The effectiveness of pulmonary rehabilitation on chronic obstructive pulmonary disease patients with concurrent presence of comorbid depression and anxiety. (June 2022)

• Record Type: Journal Article
• Authors: Yohannes, Abebaw M.; Casaburi, Richard; Dryden, Sheila; Hanania, Nicola A.
• Is Part Of: Respiratory medicine. Volume 197(2022)
• Publication Date: 2022-06
• Subjects: COPD -- Depression and anxiety -- Stress -- Quality of life -- Exercise capacity -- Pulmonary rehabilitation; COPD Chronic Obstructive Pulmonary Disease -- DASS-21 Depression Anxiety Stress Scale-21 -- PR Pulmonary Rehabilitation -- mMRC modified Medical Research Council -- MCID Minimally Clinically Important Difference -- QOL Quality of Life -- SGRQ St. George's Respiratory Questionnare -- ISWT Incremental Shuttle Walk Test; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2022.106850
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: We examined the prevalence of comorbid depression and anxiety in patients with chronic obstructive pulmonary disease (COPD) and their response to eight-weeks of pulmonary rehabilitation (PR). Methods: Seven hundred thirty four patients with clinically stable COPD completed an eight-week outpatient multidisciplinary PR, comprising 2-h (1-h exercise and 1-h education) per/week. Depression and anxiety, exercise capacity, quality of life (QOL), and dyspnea were measured pre- and post-PR by the incremental shuttle walk test (ISWT), St. George's Respiratory Questionnaire (SGRQ), and modified Medical Research Council (mMRC) scale, respectively. The Depression Anxiety Stress Scale (DASS-21) was completed and patients classified as having clinically significant comorbid anxiety and depression, anxiety alone, depression alone, or with neither. Results: The mean (SD) age of patients was 71 (8.8) years, and 51% were men. Prevalence of pre-PR comorbid depression and anxiety was 34%, anxiety alone 20%, depression alone 5% and neither 41%. The prevalence of stress was 59%. In patients with anxiety and depressive symptoms, total SGRQ score improved from 64.9 (13.8) pre-PR to 50.1 (17.2) post PR (p < 0.001), mMRC score improved from 3.4(1.0) pre-PR to 2.8 (1.1) post PR (p < 0.001), and ISWT distance walked increased from 188.6 (117.6) pre-PR to 248.6 (149.1) post PR, p < 0.001. Conclusion: One in three patients with COPD suffer from comorbid depression and anxiety with a high level of disease burden, reflected by symptoms of elevated dyspnea and impaired QOL. PR improves QOL and exercise capacity, and reduces dyspnea in patients with COPD and comorbid depression and anxiety. Take home points: One in three patients with COPD suffer from comorbid depression and anxiety. Pulmonary rehabilitation (PR) improves quality of life and increase exercise capacity in patients with comorbid anxiety and depression. Depression and anxiety group showed clinically significant improvement in stress and dyspnea. The efficacy of PR was greater in depression anxiety group, compared to depression alone or anxiety alone. Three fifths of COPD patients had increased burden of stress and related with elevated symptoms of depression and anxiety.