COPD Caused Anxiety and Depression

COPD is an abbreviation for Chronic Obstructive Pulmonary Disease. This chronic lung disease includes two main illnesses: chronic bronchitis and emphysema. Unfortunately, there is no cure for COPD at this time. COPD can be managed, but it is a progressive disease — meaning the symptoms will get worse over time.

Signs and symptoms of COPD

The most common symptom of COPD is dyspnea, or irregular breathing and shortness of breath, lasting for months or even years. This irregular breathing is sometimes accompanied by wheezing, and a persistent cough with sputum production. The sputum may contain blood, usually due to damage of the blood vessels of the airways. In serious cases of COPD, 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 an extremely complex organ with a very large surface area, the  main purpose of which is the exchange of oxygen and carbon dioxide between the body and the environment. The lungs have two main parts: bronchial tubes and alveoli - air sacs. We breathe, and the air goes through our wind pipe, then through bronchial tubes, and into the alveoli. From the alveoli, oxygen goes into blood while carbon dioxide moves out of blood.

In cases of COPD, the process is a bit different because the lining in bronchial tubes gets red and full of mucus, which blocks tubes and makes it hard to breathe. In cases of emphysema, the alveoli are irritated and stiff, unable to hold enough air.

What are the possible causes of COPD?

The most common causes, responsible for 99 percent of all COPD cases, are:

Cigarette smoking

The primary factor of COPD is chronic tobacco smoking. In the United States, 90 percent of cases of COPD are due to smoking. This isn't a rule saying that all smokers develop COPD, but smokers have at least a 25 percent greater risk of developing this disease than non-smokers. Keep this in mind every time you light a cigarette, and quit while you can!

Occupational pollutants

Certain occupational pollutants, such as cadmium and silica, can also contribute to the development of COPD. People at highest risk of developing COPD for occupational reasons include coal workers, construction workers, metal workers and cotton workers, among 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 sex, allergy, repeated airway infection, and general impaired lung function are also related to the development of COPD.

Functional Impairment in COPD Patients

Is there a link between some functional impairments and COPD, and how strong is it? Research has confirmed that there is a strong relation 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 who also suffered from anxiety, depression, and functional status impairment. It was concluded that their COPD contributed to their depression and anxiety. Also, anxiety and depression contributed significantly to the overall variance in functional status of COPD patients. Unfortunately, only a few of the patients were receiving any treatment for anxiety or depression. That is a great shame, considering that treating anxiety and depression enhances a person's quality of life and may even alleviate some COPD symptoms.

Do anxiety and depression impact patients with COPD?

Certain studies have found that psychosocial factors, such as being widowed or divorced, were closely related to relapses in male patients with COPD. 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 the two.

There is also one other study which included several patients observed after the initial emergency treatment for COPD. The psychological status of each patient was assessed four weeks after the initial emergency treatment. The hospital anxiety and depression (HAD) questionnaire was used, and the study has shown that approximately 40 percent of these patients were identified by the HAD questionnaire as having anxiety and/or depression. Not only were these patients 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 a month of the initial emergency department visit. 

Overcoming Depression and Anxiety in COPD

Depression in people with COPD is reported to be far more common than in the general population. Even in the general population, 1 in 8 people will experience clinical depression more than once in their lifetimes. What is the exact cause of depression? Although the exact answer is still unknown and likely always due to multiple factors, experts assume that it functions like all other major chronic illnesses: Patients think they are incapable of normal functioning, and this gets them down.

Although the rate of depression is high in all chronic diseases, but incidence appears to be higher in people with COPD than in those with other major chronic conditions. Some scientists even claim that depression affects almost all people with COPD. So why should depression be more prevalent in COPD?

Smoking and COPD

Some chemicals normally found in tobacco can be a possible cause of depression. Smokers have a higher rate of depression than individuals in the general population.  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.

A study has shown that almost 85 percent of patients with emphysema had, on average, 10 full years of smoking before COPD was diagnosed!

Depression & breathing deficiency

So, the connection between depression and breathing deficiency commonly seen in patients with chronic obstructive pulmonary disease is more or less an established fact. 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 main problem because by the time people are diagnosed with COPD, they could have already lost as much as 50 percent of their lung function. Breathing is such a basic function that we grow to take for granted, until it stops working as we expect it to. It is no surprise that something as scary as not being able to breathe properly would contribute to depression.

Hypoxia- the key of the answer

What exactly breathing has to do with depression - where is the connection? It is well know that the brain normally consumes about 40% of the oxygen we breathe. So it's possible that compromised breathing over time creates a chronically diminished supply of oxygen, called "hypoxia". This could be the key of the answer, because in combination with other negative physical conditions such as lesions, infarctions, and injuries to the brain – they can easily contribute to the cognitive impairment and depression.
The conclusion is simple: compromised breathing may be one of the reasons that the incidence of depression is higher in COPD than in other chronic conditions. The good news is that special breathing techniques provide effective treatment for chronic depression. This could potentially be used as a tool or treatment technique for treatment of depression in the future.