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Cited by 746Chronic Obstructive Pulmonary Disease (COPD) ResearchAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesSmoking Behavior and Cessation

Anxiety and Depression in COPD

Open access
Maurer, Janet, Rebbapragada, Venkata, Borson, Soo, Goldstein, Roger, Kunik, Mark E., Yohannes, Abebaw M., Hanania, Nicola A.·2008·Chest
DOI 10.1378/chest.08-0342PMC PMC2849676
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Abstract

Background Approximately 60 million people in the United States live with one of four chronic conditions: heart disease, diabetes, chronic respiratory disease, and major depression. Anxiety and depression are very common comorbidities in COPD and have significant impact on patients, their families, society, and the course of the disease.Methods We report the proceedings of a multidisciplinary workshop on anxiety and depression in COPD that aimed to shed light on the current understanding of these comorbidities, and outline unanswered questions and areas of future research needs.Results Estimates of prevalence of anxiety and depression in COPD vary widely but are generally higher than those reported in some other advanced chronic diseases. Untreated and undetected anxiety and depressive symptoms may increase physical disability, morbidity, and health-care utilization. Several patient, physician, and system barriers contribute to the underdiagnosis of these disorders in patients with COPD. While few published studies demonstrate that these disorders associated with COPD respond well to appropriate pharmacologic and nonpharmacologic therapy, only a small proportion of COPD patients with these disorders receive effective treatment.Conclusion Future research is needed to address the impact, early detection, and management of anxiety and depression in COPD.

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Crossref · 10.1378/chest.08-0342

Cites

114 of 114 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 143 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Prevalence of anxiety and depression in COPD is generally higher than that reported in some other advanced chronic diseases.

    “Estimates of prevalence of anxiety and depression in COPD vary widely but are generally higher than those reported in some other advanced chronic diseases.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Solano, 2006, A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease, J Pain Symptom Manage source

      Not checked in the free run.

  • Premisecitation

    Anxiety and depression often appear together in patients with COPD.

    “Anxiety and depression often appear together in patients with COPD.6”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Kunik, 2005, Surprisingly high prevalence of anxiety and depression in chronic breathing disorders, Chest

      Not checked in the free run.

  • Premisecitation

    In stable COPD, the prevalence of clinical depression ranges between 10% and 42%.

    “In stable COPD, the prevalence of clinical depression ranges between 10% and 42%, while that of anxiety ranges between 10% and 19% (Table 2).6–25”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [6] Kunik, 2005, Surprisingly high prevalence of anxiety and depression in chronic breathing disorders, Chest

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    • cites [7] van Manen, 2002, Risk of depression in patients with chronic obstructive pulmonary disease and its determinants, Thorax source

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    • cites [8] Wagena, 2004, Risk of depression and anxiety in employees with chronic bronchitis: the modifying effect of cigarette smoking, Psychosom Med source

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    • cites [9] Kunik, 2001, One session cognitive behavioural therapy for elderly patients with chronic obstructive pulmonary disease, Psychol Med source

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    • cites [10] Mikkelsen, 2004, Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD): a review, Nord J Psychiatry source

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    • cites [11] Aydin, 2001, Depression, anxiety comorbidity, and disability in tuberculosis and chronic obstructive pulmonary disease patients: applicability of GHQ-12, Gen Hosp Psychiatry source

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    • cites [12] Yohannes, 2000, Depression and anxiety in elderly outpatients with chronic obstructive pulmonary disease: prevalence, and validation of the BASDEC screening questionnaire, Int J Geriatr Psychiatry source

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    • cites [13] Lacasse, 2001, Prevalence of depressive symptoms and depression in patients with severe oxygen-dependent chronic obstructive pulmonary disease, J Cardiopulm Rehabil source

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    • cites [14] Aghanwa, 2001, Specific psychiatric morbidity among patients with chronic obstructive pulmonary disease in a Nigerian general hospital, J Psychosom Res source

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    • cites [15] McSweeny, 1982, Life quality of patients with chronic obstructive pulmonary disease, Arch Intern Med source

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  • Premisecitation

    In stable COPD, the prevalence of anxiety ranges between 10% and 19%.

    “In stable COPD, the prevalence of clinical depression ranges between 10% and 42%, while that of anxiety ranges between 10% and 19% (Table 2).6–25”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [6] Kunik, 2005, Surprisingly high prevalence of anxiety and depression in chronic breathing disorders, Chest

      Not checked in the free run.

    • cites [7] van Manen, 2002, Risk of depression in patients with chronic obstructive pulmonary disease and its determinants, Thorax source

      Not checked in the free run.

    • cites [8] Wagena, 2004, Risk of depression and anxiety in employees with chronic bronchitis: the modifying effect of cigarette smoking, Psychosom Med source

      Not checked in the free run.

    • cites [9] Kunik, 2001, One session cognitive behavioural therapy for elderly patients with chronic obstructive pulmonary disease, Psychol Med source

      Not checked in the free run.

    • cites [10] Mikkelsen, 2004, Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD): a review, Nord J Psychiatry source

      Not checked in the free run.

    • cites [11] Aydin, 2001, Depression, anxiety comorbidity, and disability in tuberculosis and chronic obstructive pulmonary disease patients: applicability of GHQ-12, Gen Hosp Psychiatry source

      Not checked in the free run.

    • cites [12] Yohannes, 2000, Depression and anxiety in elderly outpatients with chronic obstructive pulmonary disease: prevalence, and validation of the BASDEC screening questionnaire, Int J Geriatr Psychiatry source

      Not checked in the free run.

    • cites [13] Lacasse, 2001, Prevalence of depressive symptoms and depression in patients with severe oxygen-dependent chronic obstructive pulmonary disease, J Cardiopulm Rehabil source

      Not checked in the free run.

    • cites [14] Aghanwa, 2001, Specific psychiatric morbidity among patients with chronic obstructive pulmonary disease in a Nigerian general hospital, J Psychosom Res source

      Not checked in the free run.

    • cites [15] McSweeny, 1982, Life quality of patients with chronic obstructive pulmonary disease, Arch Intern Med source

      Not checked in the free run.

  • Premisecitation

    Only a small proportion of COPD patients with anxiety or depression receive effective treatment.

    “only a small proportion of COPD patients with these disorders receive effective treatment.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [6] Kunik, 2005, Surprisingly high prevalence of anxiety and depression in chronic breathing disorders, Chest

      Not checked in the free run.

    • cites [33] Kim, 2000, Functional impairment in COPD patients: the impact of anxiety and depression, Psychosomatics source

      Not checked in the free run.

  • Classified as probably not a substantial claim. 13
  • May combine two claims. 23

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Anxiety and depression are common comorbidities in COPD.

    “Anxiety and depression are very common comorbidities in COPD and have significant impact on patients, their families, society, and the course of the disease.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Anxiety and depression have significant impact on patients, their families, society, and the course of COPD.

    “Anxiety and depression are very common comorbidities in COPD and have significant impact on patients, their families, society, and the course of the disease.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Untreated or incompletely treated depression and anxiety have major implications for compliance with medical treatment, increased frequency of hospital admissions, prolonged length of stay, and increased consultations with primary care physicians.

    “Untreated or incompletely treated depression and anxiety have major implications for compliance with medical treatment, increased frequency of hospital admissions, prolonged length of stay, and increased consultations with primary care physicians.6,22,26”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [6] Kunik, 2005, Surprisingly high prevalence of anxiety and depression in chronic breathing disorders, Chest

      Not checked in the free run.

    • cites [22] Bosley, 1996, Psychological factors associated with use of home nebulized therapy for COPD, Eur Respir J source

      Not checked in the free run.

    • cites [26] Gudmundsson, 2006, Depression, anxiety and health status after hospitalisation for COPD: a multicentre study in the Nordic countries, Respir Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a systematic review of 37 randomized trials of collaborative care vs usual primary care, collaborative care was associated with a twofold increase in adherence to antidepressant medication over a 6-month period and significant improvement in depressive symptoms for 2 to 5 years.

    “Gilbody et al85 reported in a systematic review of 37 randomized trials of collaborative care vs usual primary care that a collaborative-care model was associated with a twofold increase in adherence to antidepressant medication over a 6-month period as well as significant improvement in depressive symptoms for 2 to 5 years.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [85] Gilbody, 2006, Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes, Arch Intern Med source

      Not checked in the free run.

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    Premisecitation

    In the IMPACT study of 1,801 elderly patients with major depression, the nurse collaborative-care intervention was associated with significant improvements in quality of depression care, depressive outcomes, and physical functioning compared to usual care over a 2-year period.

    “This study87 showed that the nurse collaborative-care intervention was associated with significant improvements in quality of depression care, depressive outcomes, and physical functioning compared to usual care over a 2-year period.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [87] Unutzer, 2002, Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial, JAMA source

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  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    While most primary care physicians inquire about and record smoking status, few assess symptoms associated with smoking that may lead to a suspicion of COPD.

    “While most primary care physicians inquire about and record smoking status, few assess symptoms associated with smoking that may lead to a suspicion of COPD, such as chronic productive cough, dyspnea with exertion, or change in functional status due to breathing difficulties.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    The PHQ-9 nine-question screener can be scored and is useful for diagnosis and follow-up.

    “The PHQ-9 nine-question screener can be scored and is useful for diagnosis and follow-up.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Physician barriers include short clinical visit times, lack of close follow-up, lack of time for educating patients about depression and counseling, limited skills, and knowledge of mood disorders.

    “Physician barriers include short clinical visit times, the lack of close follow-up, the lack of time for educating patients about depression and counseling, limited skills, and knowledge of mood disorders.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    In this setting, identification of COPD may be most crucial to improving care of depression in patients with COPD.

    “In this setting, it may be the identification of COPD that is most crucial to improving care of depression in patients with COPD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    System issues include lack of electronic records and registries, poor communication between primary care and mental health care, emphasis on productivity measured as patient throughput, and absence of reimbursement.

    “System issues include the lack of electronic records and registries, poor communication between primary care and mental health care, emphasis on productivity measured as patient throughput, and absence of reimbursement.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Only one half of patients with major depression receive an accurate diagnosis in primary care, and of those with a diagnosis, only one third to one half receive appropriate pharmacotherapy or psychotherapy.

    “Only one half of patients with major depression receive an accurate diagnosis in primary care and, of those with a diagnosis of major depression, only one third to one half receive appropriate pharmacotherapy or psychotherapy.84”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [84] Simon, 2002, Evidence review: efficacy and effectiveness of antidepressant treatment in primary care, Gen Hosp Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Other patient barriers may include preference for depression care within the primary care system, and therapies that may be limited by insurance coverage or accessibility.

    “Other barriers may include preference for depression care within the primary care system, and therapies that may be limited by insurance coverage or accessibility.74”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] Katon, 2001, Rethinking practitioner roles in chronic illness: the specialist, primary care physician, and the practice nurse, Gen Hosp Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    The PHQ-9 is probably the most commonly used tool in primary care for depression screening.

    “Probably the most commonly used tool in primary care for depression screening is the PHQ-9 (www.predictonline.com/phq9.htm).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Less commonly used depression screening choices include the Zung Self-Rating Depression Scale and the CES-D.

    “Less commonly used choices include the Zung Self-Rating Depression Scale and the CES-D.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The PHQ-9 is a nine-item measure that emulates the DSM-IV and is useful for making a diagnosis of depression and monitoring response to treatment.

    “The Patient Health Questionnaire-9 (PHQ-9) is a nine-item measure that emulates the DSM-IV and is useful for making a diagnosis of depression and monitoring response to treatment.67”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [67] Kroenke, 2001, The PHQ-9: validity of a brief depression severity measure, J Gen Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Frequent panic attacks in COPD patients who are receiving medications as prescribed are most often related to a concurrent depressive syndrome, and treatment should be directed to both depressive and anxiety components.

    “Frequent panic attacks in COPD patients who are receiving medications as prescribed are most often related to a concurrent depressive syndrome, and treatment should be directed to both depressive and anxiety components.52”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] Borson, 1998, Depression and chronic obstructive pulmonary disease: treatment trials, Semin Clin Neuropsychiatry

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationnone given

    Moving these models into everyday practice requires overcoming both clinical and system barriers.

    “Moving these models into everyday practice requires overcoming both clinical and system barriers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    A variety of validated, easily administered, or self-administered depression screening tools are available.

    “A variety of validated, easily administered, or self-administered depression screening tools are available.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Several anxiety screening tools, including the Patient Health Questionnaire-3 and the HADS, are available but are not as well validated as the depression screening tools.

    “Several tools, including the Patient Health Questionnaire-3, a three-question screener, and the HADS, are available but are not as well validated as the depression screening tools.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The collaborative-care model has been found to be associated with marked improvements in the quality of depression care in primary care and significant improvement in depression outcomes.

    “In recent years, a model of care termed the collaborative-care model has been found to be associated with marked improvements in the quality of depression care in primary care and significant improvement in depression outcomes.74”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [74] Katon, 2001, Rethinking practitioner roles in chronic illness: the specialist, primary care physician, and the practice nurse, Gen Hosp Psychiatry source

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  • May combine two claims.

    Premisecitation

    Depression lowers quality of life and decreases adherence to treatment in patients with COPD.

    “In addition, depression lowers quality of life and decreases adherence to treatment.22,58”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [22] Bosley, 1996, Psychological factors associated with use of home nebulized therapy for COPD, Eur Respir J source

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    • cites [58] Stapleton, 2005, Association of depression and life-sustaining treatment preferences in patients with COPD, Chest source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a study comparing CBT with COPD education in patients with anxiety and depressive symptoms, both treatments had a significant effect in improving quality of life and decreasing anxiety and depression over 8 weeks, and improvements were maintained during follow-up.

    “In another study83 that compared CBT with COPD education in patients with anxiety and depressive symptoms, both treatments had a significant effect in improving quality of life and decreasing anxiety and depression (p < 0.005) over 8 weeks. These improvements were maintained during follow-up.83”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [83] Kunik, 2007, COPD education and cognitive behavioral therapy group treatment for clinically significant symptoms of depression and anxiety in COPD patients: a randomized controlled trial, Psychol Med

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Psychological approaches to care have not been adequately developed or studied in clinically depressed COPD patients.

    “Psychological approaches to care have not been adequately developed or studied in clinically depressed COPD patients.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    A second small randomized placebo-controlled trial using citalopram in lung transplant patients with self-rated depressive symptoms found no overall benefit, with small improvements only in less severely affected patients.

    “A second small randomized placebo-controlled trial80 using citalopram (a selective serotonin reuptake inhibitor [SSRI] antidepressant) in lung transplant patients with self-rated depressive symptoms, rather than major depression, found no overall benefit, with small improvements seen only in the less severely affected patients.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [80] Silvertooth, 2004, Citalopram and quality of life in lung transplant recipients, Psychosomatics source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Many of the somatic symptoms of a major depression overlap with symptoms caused by severe COPD, although sustained depressed mood and marked loss of pleasure in life should not be attributed to lung disease alone.

    “Many of the somatic symptoms of a major depression overlap with symptoms caused by severe COPD, although sustained depressed mood and marked loss of pleasure in life should not be attributed to lung disease alone.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    While there is strong evidence that PR improves exercise capacity and quality of life, the evidence for its impact on clinical anxiety and depression is less defined.

    “However, while there is strong evidence that suggests PR improves exercise capacity and quality of life, the evidence for its impact on clinical anxiety and depression is less defined.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Symptoms of anxiety may be reflected in a variety of ways, including agitation as well as physiologic signs of arousal such as tachycardia, sweating, and dyspnea.

    “Symptoms of anxiety may be reflected in a variety of ways, including agitation as well as physiologic signs of arousal such as tachycardia, sweating, and dyspnea.93”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [93] Hynninen, 2005, Psychological characteristics of patients with chronic obstructive pulmonary disease: a review, J Psychosom Res source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients with chronic conditions can take responsibility for the day-to-day management of their condition, with the result of improving their confidence, control, and autonomy.

    “Patients with chronic conditions can take responsibility for the day-to-day management of their condition, with the result of improving their confidence, control, and autonomy.99”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [99] Lorig, 1999, Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial, Med Care source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    PR does improve depressive symptoms, but its effect beyond the duration of the rehabilitation program remains to be defined.

    “It does improve depressive symptoms, but its effect beyond the duration of the rehabilitation program remains to be defined.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Griffiths and colleagues reported reduced symptoms of anxiety and depression following a 6-week PR program, with symptoms of depression remaining significantly reduced at 12-month follow-up.

    “Griffiths and colleagues97 reported reduced symptoms of anxiety and depression following a 6-week PR program, with symptoms of depression remaining significantly reduced at 12-month follow-up.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [97] Griffiths, 2000, Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A study by de Godoy and de Godoy reported reductions in depression and anxiety only among patients who participated in education and stress management in addition to exercise training during a 12-week intervention; exercise training alone did not appear to have a beneficial effect on symptoms of depression and anxiety.

    “A study by de Godoy and de Godoy103 reported reductions in depression and anxiety only among patients who participated in education and stress management in addition to exercise training during a 12-week intervention. They found that exercise training alone did not appear to have a beneficial effect on symptoms of depression and anxiety.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [103] de Godoy, 2003, A randomized controlled trial of the effect of psychotherapy on anxiety and depression in chronic obstructive pulmonary disease, Arch Phys Med Rehabil source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Brief CBT will help decrease the sensation of dyspnea as well as symptoms of anxiety and depression.

    “Brief CBT will help decrease the sensation of dyspnea as well as symptoms of anxiety and depression.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In that study, history of treatment for depression was associated with limited change in depressive symptoms, whereas social support and satisfaction with treatment were predictors of improvement.

    “History of treatment for depression was associated with limited change in depressive symptoms, whereas social support and satisfaction with treatment were predictors of improvement.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [104] Alexopoulos, 2006, Outcomes of depressed patients undergoing inpatient pulmonary rehabilitation, Am J Geriatr Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Patients with major depressive disorder are less likely to respond to PR and require specialized care from a mental health professional.

    “Patients with major depressive disorder are less likely to respond. They require specialized care from a mental health professional.”
    Quote in the paperSubstantial claim
34 of 34

  • The authors state this as an assumption.

    The prevalence of minor or subclinical depression in COPD is similar to that in other chronic illnesses.

    “However, the prevalence of minor or subclinical depression may be even higher in this population, assuming that it is similar to other chronic illnesses.”

  • The paper relies on this without support.

    Depression can be managed effectively using a chronic care model in primary care settings.

    “Depression can be managed effectively using a chronic care model in the primary care settings.”

  • The paper relies on this without support.

    Patients with comorbid depression and general medical illness are more impaired, have higher mortality, and have 50 to 100% higher medical costs than those without depression, even after controlling for demographics and severity of medical illness.

    “Patients with comorbid depression and general medical illness are more impaired, have higher mortality, and have 50 to 100% higher medical costs than those without depression, even after controlling for demographics and severity of medical illness.”

  • The paper relies on this without support.

    Many COPD patients have transitory mood symptoms during respiratory exacerbations that improve spontaneously as their physical status improves.

    “Many COPD patients have transitory mood symptoms during respiratory exacerbations that improve spontaneously as their physical status improves.”

  • The paper relies on this without support.

    Anxiety and panic attacks are often associated with acute respiratory exacerbations but may also be associated with the pharmacologic effects of β2-agonists or high-dose corticosteroid therapy.

    “Anxiety and panic attacks are often associated with acute respiratory exacerbations but may also be associated with the pharmacologic effects of β2-agonists or high-dose corticosteroid therapy.”

  • The paper relies on this without support.

    In stable patients with severe COPD and marginal physiologic reserve, small amounts of exercise can precipitate panic attacks due to severe dyspnea sometimes accompanied by hypoxemia.

    “In stable patients with severe COPD and marginal physiologic reserve, small amounts of exercise can precipitate panic attacks due to severe dyspnea sometimes accompanied by hypoxemia.”

  • The authors state this as an assumption.

    CBT is based on the assumption that individuals with emotional distress tend to interpret their life experiences in a distorted way.

    “CBT is based on the assumption that individuals with emotional distress tend to interpret their life experiences in a distorted way.”

  • The paper relies on this without support.

    Symptoms consistent with anxiety or depression are highly prevalent among patients enrolling in PR.

    “The high prevalence of symptoms consistent with anxiety or depression among those enrolling in PR”

  • The paper relies on this without support.

    Dyspnea is a symptom of both COPD and anxiety.

    “Dyspnea is a symptom of both COPD and anxiety”

  • The paper relies on this without support.

    Symptoms of anxiety may contribute to the patient’s reluctance to engage in exercise as well as to difficulty concentrating.

    “Symptoms of anxiety may contribute to the patient’s reluctance to engage in exercise as well as to difficulty concentrating.”

  • The paper relies on this without support.

    SSRIs have been safely used in other chronic illnesses.

    “SSRIs have been safely used in other chronic illnesses.”

  • The paper relies on this without support.

    Tricyclic antidepressants are effective treatments for depression, anxiety, or insomnia.

    “Tricyclic antidepressants are effective treatments for depression, anxiety, or insomnia”
12 of 12

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Authors
Maurer, J., Rebbapragada, V., Borson, S., Goldstein, R., Kunik, M. E., Yohannes, A. M., & Hanania, N. A.
Affiliations
  • Baylor College of Medicine (US)
  • University of Toronto (CA)
  • Michael E. DeBakey VA Medical Center (US)
  • Manchester Metropolitan University (GB)
Corresponding author
Hanania, Nicola A.
ORCID
Venue
Chest
Publisher
Elsevier BV
Published
2008-10
Volume
134
Issue
4
Pages
43S-56S
ISSN
0012-3692 (ISSN-L)
DOI
10.1378/chest.08-0342
PMC
PMC2849676
OpenAlex
W2161243447
Cited by
720
References
113
Citations by year
2026: 16 · 2025: 34 · 2024: 34 · 2023: 33 · 2022: 32 · 2021: 41 · 2020: 39 · 2019: 33 · 2018: 50 · 2017: 50 · 2016: 61 · 2015: 43 · 2014: 48 · 2013: 57 · 2012: 43
FWCI
5.59
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • CHEST Journal (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Aging (P50AG005136)
  • National Institute of Mental Health (R13MH073228)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
Keywords
chronic obstructive pulmonary disease, anxiety, depression, comorbidities, prevalence, underdiagnosis, barriers to treatment, pharmacotherapy, non-pharmacological treatment, physical disability, health care utilization
MeSH terms
Antidepressive Agents, Anxiety, Depression, Humans, Prognosis, Anti-Anxiety Agents, United States, Cognitive Behavioral Therapy, Incidence, Prevalence, Pulmonary Disease, Chronic Obstructive, Biomedical Research

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