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BODE index versus GOLD classification for explaining anxious and depressive symptoms in patients with COPD a cross-sectional study
Discussion
This study demonstrates that anxious and depressive symptoms are common in patients with advanced COPD. The BODE index is superior to the GOLD classification for explaining these symptoms. Anxious symptoms were explained by dyspnoea. Depressive symptoms were explained by both dyspnoea and reduced exercise capacity.
COPD is increasingly considered as a disease not only of the lungs. It has been suggested as a part of the 'chronic systemic inflammatory syndrome' together with the metabolic syndrome, coronary artery disease and others [32]. The complexity of COPD and its frequent co-morbidities requires assessment and staging of the disease beyond the degree of airflow limitation. Using the hospital anxiety and depression score previous studies have yielded prevalences of anxious and depressive symptoms of up to 41% and 44%, respectively in patients with COPD [6,9]. Our findings confirm that both anxious and depressive symptoms are common in COPD and increase with disease severity. The higher prevalence of anxious symptoms in women is a known finding. Female COPD patients were reported to suffer from psychiatric disorders and psychological distress more often than male patients [33].
We found that the degree of lung function impairment cannot sufficiently explain anxious and depressive symptoms in COPD. This is in concordance with previous research. FEV1%predicted was similar in patients with anxiety or depression compared to patients without either problem in a study by Dahlen on patients with obstructive lung disease [7]. Also, in a study by Ng on Singapore resident COPD patients FEV1%predicted alone was not able to predict the presence of anxiety and depression [9]. In a study by Mishima FEV1 did not correlate with the anxiety score and had only a borderline correlation with the depression score in COPD patients with long-term domiciliary oxygen therapy [22]. In concordance with our findings, dyspnoea correlated with both anxious and depressive symptoms.
In our data BODE index better explained the psychological consequences of COPD compared to the GOLD classification based on FEV1%predicted alone. Due to the incorporation of dyspnoea and exercise capacity the BODE index is a reliable predictor of objective COPD outcomes such as hospitalisation and survival [24,26]. On the one hand severe dyspnoea and reduced exercise capacity are obvious indicators for advanced lung disease. On the other hand our data show that they are also associated with symptoms of anxiety and depression, which themselves are independent predictors of objective COPD outcomes such as readmission and survival [6,7,9]. Therefore anxiety and depression might explain a part of the predictive power of the BODE index regarding objective COPD outcomes. It is unknown whether anxiety and depression remain independent predictors of clinical outcome of COPD, if the disease is staged by the BODE system. If so, these psychiatric co-morbidities might play a role in future classification systems of COPD. Anxiety and depression are aspects of COPD susceptible to both pharmacological and non-pharmacological treatment [10]. Specifically, psychotherapy reduces anxiety and depression in COPD [34]. Moreover, pulmonary rehabilitation improves depression, anxiety, dyspnoea and health status in patients with COPD [35,36].
Due to the cross-sectional design of the present study only associations can be assessed and causal inferences cannot be drawn. The dyspnoea score was the only factor associated with anxious symptoms in linear regression. It is quite evident that dyspnoea can cause anxiety. On the other hand, presence of anxiety might also aggravate the sensation of dyspnoea. Depressive symptoms were best explained by the dyspnoea score and the six minute walking distance. It is well imaginable that patients who suffer from breathlessness and whose exercise capacity is limited are at increased risk of depression. On the other hand, depressive symptoms might also worsen the sensation of dyspnoea and limit the effort during the walking test. Whether or not depression and anxiety are comorbidities in COPD, they influence the clinical outcome of COPD [6,7,9]. The small number of patients in GOLD stage I is a limitation of the study. However, these patients usually do not experience dyspnoea and are therefore unlikely to have consecutive anxiety or depression.
Conclusion
In conclusion, anxious and depressive symptoms are common in patients with advanced COPD. The BODE index is superior to the GOLD classification for explaining anxious and depressive symptoms in COPD patients. Future classifications of COPD severity might include those psychological aspects, as they are potentially treatable aspects of the disease.
http://respiratory-research.com/content/10/1/1/++++++++++++++++++++++/ARTICLES/BROWSE.ASP/PREPUB/comments
Discussion
This study demonstrates that anxious and depressive symptoms are common in patients with advanced COPD. The BODE index is superior to the GOLD classification for explaining these symptoms. Anxious symptoms were explained by dyspnoea. Depressive symptoms were explained by both dyspnoea and reduced exercise capacity.
COPD is increasingly considered as a disease not only of the lungs. It has been suggested as a part of the 'chronic systemic inflammatory syndrome' together with the metabolic syndrome, coronary artery disease and others [32]. The complexity of COPD and its frequent co-morbidities requires assessment and staging of the disease beyond the degree of airflow limitation. Using the hospital anxiety and depression score previous studies have yielded prevalences of anxious and depressive symptoms of up to 41% and 44%, respectively in patients with COPD [6,9]. Our findings confirm that both anxious and depressive symptoms are common in COPD and increase with disease severity. The higher prevalence of anxious symptoms in women is a known finding. Female COPD patients were reported to suffer from psychiatric disorders and psychological distress more often than male patients [33].
We found that the degree of lung function impairment cannot sufficiently explain anxious and depressive symptoms in COPD. This is in concordance with previous research. FEV1%predicted was similar in patients with anxiety or depression compared to patients without either problem in a study by Dahlen on patients with obstructive lung disease [7]. Also, in a study by Ng on Singapore resident COPD patients FEV1%predicted alone was not able to predict the presence of anxiety and depression [9]. In a study by Mishima FEV1 did not correlate with the anxiety score and had only a borderline correlation with the depression score in COPD patients with long-term domiciliary oxygen therapy [22]. In concordance with our findings, dyspnoea correlated with both anxious and depressive symptoms.
In our data BODE index better explained the psychological consequences of COPD compared to the GOLD classification based on FEV1%predicted alone. Due to the incorporation of dyspnoea and exercise capacity the BODE index is a reliable predictor of objective COPD outcomes such as hospitalisation and survival [24,26]. On the one hand severe dyspnoea and reduced exercise capacity are obvious indicators for advanced lung disease. On the other hand our data show that they are also associated with symptoms of anxiety and depression, which themselves are independent predictors of objective COPD outcomes such as readmission and survival [6,7,9]. Therefore anxiety and depression might explain a part of the predictive power of the BODE index regarding objective COPD outcomes. It is unknown whether anxiety and depression remain independent predictors of clinical outcome of COPD, if the disease is staged by the BODE system. If so, these psychiatric co-morbidities might play a role in future classification systems of COPD. Anxiety and depression are aspects of COPD susceptible to both pharmacological and non-pharmacological treatment [10]. Specifically, psychotherapy reduces anxiety and depression in COPD [34]. Moreover, pulmonary rehabilitation improves depression, anxiety, dyspnoea and health status in patients with COPD [35,36].
Due to the cross-sectional design of the present study only associations can be assessed and causal inferences cannot be drawn. The dyspnoea score was the only factor associated with anxious symptoms in linear regression. It is quite evident that dyspnoea can cause anxiety. On the other hand, presence of anxiety might also aggravate the sensation of dyspnoea. Depressive symptoms were best explained by the dyspnoea score and the six minute walking distance. It is well imaginable that patients who suffer from breathlessness and whose exercise capacity is limited are at increased risk of depression. On the other hand, depressive symptoms might also worsen the sensation of dyspnoea and limit the effort during the walking test. Whether or not depression and anxiety are comorbidities in COPD, they influence the clinical outcome of COPD [6,7,9]. The small number of patients in GOLD stage I is a limitation of the study. However, these patients usually do not experience dyspnoea and are therefore unlikely to have consecutive anxiety or depression.
Conclusion
In conclusion, anxious and depressive symptoms are common in patients with advanced COPD. The BODE index is superior to the GOLD classification for explaining anxious and depressive symptoms in COPD patients. Future classifications of COPD severity might include those psychological aspects, as they are potentially treatable aspects of the disease.
http://respiratory-research.com/content/10/1/1/++++++++++++++++++++++/ARTICLES/BROWSE.ASP/PREPUB/comments
I would be inclined to say though that anxiety and depression affects all stages of COPD at different times, although fortunately for some not all the time.
For those that are experiencing anxiety and depression all the time I do think it is important to get help with this too. Perhaps its learning how to manage all aspects of COPD not just the breathing but the psychological impact too.
Thank you for sharing this information and this site link Holly.
Hugs xox