Preventing exacerbations in chronic obstructive pulmonary disease

I enjoyed both the review on preventing COPD exacerbations (from the
DTB) and the management of Generalised Anxiety Disorder in adults (summary
of NICE guidance), in this weeks BMJ, but thought their juxtaposition
missed a trick.

Whilst, the DTB article, stated "patients with frequent exacerbations
have high levels of anxiety and depression...", there was no mention of
how the reverse could also be true e.g. high levels of anxiety and
depression result in patients attending with frequent exacerbations.
Whilst this may appear a circular argument, this is a common finding in
many an Emergency Department and Medical Admissions Unit across the UK.

There was also no mention, of how treating such anxiety and
depression could reduce such exarcebations, or at least hospital
admission. Being breathless is frightening, many of these patients are
breathless chronically and thus it is no surprise that many of them
develop anxiety but objectively when assessed 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 very often these patients are
discharged only to be re-admitted the following, or indeed the same day.

Is there a longer term psychological crook we can offer?

Unless it is me who is missing a trick.