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What Risk Factors Contribute to Physical and Mental Stress in COPD?

Wallace Stephens
Researchers examined risk factors that could lead to frequent physical or mental stress in Americans with chronic obstructive pulmonary disease (COPD). 
The majority of Americans with chronic obstructive pulmonary disease (COPD) experience frequent physical and mental distress from a variety of risk factors, according to a study in the International Journal of Chronic Obstructive Pulmonary Disease.

COPD can increase a patient's risk of having restricted physical mobility and emotional distress. Individuals living with the disease endure a cycle of symptomatic living and face a multitude of challenges that can interfere with health management and adherence to a treatment regimen. Researchers conducted the study as there is only limited data available on how discrete behavioral and health risk factors influence the prevalence of physical and mental distress among individuals with COPD.

“The efforts to understand the modifiable behavioral and environmental factors that contribute to patients’ physical and emotional distress represent the fundamental public health goals to alleviate the burden of COPD worldwide, advance the health and well-being of this underserved patient population, and ultimately improve quality of life,” researchers wrote.

Data were analyzed from the 2016 Behavioral Risk Factor Surveillance System, a population-based, randomized telephone survey of individuals 18 years or older designed to monitor access to care, health conditions, and behavioral health risks that contribute to leading causes of death and disease. Respondents were considered to have COPD if they answered “yes” to the question of whether a doctor, nurse, or other health professional ever said that they had COPD, emphysema, or chronic bronchitis.

Researchers selected relevant risk indicators in 4 health-related areas. The areas included:
  • Health risk behaviors
  • Lack of preventive vaccinations
  • Limited access to healthcare
  • Comorbidities
Researchers also assessed 5 health risk behaviors among respondents who reported being diagnosed with COPD, including:
  • Current tobacco usage (every day or some days)
  • Binge drinking (≥5 alcoholic drinks during 1 occasion for men, ≥4 for women, in the past 30 days)
  • Higher risk drinking (≥3 drinks alcoholic drinks during 1 occasion for men, ≥2 for women, in the past 30 days)
  • Use of e-cigarettes (every day or some days)
  • Use of chewing tobacco (every day or some days)
Respondents with COPD were considered to lack vaccination use if they stated that they were never vaccinated for pneumonia or did not have an influenza vaccination within the past year. Healthcare access was determined by questions that asked if they were insured, had a primary care provider, and had a routine checkup within the past year.

Health-related quality of life (HRQoL) was determined by how many days out of 30 respondents reported physical or mental distress. Those who reported 14 or more days of feeling “not good” for either category were considered to experience “more frequent” distress while those who said they didn’t feel good for 13 or less days were considered to experience “less frequent” distress.

Latent class modelling, an analytical strategy for summarizing indicators of distress using latent classes that define risk classes, was used to identify how health-related indicators in the 4 health-related areas affected reports of physical or mental distress.

The study found that 53.76% of individuals with COPD reported physical distress and 58.23% reported mental distress within the past 2 weeks, indicating “frequent distress.” The highest frequencies of both physical and mental distress were reported among women with COPD between 45 and 64 years old who were white and of low socioeconomic status. It was found that respondents with intermediate- to high-risk behaviors, intermediate to multiple comorbidities, limited access to healthcare, and intermediate to low vaccination use were more likely to report frequent physical distress compared with low-risk respondents. It was also found that those with high-risk behaviors, intermediate to multiple comorbidities, and low vaccination use were more likely to report frequent mental distress than those considered low risk.

The researchers suggested that individuals with COPD who were considered high-risk could improve HRQoL with disease management, as well as secondary or tertiary health promotion interventions. They recommended that future research should address disparities in risk factors, particularly among individuals with COPD and low socioeconomic status.


"These findings indicate the need for innovative solutions that increase availability and access to care. Future research should explore the temporal relationship between substance use behaviors and physical and mental distress reported by patients with COPD," researchers concluded.


Stellefson M, Paige SR, Barry AE, Wang MQ, Apperson A. Risk factors associated with physical and mental distress in people who report a COPD diagnosis: latent class analysis of 2016 behavioral risk factor surveillance system data. Int J Chron Obstruct Pulmon Dis. 2019;14:809-822. doi: 10.2147/COPD.S194018.

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