Intended for healthcare professionals

Letters COPD exacerbations

Anxious not to be breathless

BMJ 2011; 342 doi: (Published 15 February 2011) Cite this as: BMJ 2011;342:d995
  1. David R Warriner, clinical research fellow and honorary cardiology specialist registrar1
  1. 1University of Sheffield, Sheffield, UK
  1. d.r.warriner{at}

I thought that the publication of the review on preventing exacerbations of chronic obstructive pulmonary disease (COPD) (from Drug and Therapeutics Bulletin; DTB) and the summary of National Institute for Health and Clinical Excellence guidance on the management of generalised anxiety disorder in adults in the same issue of the BMJ missed a trick.1 2

Although the DTB article stated, “patients with frequent exacerbations have high levels of anxiety and depression,” it did not mention how the reverse could be true—that high levels of anxiety and depression result in patients presenting with frequent exacerbations. Although this may seem like a circular argument, it is a common finding in many emergency department and medical admissions units across the UK.

Neither did the article mention how treating anxiety and depression might reduce exacerbations, or at least hospital admission. Being breathless is frightening. Many of these patients are breathless chronically, so not surprisingly, many develop anxiety, but when assessed objectively such patients are often no (physiologically) worse than normal (for them).

Certainly, medical teams can offer a bed, reassurance, and regular medical and nursing assessment, but often these patients are discharged only to be readmitted on the next or the same day. Is there a longer term psychological crook we can offer?

Or am I missing a trick?


Cite this as: BMJ 2011;342:d995


  • Competing interests: None declared.


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