These last couple of years, COPD has been a subject of many studies, especially, to find out is there a link between COPD and depression or anxiety! We will try to answer some of the most important question related to this subject! What exactly is COPD? Well, it is a short-term for chronic obstructive pulmonary disease. It represents one chronic lung disease that includes two main illnesses: chronic bronchitis and emphysema. Unfortunately, it is also important to point out that, presently, there is no cure for COPD. What should we know about anxiety and depression that appear often in patients diagnosed with COPD?
Signs and symptoms of COPD
What are the most common symptoms of COPD? Well, there are a lot of symptoms but the main is definitely dyspnea, or irregular and short breathing lasting for months or perhaps years. This irregular breathing is sometimes accompanied by wheezing, and a persistent cough with sputum production. This sputum is interesting because it may contain blood, usually due to damage of the blood vessels of the airways.
If we talk about some serious cases of COPD, then we should know that it can also be accompanied with cyanosis caused by a lack of oxygen in the blood.
How do lungs normally work
The human lungs are one very interesting and extremely complex organ with a very large surface area which main purpose is the exchange of oxygen and carbon dioxide between the body and the environment. Like we already know- our lungs have 2 main parts: bronchial tubes and alveoli - air sacs. So the process is rather simple! We breath and the air goes through our wind pipe, and then through bronchial tubes and into alveoli. From the alveoli, oxygen goes into blood while carbon dioxide moves out of blood. Well, this is when the individual isn't diagnosed with COPD! In cases that the person has the COPD, a process is a bit different because the lining in bronchial tubes gets red and full of mucus.
It is reasonable to assume that this mucus blocks tubes, and makes it hard to breathe. In cases of emphysema, alveoli are irritated and because of that- they get stiff and can't hold enough air.
What are the possible causes of COPD
There are many possible causes of COPD but the most common, which are responsible for 99% of all COPD cases, are:
· Cigarette smoking
Every patient should be aware of one devastating fact- definitely the primary factor of COPD is chronic tobacco smoking. In the United States, around 90% of cases of COPD are due to smoking. Don’t get me wrong- this isn't some rule and not all smokers will develop COPD, but smokers have at least a 25% risk. Keep this in mind every time you light your cigar!
· Occupational pollutants
Experts are saying that some occupational pollutants, such as cadmium and silica, also can contribute to the development of COPD. The people at highest risk for these pollutants include coal workers, construction workers, metal workers and cotton workers, amongst others.
· Air pollution
Urban air pollution may be a contributing factor for COPD as it is thought to impair the development of the lung function. In developing countries indoor air pollution, usually due to biomass fuel, has been linked to COPD, especially in women.
· Genetics
Very rarely, there may be a deficiency in an enzyme known as alpha 1-antitrypsin which causes a form of COPD.
· Other risk factors
Increasing age, male gender, allergy, repeated airway infection and general impaired lung function are also related to the development of COPD.
Functional Impairment in COPD Patients
Well, the right question is – is there and how strong is the link between some functional impairments and COPD! Several researches done in the past have confirmed that there is a strong relationship between functional status and comorbid anxiety and depression in elderly patients with chronic obstructive pulmonary disease (COPD). The study has been conducted on 43 male veterans with COPD which also suffered from anxiety, depression, and functional status impairment. What authors concluded is that their COPD contributed to their depression, and anxiety. Anxiety and depression contributed significantly to the overall variance in functional status of COPD patients. Bad thing is that only few patients were receiving any treatment for anxiety or depression.
Do anxiety and depression impact patients with COPD?
How did experts come to the idea that depression and anxiety, and emotional status in generally, have anything to do with the primary disease- COPD? Well, one study found that psychosocial factors, such as being widowed or divorced, were closely related to relapses in male patients with COPD.
That’s why- we can assume that if psychological factors predicted outcome emergency treatment of patients with acute exacerbations of obstructive pulmonary disease, there is a strong link between them!
There is also one another study that included several patients which were observed after the initial emergency treatment! The psychological status of each patient was assessed four weeks after the initial emergency treatment. What was concluded? Well, the hospital anxiety and depression questionnaire was used. Study has showed that approximately 40 percent of these patients were identified by the HAD questionnaire as having anxiety and/or depression. Not only that they were diagnosed with anxiety and depression, but their primary disease- COPD was much more serious! They were significantly more likely to be admitted to the hospital or to have a relapse within one month of the initial emergency department visit.
Overcoming Depression and Anxiety in COPD
After all that we have said- the one thing is sure- depression in people with COPD is reported to be far more common than in the general population. Although the studies confirmed this fact- the fact is also that even in the general population, 1 in 8 people would experience clinical depression more than once. What is the exact cause of this depression? Although, the exact answer is still unknown- experts assume that it was like with all other major chronic illnesses. Patients think that are incapable of normal functioning! Although, the depression is high in all chronic diseases – the fact is that the incidence of depression appears to be higher in people with COPD than with those with other major chronic conditions. Some scientists are even talking that depression affects almost all people with COPD. Why should depression be more prevalent in COPD?
Smoking and COPD
Some are even saying that some chemicals normally found on tobacco nicotine can be the possible of depression! The fact is that smokers have a higher rate of depression than individuals in the general population. We should also be aware of one fact, we know that depressed adolescents are more likely to start smoking and continue smoking. Therefore, many depression- predisposed teens start smoking early, get hooked on nicotine and later develop COPD.
One another study showed that almost 85% of patients with emphysema had, on average, 10 pack years of smoking before COPD was diagnosed!
Depression & breathing deficiency
Is there a real connection between the depression and breathing deficiency commonly seen in patients with chronic obstructive pulmonary disease! Probably the answer is YES! How come? Well, experts do know that people tend to experience breathing difficulties for a long time before they consult a physician and are finally diagnosed with COPD. This could be the biggest problem because several researches done in the past showed that, by the time people are diagnosed with COPD, on average, they have already lost 50% of their lung function! Can you imagine this?
Hypoxia- the key of the answer
What exactly breathing has to do with depression- where the connection is? Well, it is well know that the brain normally consumes about 40% of the oxygen we breathe! That’s why, it is logical to assume that, it's possible that compromised breathing over time creates a chronically diminished supply of oxygen called "hypoxia." This hypoxia could be the key of the answer because with combinations with other negative physical conditions such as lesions, infarctions, and injuries and insults to the brain – they can easily contribute to the cognitive impairment and depression. Conclusion is simple- this compromised breathing may be one of the reasons that the incidence of depression is higher in COPD than in other chronic conditions. That’s why; the good news is that special breathing techniques provide effective treatment for chronic depression. This should definitely be in future used as a tool or treatment techinique for treatment of depression!
