A Prevalence Of Anxiety And Depression In Patients With An Acute Exacerbation Of COPD

Background and ObjectiveCOPD is considered to be a multi-component disease, and depression is one of the major comorbidities in COPD patients. The Gold2011for managing COPD highlight the importance of being aware of anxiety and depression in these patients, But these disorders are not routinely screened for in COPD patients especially in those with an exacerbation. We want to find the incidence of anxiety and depression in patients hospitalized with an AECOPD in a General hospital in Beijing China, to observe the relationship among the CAT, MMRC, PCR level and frequences of AECOPD which recommended to evaluate in the new Gold. At same time, the relationship between anxiety, depression and cytokines reported in the literature, some patients blood testing cytokines, hoping to find the association.Materials and methodsA prospective observational survey was conducted. The Hospital Anxiety and Depression Scale (HAD) questionnaire was completed by64patients with an acute exacerbation of COPD admitted between Nov.2011and July.2012. Detailed history including age, smoking history, combined other medical illness, MMRC dyspnea scale, ACT (COPD Assessment Test), ADL score (activity of daily living), hospitalization in the last year and many physiological variables such as FEV1, FEV1/FVC, BMI were all recorded. The Pearson correlation coefficient was used to evaluate the relationships between HAD and other variables. Patients with cancer and dementia were excluded. Reported in the literature COPD patients with a good anxiety and depression, but there is little literature on COPD and anxiety, depression and related factors were analyzed.ResultPatients were75±9years old (F=24),26of the64patient’s HAD score>8(40.6%). Smoked59±17 pack years. MMRC scale0:2(3.2%),1:10(16.1%),2:24(32.3%),3:23(35.3%) and4:6(9.7%). ACT score:20.98±8.07. ADL score:26.41±11.38. Hospitalized time1.0±0.2. Although HAD-Anxiety score and HAD-Depression score was positively correlated with CAT score (r=0.44, p<0.01;and r=0.43, p<0.01respectively),ADL score (r=0.44, p<0.01;and r=0.51, p<0.01), and HAD-Depression score was positively correlated with age (r=0.305, p<0.05, respectively) it was not correlated with BMI, FEV1%, CRP, times of AECOPD and smoked pack years (p>0.05). Both the differences of HAD-anxiety score and HAD-depression score among patients with different grade of MRC score were statistical significant (F=4.19, P<0.01;and F=2.93, P<0.05, respectively). The cytokine detection results show that IL-6, IL-10, and anxiety correlated simultaneously IL-6, IL-10, IL-17and the occurrence of depression relevance.ConclusionsThere was a high incidence of anxiety state and/or depression state (40.6%) in these patients, which have relationship with dyspnea, activity of daily living and quality of life, not the FEV1. It also appears that these disorders were unrecognised and untreated in most of the cases. The COPD patients should have a preventive and therapeutic role in this comorbidity and improve the daily care and quality of life. In addition, the detection of inflammatory cytokines did not show anxiety, depression correlated with COPD combined. Is likely this group of small sample size, the sample needs to be further expanded, for multi-center study to further explore.