Chest
Volume 140, Issue 3, September 2011, Pages 730-736
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Original Research
Pulmonary Rehabilitation
The Impact of Anxiety and Depression on Outcomes of Pulmonary Rehabilitation in Patients With COPD

https://doi.org/10.1378/chest.10-2917Get rights and content

Background

Anxiety and depression are prevalent comorbidities in COPD and are related to a worse course of disease. The present study examined the impact of anxiety and depression on functional performance, dyspnea, and quality of life (QoL) in patients with COPD at the start and end of an outpatient pulmonary rehabilitation (PR) program.

Methods

Before and after PR, 238 patients with COPD (mean FEV1 % predicted = 54, mean age = 62 years) underwent a 6-min walking test (6MWT). In addition, anxiety, depression, QoL, and dyspnea at rest, after the 6MWT, and during activities were measured.

Results

Except for dyspnea at rest, improvements were observed in all outcome measures after PR. Multiple regression analyses showed that before and after PR, anxiety and depression were significantly associated with greater dyspnea after the 6MWT and during activities and with reduced QoL, even after controlling for the effects of age, sex, lung function, and smoking status. Moreover, before and after PR, anxiety was related to greater dyspnea at rest, whereas depression was significantly associated with reduced functional performance in the 6MWT.

Conclusions

This study demonstrates that anxiety and depression are significantly associated with increased dyspnea and reduced functional performance and QoL in patients with COPD. These negative associations remain stable over the course of PR, even when improvements in these outcomes are achieved during PR. The results underline the clinical importance of detecting and treating anxiety and depression in patients with COPD.

Section snippets

Participants

We studied 238 consecutive patients with COPD who were referred to and completed an established, standardized, 3-week, outpatient PR program at an urban outpatient PR center (Atem-Reha GmbH; Hamburg, Germany) between January 1, 2008, and December 31, 2008. Anamnestic interviews and diagnostic classification were performed by one (out of two) pulmonary physicians according to GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines.1 While participants were seated, spirometry was

Participants

The data of 238 patients were analyzed. In general, the study population was elderly, and 57% were men (Table 1); 63% (n = 151) of the patients lived with a partner, and 37% (n = 87) lived alone. The prevalence of symptoms of anxiety was 41% (n = 98) and of depression, 30% (n = 71).

Effects of PR

Compared with at the start of PR, improvements were observed after PR in 6MWD (P < .001), paralleled by improved dyspnea after the 6MWT (P < .01) (Table 2). Dyspnea at rest remained stable (P > .90), whereas a TDI

Discussion

The present results show that PR was significantly associated with improvements in 6MWD, dyspnea after the 6MWT and during activities, and increased physical and mental QoL, as well as reduced anxiety and depression, which converges with many previous findings.13, 14, 15, 16, 17, 18 Most importantly, we observed that anxiety and depression were related to worse outcomes not only at the start of PR, but also at the end of PR. At both time points, anxiety and depression (after controlling for the

Conclusions

In summary, the present study demonstrates that anxiety and depression are significantly associated with increased dyspnea and reduced functional performance and QoL in patients with COPD. These negative associations remain stable over the course of PR, even when improvements in these outcomes are achieved during rehabilitation. Therefore, the detection and treatment of anxiety and depression in patients with COPD is of considerable clinical importance.

Acknowledgments

Author contributions: Dr von Leupoldt: contributed to development of the study design, data collection, statistical analyses, and writing of the manuscript.

Dr Taube: contributed to development of the study design, data collection, and writing of the manuscript.

Ms Lehmann: contributed to development of the study design, data collection, and writing of the manuscript.

Dr Fritzsche: contributed to development of the study design, data collection, statistical analyses, and writing of the manuscript.

References (42)

  • JC Trappenburg et al.

    Psychosocial conditions do not affect short-term outcome of multidisciplinary rehabilitation in chronic obstructive pulmonary disease

    Arch Phys Med Rehabil

    (2005)
  • JA Cully et al.

    Quality of life in patients with chronic obstructive pulmonary disease and comorbid anxiety or depression

    Psychosomatics

    (2006)
  • DA Mahler et al.

    The measurement of dyspnea. Contents, interobserver agreement, and physiologic correlates of two new clinical indexes

    Chest

    (1984)
  • DA Mahler et al.

    Evaluation of the short-form 36-item questionnaire to measure health-related quality of life in patients with COPD

    Chest

    (1995)
  • A Kullowatz et al.

    Association of depression and anxiety with health care use and quality of life in asthma patients

    Respir Med

    (2007)
  • ME Kunik et al.

    Surprisingly high prevalence of anxiety and depression in chronic breathing disorders

    Chest

    (2005)
  • A Neuman et al.

    Dyspnea in relation to symptoms of anxiety and depression: a prospective population study

    Respir Med

    (2006)
  • Global Initiative for Chronic Obstructive Lung Disease (GOLD)

    Global strategy for diagnosis, management, and prevention of COPD, 2008, GOLD Web site

  • DE O'Donnell et al.

    Pathophysiology of dyspnea in chronic obstructive pulmonary disease: a roundtable

    Proc Am Thorac Soc

    (2007)
  • M Decramer et al.

    COPD as a lung disease with systemic consequences—clinical impact, mechanisms, and potential for early intervention

    COPD

    (2008)
  • AM Yohannes et al.

    Depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease: prevalence, relevance, clinical implications and management principles

    Int J Geriatr Psychiatry

    (2010)
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    Funding/Support: This study was supported by a stipend [Heisenberg-Stipendium, LE 1843/9-1] from the German Research Society (Deutsche Forschungsgemeinschaft) (to A. v. L.).

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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