COPD and Psychological Issues in the Elderly

TThe following is a literature review of the article “Chronic Obstructive Pulmonary Disease: Assessing and Treating Psychological Issues in Patients with COPD” by Angela Burgess, BS, Mark E. Kunik, MD, MPH, and Melinda A. Stanley, PhD. The article originally appeared in Geriatrics, volume 60 issue 12, in December 2005.

Chronic obstructive pulmonary disease (COPD) refers to impairment of lung function from a variety of breathing disorders including asthma and emphysema. COPD causes physical and emotional strain and increases the prevalence of conditions such as anxiety, depression, and panic disorder. Researchers have found that, in turn, psychological conditions can increase the severity of COPD, complicating preexisting conditions and prolonging poor health. Because of the relationship between COPD and psychological disorders, it is important for healthcare providers to recognize and treat depression, anxiety, and related conditions in order to reduce the severity or impact of COPD on patients.

Depression is known to have physically detrimental effects and, thus, can worsen conditions created by COPD. Depression decreases the energy needed to compensate for the effects of COPD and causes patients to be less active, furthering physical deterioration. Anxiety also severely affects patients with COPD because of fear-induced breathing distress, which is exacerbated by COPD. Difficultly breathing can also be misunderstood by patients with anxiety as suffocation or another threat to his or her life and can result in panic attacks.

Because the physical symptoms of depression, anxiety, and COPD-related illness are often similar, emotional and mental evaluations, often in the form of questionnaires, should be conducted to properly assess patients. Appropriate screening and assessment techniques include questions from:

• The Primary Care Evaluation of Mental Disorders (PRIME-MD)
• The Beck Depression Inventory (BDI)-II
• The Beck Anxiety Inventory (BAI)
• The Hospital Anxiety and Depression Scale
• The Zung Self-Rating Depression Scale
• The Geriatric Depression Scale

Treatment of patients who test positive for depression and/or anxiety in addition to COPD can be both nonpharmacologic and pharmacologic. Nonpharmacologic treatments include, but are not limited to, exercise therapy, pulmonary rehabilitation, brief psychotherapy, and cognitive behavior therapy (CBT). Pharmacologic treatments include antidepressant drugs that can help reduce symptoms of depression and anxiety that worsen COPD conditions. These drugs included selective serotonin reuptake inhibitors and tricyclic inhibitors.