Identifying Mental, Physical Risk Factors for COPD Exacerbations

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Two abstracts presented at CHEST 2021 outlined risk factors for exacerbations of chronic obstructive pulmonary disease (COPD) among veterans.

Posters presented at CHEST 2021 highlighted how comorbid conditions such as anxiety and diabetes may worsen outcomes in patients with chronic obstructive pulmonary disease (COPD).

In the first analysis,1 researchers sought to examine the effects of anxiety, depression, and social support on the risk of severe acute exacerbations in COPD using data from a prospective study of veterans at 2 Veterans Affairs (VA) medical centers.

All patients who were treated for an exacerbation over a 1-year period completed phone assessments every 2 weeks on exacerbation symptoms and treatments. Participants were all at least 40 years old, and they were assessed for significant depression and anxiety symptoms, dyspnea, and social support.

Of the 410 adults included, the mean age was 69.6 years and the majority (96%) were male.

Researchers found:

  • The prevalence of anxiety symptoms (Hospital Anxiety Depression Scale [HAD]-anxiety >8) was 32% and of depressive symptoms (HAD-depression >8) was 27%.
  • After adjusting for age, sex, COPD severity, and comorbidity, in a model with both anxiety and depression, only baseline anxiety was related with increased risk of COPD hospitalization.
  • In an adjusted model examining elevated anxiety, social support, living alone, and lower emotional support were related with risk of severe acute exacerbations in patients with COPD.
  • Living alone was associated with 72% increase in rate of COPD exacerbations compared with those living with others.

Overall, “patients with elevated anxiety but not depressive symptoms were twice as likely to develop a COPD hospitalization,” researchers said.

“COPD patients with elevated anxiety symptoms, those with lower emotional support, and living alone may require closer medical follow-up and monitoring, with an appropriate treatment plan to reduce the risk of acute hospitalized exacerbations,” they concluded.

Because “diabetes leads to micro-and macroscopic end-organ complications,” a second analysis2 assessed the role of diabetes in COPD exacerbations. Researchers also conducted a retrospective study among veterans divided into those with acute exacerbation of COPD (AECOPD) and diabetes mellitus (DM) and those without DM.

After assessing readmission rates, multivariate analyses showed that diabetes stands out as an independent predictor of AECOPD. In addition, data revealed that body mass index, hypertension, hyperlipidemia, a-fibrillation/a-flutter, and sleep apnea also served as independent predictors of AECOPD.

On average, those with DM had 2.28 total readmission days post discharge compared with 1.39 among those without DM (P = .0126).

“COPD requires multidisciplinary management, and having diabetes should be concerning for risk of readmissions and exacerbations,” the authors wrote. “Conjoined care with other specialties in optimizing diabetes aggressively could help prevent AECOPD and readmissions.”

However, larger prospective studies also ought to be carried out, they concluded.


1. Yohannes AM, Locke ER, Battaglia CT, et al. Anxiety is a risk factor of developing severe acute exacerbations in patients with chronic obstructive pulmonary disease. Presented at: CHEST Annual Meeting 2021; October 17-20, 2021. Abstract 38482.

2. Damania D, Hameed S, Eng A, et al. Role of diabetes in exacerbation of chronic obstructive pulmonary disease. Presented at: CHEST Annual Meeting 2021; October 17-20, 2021. Abstract 39021.