Study Finds Depression, Anxiety to Be More Common in COPD Than Other Chronic Comorbidities

Patients with chronic obstructive pulmonary disease (COPD) have a high risk of developing depression or anxiety, suggesting that mental health issues, compared with other chronic conditions, may be more prevalent among patients with COPD, according to a recent study.

The retrospective cohort study, published in Therapeutic Advances in Respiratory Disease, is one of the first pieces of evidence to quantify the use of antianxiety drugs, also known as anxiolytics (ANXs) and antidepressants (ATDs), in patients with COPD and compare their use with medications that treat other chronic diseases.

Extrapulmonary comorbidities, such as cardiovascular disease and diabetes, are highly prevalent in COPD. Additionally, previous studies suggest that depression affects between 24.6% and 27.1% pf patients with COPD. Also, one study found that around 40% of patients with COPD experienced depressive symptoms.

“The high prevalence of depression and anxiety is concerning because these problems are associated with reduced efficacy of COPD therapies partly due to physical activity avoidance, worsening of symptoms, and increased mortality,” noted the investigators.

However, evidence on the use of ANXs and ATDs in patients with COPD is limited because most studies focus on the use of drugs used to treat depression that pos safety risks in COPD, such as benzodiazepines.

The investigators selected patients using the NControl database containing information on drug dispensing in the Netherlands, extracting data entered between January 1, 2013, and January 1, 2019. All subjects were older than 55 years.

The study included 2 control groups: group 1 contained all subjects who did not have any of the chronic diseases studied and group 2 contained patients who received at least 2 prescriptions per year for 5 of the 6 years making up the study period.

A total of 96,319 patients with COPD were selected, of whom 14,619 (15.2%) had been using used ATDs and ANXs long term. Among the 62,865 patients with long-term use of medications for dermatological conditions, 9627 also used ATDs and ANXs long term.

Additionally, among the 7900 patients who used disease-modifying antirheumatic drugs and the 422,396 patients who used statins, 1042 (13.2%) and 49,203 (11.6%) patients also used ATDs and ANXs, respectively. Of the 165,975 users of oral glucose-lowering medications, 19,955 (11.4%) also used ATDs and ANXs.

Long-term use of ATDs and ANXs was higher across all chronic disease groups compared with control group 1 and control group 2, with the exception of oral glucose-lowering medication users compared with control group 2.

The risk ratio (RR) for long-term use of ATDs and/or ANXs in patients with COPD was almost 6 times higher compared with control group 1 (RR, 5.80; 95% CI, 5.67-5.92). This was also higher in men compared with women. With the exception of medications used to treat dermatological diseases, the RR was higher in the patients in the COPD group than patients with other chronic diseases.

Patients 75 years or older had a higher RR for ATD or ANX use (RR, 6.43; 95% CI, 6.14-7.73) vs patients aged 55 to 65 years (RR, 5.68; 95% CI, 5.50-8.87) and patients aged 65 to 75 years (RR, 5.66; 95% CI, 5.46-5.87).

The investigators identified some limitations to their findings, such as the inability to see whether patients were taking ATDs and ANXs prior to receiving a COPD diagnosis and not being able to rule out the influence of asthma on the results due to there being a lot of similarities between asthma and COPD.

“It is important to consider this, because a relation between mental health and asthma has been demonstrated before, represented by the high prevalence of anxiety and depression,” wrote the investigators.

The researchers suggesting that a follow-up cohort study should examine the incidence, causes, and prognosis of depression and anxiety in patients with COPD to elaborate on their results.

Reference

Pelgrim CE, van den Heuvel JM, Folkerts G, Garssen J, Maitland-van der Zee AH, Kranveld AD. Higher prescription of antidepressants and/ or anxiolytics among chronic obstructive pulmonary disease patients. Ther Adv Respir Dis. Published online March 22, 2021. doi:10.1177/1753466620961696