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SupplementAnxiety and Depression in COPDAnxiety and Depression in COPD: Current Understanding, Unanswered Questions, and Research Needs
Section snippets
Burden of COPD
COPD is a largely preventable and treatable disease responsible for a substantial human and economic burden throughout the world.1 It is currently the fourth-leading cause of death in the United States and is expected to surpass stroke within the next decade to become the third-leading cause of death.2 The diagnosis of COPD is based on the documentation of a postbronchodilator FEV1/FVC < 70%.3, 4 Using this definition, 23.6 million adults (13.9%) in the United States have COPD and 2.4 million
Screening for Anxiety and Depression
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. The Global Initiative for Chronic Obstructive Lung Disease guidelines3 recommend that new COPD patients should have a detailed medical history including an “assessment of feelings of depression or anxiety.” Similarly, primary care guidelines63 recommend screening for mental health
Efficacy of Different Treatment Models in COPD
Managing depression and anxiety in primary and specialty medical settings starts with an accurate diagnosis. Many COPD patients have transitory mood symptoms during respiratory exacerbations that improve spontaneously as their physical status improves. There is no evidence that these time-limited minor depressive symptoms require specific treatment. By contrast, major depression is likely to require antidepressant medication or other specific mood-focused therapy79 to improve functioning and
Summary
Symptoms of anxiety and depression are common in patients with COPD, but they are rarely diagnosed and treated appropriately because there are few published data to guide health-care professionals in the management of these symptoms. Furthermore, physician attitudes and patient beliefs both mitigate against optimal patient care. We have summarized the current state of knowledge, outlined some unanswered questions, and suggested areas for ongoing and future clinical and research priorities. We
Appendix
This report was developed from the proceedings of a workshop organized by the ACCP in Chicago, in September 2006. Workshop Chair: Janet Maurer, MD, Phoeniz, AZ; Co-Chair: Nicola A. Hanania, MBBS, MS, Houston, TX.
Acknowledgment
The authors acknowledge the assistance of Ms. Lee Ann Fulton, Sydney Parker, PhD, and the staff and members of the Steering Committee of the Clinical Pulmonary Network of the ACCP for their assistance and input in organizing this workshop.
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This workshop was supported by grant R13-MH073228-01A1 from the National Institute of Mental Health and the Alpha-1 Foundation.
The authors disclose that no financial or other potential conflicts of interest exist.
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A list of speakers is given in the Appendix.