Influence de l’anxiété et de la dépression sur les exacerbations au cours de la BPCO

Clinical and economic burden of anxiety/depression among older adult COPD patients: evidence from the COPD-AD China Registry study

Background

Anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD), especially older adult patients. This can complicate the disease progression and lead to increased clinical and economic burden. We sought to investigate the clinical and economic burdens associated with the presence of anxious and/or depressive symptoms among older adult COPD patients.

Methods

We screened 579 patients aged over 60 years and diagnosed with COPD via a lung function test following the 2017 Global Initiative Chronic Obstructive Lung Disease (GOLD) guidelines. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) through face-to-face interviews at admission. Follow-up was conducted by telephone calls at 6, 12, 18, 24, and 36 months after discharge to assess clinical and economic burden. COPD-anxiety and/or depression patients were matched to patients without anxiety and depression (COPD-only) using propensity scores. Multivariate regression models were used to compare clinical and economic burden between COPD-anxiety and/or depression and COPD-only groups.

Results

Compared with COPD-only patients, COPD patients complicated with anxiety and/or depression had increased clinical burden, including higher COPD-related outpatient visits, COPD-related hospitalizations, and length of COPD-related hospitalizations (p < 0.001). Moreover, they also had an increased economic burden, including higher annual total healthcare costs, medical costs, and pharmacy costs (p < 0.001).

Conclusion

Older adult COPD patients with anxiety or depression had significantly higher clinical and economic burdens than patients without these comorbidities. These findings deserve further exploration and may be useful for the formulation of relevant healthcare policies.

Diagnostic value of serum neuroactive substances in the acute exacerbation of chronic obstructive pulmonary disease complicated with depression

We aimed to investigate the potential diagnostic value of five serum neuroactive substances in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with depression. A total of 103 patients with AECOPD were enrolled between August 2020 and August 2021. All patients were assessed using a self-rating depression scale and divided into AECOPD with or without depression groups. Baseline data and serum neuroactive substance levels were compared between the two groups. Logistic regression was used to identify the risk factors. The diagnostic performance of neuroactive substances was evaluated using receiver operating characteristic (ROC) curves. Patients with AECOPD complicated with depression exhibited higher partial pressure of CO2 values and higher chronic obstructive pulmonary disease assessment test (CAT) scores. An elevated proportion of patients with more than two acute exacerbations (AEs) in the previous year was observed in this patient group (all P < 0.001). The CAT score and number of AEs during the previous year were identified as independent risk factors for AECOPD complicated with depression. No significant differences were observed in the levels of aspartic acid and glutamate between the two groups (P > 0.05). Serum γ-aminobutyric acid (GABA) and glycine (Gly) levels were decreased. In contrast, serum nitric oxide (NO) levels were increased in the AECOPD complicated with the depression group (P < 0.05). Serum GABA and Gly levels exhibited a negative correlation, and NO levels positively correlated with the number of AEs in the previous year and the CAT score. The area under the ROC curve values for GABA, Gly, and NO were 0.755, 0.695, and 0.724, respectively. Serum GABA exhibited a sensitivity of 85.1% and a specificity of 58.9%, below the cut-off value of 4855.98 nmol/L. Serum GABA, Gly, and NO may represent potential biomarkers for AECOPD complicated with depression.

A network analysis of anxiety and depression symptoms in Chinese disabled elderly

BACKGROUND

Mental health is an essential dimension of healthy aging. The number and severity of disabled elderly in China show an increasing tendency year by year. Due to their impaired ability of daily activities, reduced social participation and reduced self-care ability, they are more prone to depression and anxiety.

METHOD

We included 2131 individuals aged 65 and older from the Chinese Longitudinal Healthy Longevity Survey (CLHLS 2017-2018). We used the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) and the Generalized Anxiety Disorder scale-7 (GAD-7) to assess depression and anxiety, respectively. The structure of depressive and anxiety symptoms was characterized using "Expected Influence" and "Bridge Expected Influence" as centrality indices in the symptom network. Network stability was tested using a case-dropping bootstrap procedure. Finally, a Network Comparison Test (NCT) was conducted to examine whether network characteristics differed by gender.

RESULTS

Network analysis revealed that nodes CESD3 (Felt sadness), GAD2 (Uncontrollable worry), and GAD4 (Trouble relaxing) were the primary symptoms of the anxiety-depression network. Anxiety and depression were united by the symptoms of CESD9 (Could not get going), GAD1 (Nervousness or anxiety), CESD10 (Sleep quality), and GAD4 (Trouble relaxing). Additionally, Gender did not significantly affect the network structure.

CONCLUSION

Central symptoms (e.g., felt sadness, uncontrollable worry and trouble relaxing) and key bridge symptoms (e.g., could not get going, nervousness and anxiety) in the depressive and anxiety symptoms network may be used as potential targets for intervention among disabled elderly who is at risk for or suffer from depressive and anxiety symptoms.

The feasibility of remotely monitoring physical, cognitive, and psychosocial function in individuals with stroke or chronic obstructive pulmonary disease

Objective

Clinical implementation of remote monitoring of human function requires an understanding of its feasibility. We evaluated adherence and the resources required to monitor physical, cognitive, and psychosocial function in individuals with either chronic obstructive pulmonary disease or stroke during a three-month period.

Methods

Seventy-three individuals agreed to wear a Fitbit to monitor physical function and to complete monthly online assessments of cognitive and psychosocial function. During a three-month period, we measured adherence to monitoring (1) physical function using average daily wear time, and (2) cognition and psychosocial function using the percentage of assessments completed. We measured the resources needed to promote adherence as (1) the number of participants requiring at least one reminder to synchronize their Fitbit, and (2) the number of reminders needed for each completed cognitive and psychosocial assessment.

Results

After accounting for withdrawals, the average daily wear time was 77.5 ± 19.9% of the day and did not differ significantly between months 1, 2, and 3 (p = 0.30). To achieve this level of adherence, 64.9% of participants required at least one reminder to synchronize their device. Participants completed 61.0% of the cognitive and psychosocial assessments; the portion of assessments completed each month didnot significantly differ (p = 0.44). Participants required 1.13 ± 0.57 reminders for each completed assessment. Results did not differ by disease diagnosis.

Conclusions

Remote monitoring of human function in individuals with either chronic obstructive pulmonary disease or stroke is feasible as demonstrated by high adherence. However, the number of reminders required indicates that careful consideration must be given to the resources available to obtain high adherence.

The Overlap Syndrome of Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease: A Systematic Review

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are common diseases that strongly impact the quality and length of life. Their coexistence is determined by overlap syndrome (OS). This systematic review aims to define the significance of these comorbidities according to the current state of knowledge. For this systematic review, we searched PubMed, Scopus, and Cochrane for studies published between 2018 and 26 October 2022, to find original, observational, human studies published in English, where the diagnosis of COPD was according to the Global Initiative for Obstructive Lung Disease guidelines and the diagnosis of OSA was based on polysomnography. The quality of studies was assessed using the Newcastle-Ottawa quality assessment tool for cohort and case-control studies, as well as its modification for cross-sectional studies. Of the 1548 records identified, 38 were eligible and included in this systematic review. The included studies covered a total population of 27,064 participants. This paper summarizes the most important, up-to-date information regarding OS, including the prevalence, meaning of age/gender/body mass index, polysomnography findings, pulmonary function, comorbidities, predicting OSA among COPD patients, and treatment of this syndrome.

[Chronic obstructive pulmonary disease: somato-psychological dimensions]

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and is a poorly understood lung disease. It is accompanied by significant psychological co-morbidities (anxiety, depression, identity and body image disorders) which are under-diagnosed and have an impact on quality of life and the frequency of  re-hospitalization. The management of COPD is multidisciplinary and its role is to prevent complications, relieve symptoms and slow the progression of the disease. Therapeutic education of the patient brings a real added value in this multidisciplinary management.

Temporal trends in anxiety and depression prevalence and their association with adverse outcomes in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease in Beijing, China, from 2004 to 2020

AIMS

To investigate the temporal trend in anxiety and/or depression prevalence in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing and their association with adverse outcomes.

MATERIALS AND METHODS

Hospital admission records from 2004 to 2020 with a primary discharge diagnosis of AECOPD were retrieved from Beijing Public Health Information Centre database. The anxiety and depression were identified from discharge diagnoses of each record. Joinpoint regression was used to analyze the temporal trend and calculate the annual percentage change (APC) for the prevalence of anxiety and/or depression. Generalized linear model was used to analyze the associations between anxiety and/or depression and patients' adverse outcomes.

RESULTS

A total of 382,125 records were included, most of which were male (66.0%) and aged ≥ 75 years (59.7%). Three segments in the temporal trend were observed, with a mild increase during 2004-2009 (APC: 5.9%, 95% CI: -14.9 to 31.7%), followed by a sharply increase during 2009-2012 (APC: 60.4%, 95% CI: 10.6 to 132.7%), then stabilized at about 3% during 2012-2020 (APC: 1.9%, 95% CI: -0.4 to 4.3%). On average, anxiety, and/or depression was more prevalent in females, the aged and those admitted in secondary hospitals (all P < 0.001). Patients with anxiety and/or depression had lower in-hospital mortality (IHM) (OR = 0.74, 95% CI: 0.63-0.88), but longer hospital stay (OR = 1.10, 95% CI: 1.07-1.13), more medical costs (OR = 1.12, 95% CI: 1.08-1.17) and higher risks of readmission for AECOPD at 30-, 90-, 180-day, and 1-year (ORs ranged from 1.22 to 1.51).

CONCLUSION

The prevalence of anxiety and/or depression in patients hospitalized for AECOPD in Beijing stabilized at approximately 3% after 2012. Anxiety and/or depression is associated with a heavier burden on patients, health care, and medical insurance systems. Appropriate diagnosis and effective treatment of anxiety and depression is crucial for patients with AECOPD.

Anxiety and depression in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome

PURPOSE

Psychological symptoms are increasingly being noted in patients with chronic diseases. Currently, little evidence is available on the mental health of patients with overlap syndrome (OVS, chronic obstructive pulmonary disease plus obstructive sleep apnea). This study aimed to describe the prevalence and identify influencing factors of anxiety and depression in patients with OVS.

METHODS

We recruited patients admitted for chronic obstructive pulmonary disease (COPD) from July 2018 to July 2019 who also underwent polysomnography tests to assess obstructive sleep apnea (OSA). COPD patients who had an apnea-hypopnea index (AHI) ≥ 5/h were defined as OVS. COPD patients who had an AHI < 5/h were identified as pure COPD. Questionnaires were administered to evaluate depression and anxiety in all subjects. We compared the differences in scores between patients with OVS and pure COPD.

RESULTS

Two hundred and fifty-two patients were included, 180 (71%) patients had OVS, while only 72 patients had pure COPD. In the OVS group, 54% of the patients had depression, and 77% of the patients had anxiety. We found that patients with OVS had higher anxiety (8.00 (4.00, 10.00) vs. 6.00 (3.00, 9.00), p = 0.018) and depression (8.00 (4.00, 10.00) vs. 5.50 (2.25, 10.00), p = 0.022) scores than patients with pure COPD. A higher proportion of patients with hypertension (41% vs. 21%) and coronary heart disease (14% vs. 4%) were found in the OVS group. Chest pain, COPD Assessment Test (CAT) score, and OVS were independent risk factors for depression (P<0.05). A positive correlation was shown between anxiety and depression (r=0.638, p < 0.001).

CONCLUSIONS

Anxiety and depression were more severe in patients with OVS than in patients with pure COPD. More attention should be paid to the mental health of OVS patients.

TRIAL REGISTRATION

ClinicalTrials.gov; URL: www.clinicaltrials.gov . NO.: NCT03182309. Registered on June 9, 2017; https://clinicaltrials.gov/ct2/show/NCT03182309?term=NCT+03182309&draw=2&rank=1.

Chinese herbal medicine for symptoms of depression and anxiety in chronic obstructive pulmonary disease: A systematic review and meta-analysis

OBJECTIVES

To evaluate the efficacy and safety of Chinese herbal medicine (CHM) on symptoms of depression and anxiety complicated by chronic obstructive pulmonary disease (COPD).

METHODS

Literature from 8 electronic medical databases were searched for meta-analysis using RevMan (version 5.3) and Stata (version 12.0) software. The GRADE Pro Guideline Development Tool and TSA Viewer (version.0.9.5.10 beta) were adopted to evaluate the certainty and conclusiveness of the evidence.

RESULTS

26 studies involving 2529 participants were identified. CHM demonstrated significant lower scores on the Hamilton Depression Rating Scale, Self-Rating Depression Scale, Hamilton Anxiety Rating Scale, and Self-Rating Anxiety Scale compared to the control group without CHM. Moreover, CHM showed favorable safety.

CONCLUSIONS

The evidence verified the efficacy and safety of CHM on relieving depression and anxiety in COPD. However, further large-scale and rigorously designed studies are urgently warranted to strengthen the evidence.

Trends in Hospital Admissions for Chronic Obstructive Pulmonary Disease in Men and Women in Spain, 1998 to 2018

The prevalence of chronic obstructive pulmonary disease (COPD) is rising faster in women in some countries. An observational time trends study was performed to assess the evolution of hospital admissions for COPD in men and women in Spain from 1998 to 2018. ICD-9 diagnostic codes (490–492, 496) from the minimum basic data set of hospital discharges were used. Age-standardised admission rates were calculated using the European Standard Population. Joinpoint regression models were fitted to estimate the annual percent change (APC). In 2018, the age-standardised admission rate per 100,000 population/year for COPD was five times higher in men (384.8, 95% CI: 381.7, 387.9) than in women (78.6, 95% CI: 77.4, 79.9). The average annual percent change (AAPC) was negative over the whole study period in men (−1.7%/year, 95% CI: −3.1, −0.2) but positive from 2010 to 2018 (1.1%/year, 95% CI: −0.8, 2.9). In women, the APC was −6.0% (95%CI: −7.1, −4.9) from 1998 to 2010, but the trend reversed direction in the 2010–2018 period (7.8%/year, 95% CI: 5.5, 10.2). Thus, admission rates for COPD decreased from 1998 to 2010 in both men and women but started rising again until 2018, modestly in men and sharply in women.

[COPD, anxiety-depression and cognitive disorders: Does inflammation play a major role?]

COPD is a chronic respiratory disease, often associated with extrapulmonary manifestations. Co-morbidities, including anxiety, depression and cognitive impairment, worsen its progression and quality of life. The prevalence of these disorders is high, yet they are often poorly understood and inadequately managed. In the development of psychological disorders, there is accumulated evidence highlighting the major role of systemic inflammation, as well as chronic disease, genetics, the consequences of smoking, hypoxaemia, oxidative stress, and the gut microbiome In addition to traditional treatments such as bronchodilatator medications, respiratory rehabilitation and smoking cessation, systemic inflammation is an interesting therapeutic target, with the use of anti-inflammatory drugs, anti-cytokines, and nutritional interventions.

The Impact of Depression and Anxiety on Chronic Obstructive Pulmonary Disease Acute Exacerbations: A prospective cohort study

BACKGROUND

To explore the impact of anxiety and depression in chronic obstructive pulmonary disease(COPD) patients on the risk of acute exacerbation.

METHODS

600 COPD patients were recruited and followed in Beijing, China. The demographic data, medical history, smoking history, therapy, assessments for anxiety and depression were completed by our physicians by face-to-face interview. Then the acute exacerbation events during the past one year was derived from their case record.

RESULTS

504 people (295 men and 209 women) were thus included in the final analyses.The patients with anxiety scored more than 50 showed higher risk of acute exacerbation(54.1%) than those who scoring less than 50(39.8%). Similarly, the patients with depression scored more than 53 showed higher risk of acute exacerbation(52.1%) than those who scoring less than 53(40.4%). Eventually, Anxiety and/or depression will increase the risk of acute exacerbation in chronic obstructive pulmonary disease patients(AECOPD) (adjusted OR = 1.60, 95%CI: 1.10-2.31), after adjusting the influence of family history, duration of disease, BMI index and other factors. Besides, the prevalence of acute exacerbation in patients with anxiety and/or depression was higher than those without acute exacerbation (P<0.05).

LIMITATIONS

The frequency of AECOPD was limited to self-reported data, recall bias should be reconsidered, and it also may underestimate the association between anxiety and/or depression and AECOPD. Anxiety and depression were assessed by questionnaires rather than by a clinical diagnosis.

CONCLUSION

Anxiety and/or depression in stable COPD patients were significantly associated with a higher risk of acute exacerbation. Mental health care should be paid more attention, to decrease the risk of acute exacerbation in COPD patients.

A protocol of randomized controlled trial for Modified Xiaoyao Powder in the treatment of chronic obstructive pulmonary disease combined mild to moderate depression

INTRODUCTION

Depression is an important complication of chronic obstructive pulmonary disease (COPD), occurring in more than one-third of individuals with COPD, and its severity is closely related to the severity and acute exacerbation of COPD, significantly contributing to the risk of death from COPD. Comorbid depression in COPD can be a burden on COPD-related diseases by reducing quality of life and compliance with treatment. Unfortunately, symptoms of COPD combined anxiety and depression are not properly diagnosed and treated in clinical practice, especially in the early stages of mood changes in patients with COPD, as the symptoms are mild and monotonous, and are overlooked.

METHODS

In this prospective, randomized, placebo-controlled trial, we will assigned 280 eligible patients who had COPD combined depression to receive either Modified Xiaoyao Powder (MXP) or placebo. The primary end point is the change in the Hamilton Depression Scale (17 items) (HAMD-17) score from baseline on weeks 4, 12, and 24.

DISCUSSION

Six months of MXP for COPD combined mild to moderate depression may alleviate the symptoms of depression, reduce the frequency of hospitalizations, the number of exacerbations, and improve the compliance of treatment.

TRIAL REGISTRATION

ChiCTR2000038741.

Co-Morbidity Patterns Identified Using Latent Class Analysis of Medications Predict All-Cause Mortality Independent of Other Known Risk Factors: The COPDGene® Study

PURPOSE

Medication patterns include all medications in an individual's clinical profile. We aimed to identify chronic co-morbidity treatment patterns through medication use among COPDGene participants and determine whether these patterns were associated with mortality, acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and quality of life.

MATERIALS AND METHODS

Participants analyzed here completed Phase 1 (P1) and/or Phase 2 (P2) of COPDGene. Latent class analysis (LCA) was used to identify medication patterns and assign individuals into unobserved LCA classes. Mortality, AECOPD, and the St. George's Respiratory Questionnaire (SGRQ) health status were compared in different LCA classes through survival analysis, logistic regression, and Kruskal-Wallis test, respectively.

RESULTS

LCA identified 8 medication patterns from 32 classes of chronic comorbid medications. A total of 8110 out of 10,127 participants with complete covariate information were included. Survival analysis adjusted for covariates showed, compared to a low medication use class, mortality was highest in participants with hypertension+diabetes+statin+antiplatelet medication group. Participants in hypertension+SSRI+statin medication group had the highest odds of AECOPD and the highest SGRQ score at both P1 and P2.

CONCLUSION

Medication pattern can serve as a good indicator of an individual's comorbidities profile and improves models predicting clinical outcomes.

Medication adherence among patients with chronic obstructive pulmonary disease treated in a primary general hospital during the COVID-19 pandemic

Background

The objective of this study was to investigate medication adherence and the associated influencing factors in patients with chronic obstructive pulmonary disease (COPD) who were treated in a primary general hospital in Shanghai China during the 2019 novel coronavirus (COVID-19) pandemic.

Methods

From March to April 2020, all of the COPD patients treated in our department in the last 7 years were interviewed by telephone. The basic patient data and each questionnaire item were collected, and influencing factors were analyzed by the Chi-square test, U test, and univariate and multivariate logistic regression analyses.

Results

A total of 191 patients with COPD were queried, and 84 (44.0%) valid questionnaires were obtained. Among them, individuals with group B symptoms were most represented (45.2%); 53.6% had Medical Research Council (MRC) dyspnea levels of 2 or above. Chronic obstructive pulmonary disease assessment test (CAT) had an average of 9 [3, 13], and 52.4% of patients used two-drug combination therapy. Medication adherence was both good in ordinary times and over the past 2 months of the pandemic, and 88.8% of patients had no acute exacerbation during the pandemic. The CAT scores of male patients <70 years old, and patients with general outpatient follow-up and regular gargling were reduced (P<0.05). Drug combination and doctor’s supervision were favorable factors affecting medication adherence during the 2 months of the pandemic, while possible depression was an unfavorable factor (P<0.05).

Conclusions

During the pandemic, medication adherence in patients with COPD was similar to that in regular times, and was significantly related to drug combination, doctor’s supervision, and accompanying mood disorders. An effective way to improve patient adherence and disease control could be strengthening follow-up education and diagnosing and treating depression and other complications.

Effect of Qigong on self-rating depression and anxiety scale scores of COPD patients: A meta-analysis

OBJECTIVE

To explore the clinical efficacy and safety of Qigong in reducing the self-rating depression scale (SDS) and self-rating anxiety scale (SAS) scores of patients with chronic obstructive pulmonary disease (COPD).

METHODS

We searched CNKI, Wan fang, Chongqing VIP, China Biology Medicine disc, PubMed, Cochrane Library, and EMBASE for studies published as of Dec 31, 2018. All randomized controlled trials of Qigong in COPD patients, which met the inclusion criteria were included. The Cochrane bias risk assessment tool was used for literature evaluation. RevMan 5.3 software was used for meta-analysis.

RESULTS

Six studies (combined n = 415 patients) met the inclusion criteria. Compared with conventional therapy alone, Qigong in combination with conventional therapy significantly improved the following outcome measures: SDS score [mean difference (MD) -3.99, 95% CI (-6.17, -1.82), P < .001, I = 69%]; SAS score[MD -4.57, 95% CI (-5.67, -3.48), P < .001, I = 15%]; forced expiratory volume in one second/prediction (FEV1% pred) [MD 3.77, 95% CI (0.97,6.58), P < .01, I = 0]; forced expiratory volume in one second (FEV1) [MD 0.21, 95% CI (0.13, 0.30), P < .001, I = 0%]; forced vital capacity (FVC) [MD 0.28, 95% CI (0.16, 0.40), P < .001, I = 0]; 6-minute walk test (6MWT) distance [MD 39.31, 95% CI (18.27, 60.34), P < .001, I = 32%]; and St. George's Respiratory Questionnaire (SGRQ) total score [MD -11.42, 95% CI (-21.80, -1.03), P < .05, I = 72%].

CONCLUSION

Qigong can improve the SDS and SAS scores of COPD patients, and has auxiliary effects on improving lung function, 6MWT distance, and SGRQ score.