Perspectives on Chronic Obstructive Pulmonary Disease and Chronic Depression

Added September 3, 2019

Chronic Obstructive Pulmonary Disease: What it is.

The World Health Organization (WHO) defines Chronic obstructive pulmonary disease (COPD) as, “a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible…”[1].

According to the definition from the Global Initiative for Obstructive Lung Diseases (GOLD) chronic obstructive pulmonary disease is a disease that is usually progressive, life-limiting and can eventually lead to early mortality. COPD is the fourth leading cause of death in the United States [2].

Methods of Diagnosis

There are several options available to physicians to diagnose COPD. One test is called Spirometry [3]. This test measures lung capacity and air flow it detects COPD before a patient develops the further stages and symptoms of the disease. A Spirometry machine will determine the progression of disease and monitor how effective current treatments are. There are signs and symptoms that a qualified clinician will be able to recognize and add to the diagnosis. A spirometry test can also be used to discover other underlying lung conditions a COPD patient may have, these could include asthma, bronchitis and emphysema (the last two conditions have been closely linked with COPD), or to identify other explanations as to why a patient may struggle from shortness of breath.

One of the great advantages of the Spirometry is that it provides early detection of disease before symptoms are fully evident. Spirometry can also mark a path in the severity of COPD and monitor changes or progression in the disease.

Depression: The often-undetected player in COPD

Depression is frequently paired with Chronic obstructive pulmonary disease. Around 40-50% of COPD patients are diagnosed with depressive symptoms or clinical depression. This percentage is likely higher, because of how difficult it is to detect depression in COPD patients because of the overlapping symptoms. These overlapping symptoms may include lack of energy, anxiety or decreased appetite. As a result, these depressive symptoms get classified as COPD symptoms instead. In a number of multimorbidity cases, the underlying psychiatric disease goes undiagnosed and untreated. These comorbidities in COPD have significant impact on patients, their families, society, and the course of the disease.

Patients living with type 3-4 or severe COPD sometimes report their struggle with anxiety and comorbid depression extends into the psychosocial aspect of social isolation. Comorbid depression and anxiety greatly multiply the complexity of treatment of this respiratory disease and because of this, healthcare providers may fail to adequately realize the burden of chronic illness upon the patient’s quality of life.

Understanding the patient perspective can help to guide treatment and future management. Listening to the patient will help define what type of support is best suited according to the needs of the individual.

Tools for the detection and management of chronic depression in COPD patients.

There are many options for effectively managing depression in relation to COPD. Encouraging patient support from family, friends, co-workers and the patient care management team benefit everyone in many ways. Psychiatry-individual or group counselling- as well as peer-led support groups can also help a person feel less isolated and alone. Within these tools are many opportunities to educate the patient in managing different situations and feelings they may not yet have encountered, as well as experiment with different approaches they may not have thought of before to try and find the solution that fits.

Exploring these resources with the patient will help the provider/patient relationship become stronger, produce more confidence in treatment and enable the provider to connect the patient with the chronic support they need.

Another tool available in the discerning of the severity of depression with COPD patients is the Hamilton Depression Rating Scale (HAM-D)[4] This scale was developed in 1960 by Dr. Max Hamilton of the University of Leeds, England. The scale has been widely used in clinical practice and has become a standard in pharmaceutical trials. The HAM-D has between 17-24 item ratings , there is also a 6-item version that offers the same sensitivity regarding assessment of the severity of depression, comparable to other standard and more elaborate versions of the HAM-D scale [6].

Therapeutic interventions have focused on optimizing function and slowing the disease progression, though there are no known cures. Care providers have focused attention on health strategies such as smoking cessation, oxygen therapy, influenza vaccines, surgical options, graduated exercise of the peripheral muscles, and chronic disease self-management. Relaxation therapy comes under the banner of therapeutic intervention. This therapy encompasses varied approaches such as breathing exercises, sequential muscle relaxation, biofeedback, guided imagery, distraction therapy, hypnosis, meditation/mindfulness, and physical posture therapy [7]. Relaxation techniques are often used to calm anxiety, increasing the patient’s awareness of of self-control and harmonizing his or her emotions, in order to promote the physical and mental health of the subject.

Patient thoughts. Living with end-stage COPD

Psychological impairments such as anxiety and depression are common in patients with chronic obstructive pulmonary disease and heighted in patients who have comorbid depression and full diagnostic mental disorders. In the case of end-stage COPD, thoughts of impending clinical death and the greater magnitude of dyspnea can heighten anxiety, fatigue and loss of sleep. An end-stage COPD patient may also experience loss and grief adding to the emotional and mental distress [8].

Regardless of the prevalence of chronic depression, anxiety and the impact on the morbidity connected with COPD, many of these psychological aspects of the disease are rarely addressed within the respiratory medicine community. The purpose of CareAdopt remote care management technology is to increase awareness and education among pulmonologists, primary care providers and specialist health professionals to the secondary psychological impairment associated with COPD and to provide real time patient monitoring as well as psychiatric counselling and support through our fully integrated program. The program aim is to care for the whole patient, not just the obvious diagnosable condition.

Ian Venemore, living in Australia was diagnosed with COPD in his mid-50’s. He is a volunteer for the Lung Foundation in Australia and chair of the associated COPD Patient Advocacy Group (CPAG). He also participates in international meetings. Ian’s goal is to change the future of COPD recognition, diagnosis and treatment. He is a strong advocate for pulmonary rehabilitation and attends his gym classes “religiously.” He is also a firm believer in and proponent of patient education and self-management [9].

“In retrospect, it would be easy but unfair to single out doctors for their often reactive approach to the management of chronic diseases such as COPD. More often than not, they have an abundance of patients, multiple critical cases and time pressures to deal with. As patients we must learn to help ourselves by demanding the time of our doctors, educating ourselves on diseases prior to consultations and preparing questions. We are generally not keen to hear bad news, the rationale being that if we need to hear more, the doctor will tell us all. If he does not, then all is well. There can be fatal flaws in that belief. If we do not show initiative and purpose in our dealings with clinicians or take responsibility for the management of our own health, we deserve the treatment we get”

Ian’s advice is simple. Knowledge is power

Through CareAdopt, providers and patients can access chronic education and then be equipped and supported in all aspects within the treatment of the COPD condition.






4 (HAM-D)
6 (HAM-D 6)

Photo by Robina Weermeijer