Lung disease, depression link may boost outcomes

11 April, 2013

New research revealing links between two global health challenges – depression and chronic lung disease – suggest screening for both disorders simultaneously could improve outcomes for patients.

The study by Senior Research Fellow Dr Evan Atlantis from the University of Western Sydney, and colleagues, found patients with diagnosed chronic obstructive pulmonary disease (COPD) who also had depression or anxiety consistently had worse outcomes including increased mortality.

The researchers report in CHEST - the online journal of the American College of Chest Physicians COPD patients with comorbid depression had an 83 per cent increased risk of mortality.

Additionally, COPD patients had a much higher chance of also being diagnosed with depression. Forty per cent of COPD patients had clinically relevant depression and anxiety compared to less than 10 per cent in the general population across most countries surveyed.

The researchers analysed data from longitudinal studies in adult populations that reported an association between clinically relevant depression or anxiety and COPD, or reported their combined risk for having an exacerbation (a serious worsening of COPD) and/or dying.

"It’s clear from the studies we reviewed that depression and anxiety adversely affect prognosis for COPD patients and COPD patients have a greater likelihood of having depression or anxiety compared to the general population," Dr Atlantis, who is a member of the UWS School of Nursing and Midwifery’s Family and Community Health Research Group, said.

"Screening for these disease combinations would identify patients with both COPD and depression/anxiety and provide clinicians the opportunity to treat both problems at the same time - potentially delivering a better overall health outcome."

Depression or anxiety comorbidity in COPD patients predict poor adherence to pulmonary rehabilitation and COPD-related medications, decreased exercise capacity and health-related quality of life.  There is also lost productivity and increased health resource utilisation and functional disability and increased risk of exacerbation and mortality.

"Currently about 10 per cent of the world’s population aged 40 years and older have COPD," Dr Atlantis said.

"COPD rates increase with age, independently of smoking history. So, an ageing world population will increase the rates of COPD and undoubtedly cause significant stress on healthcare systems in high-income countries, and may threaten economic growth in developing countries."