalization (serious). Variables of interest were recorded for each patient, including anxiety and depression ( Hospital Anxiety and Depression Scale ), and we analysed their association with frequent exacerbation through the adjusted odds ratio (aOR) by means of a logistic regression model. Results The prevalence of anxiety/depression at the start of the study was of 15.6%. During the 2 years of monitoring, 77.9% of the patients suffered at least moderate-to-severe exacerbation. 54.1% were frequent exacerbators. Anxiety/depression were strongly associated with moderate–severe frequent exacerbation in the crude analysis (OR c = 2.28). In the multivariate analysis, the risk factors also associated with frequent exacerbation were being overweight (aOR 2.78); obesity (aOR 3.02); diabetes (aOR 2.56) and the associated comorbidity (BODEx) (ORa = 1.45). Conclusions The prevalence of anxiety/depression in COPD patients is high, and they are relevant risk factors in frequent exacerbation although the effect is lower in the multivariate analysis when adjusting for different variables strongly associated with exacerbation.