COPD: How to manage comorbid depression and anxiety

Support groups can increase social interaction and offer a chance to discuss disease-related medical, psychological, and social issues with other COPD patients.

Pulmonary rehabilitation has been shown to decrease depression and anxiety, increase functioning, and promote independence in patients with COPD.¹² Patients are educated about their disease and learn breathing techniques to reduce air hunger and exercises to optimize oxygen use.

Physical exercise figures prominently in pulmonary rehabilitation by improving oxygen consumption efficiency. This in turn improves exercise tolerance.¹⁵

COPD AND DELIRIUM

Delirium is common among older patients with COPD. Two or more causes can be at work simultaneously, such as:

• hypoxia and hypercapnia
• reactions to antibiotics, antivirals, and corticosteroids used to treat COPD.

Delirium can simulate depression, anxiety, mania, and psychosis because affective lability, fluctuating levels of consciousness, and impaired reality testing are features of delirium.

A COPD patient’s sudden change in mental status should prompt a careful review of medications and medical conditions and an oxygen saturation measurement. An arterial blood gas reading may also be helpful because hypercapnia can be present without hypoxia. The sudden onset of psychotic symptoms in a patient with COPD should also prompt a thorough search for causes of delirium.¹⁶

Related resources

• Braunwald E, Fauci AS, Kasper DL, et al (eds.). Harrison’s principles of internal medicine (15th ed.). New York: McGraw-Hill Medical Publishing, 2001.
• American Lung Association: Around the clock with COPD. https://www.lungusa.org/diseases/copd_clock.html
• National Emphysema Foundation. https://www.emphysemafoundation.org/

Drug brand names

• Albuterol • Proventil, Ventolin
• Alprazolam • Xanax
• Amantadine • Symmetrel
• Atorvastatin • Lipitor
• Budesonide • Pulmicort
• Bupropion • Wellbutrin
• Buspirone • BuSpar
• Cimetidine • Tagamet
• Ciprofloxacin • Ciloxan, Cipro
• Citalopram • Celexa
• Clonazepam • Klonopin
• Diazepam • Valium
• Digoxin • Lanoxin
• Divalproex • Depakote
• Erythromycin • Emgel, others
• Escitalopram • Lexapro
• Fluconazole • Diflucan
• Fluoxetine • Prozac
• Fluticasone • Flovent
• Gabapentin • Neurontin
• Hydroxyzine • Atarax, Vistaril
• Ipratropium • Atrovent
• Itraconazole • Sporanox
• Levodopa • Sinemet
• Lorazepam • Ativan
• Mirtazapine • Remeron
• Montelukast • Singulair
• Nefazodone • Serzone
• Paroxetine • Paxil
• Propranolol • Inderal
• Risperidone • Risperdal
• Salmeterol • Serevent
• Sertraline • Zoloft
• Simvastatin • Zocor
• Theophylline • Theo-dur, others
• Triazolam • Halcion
• Venlafaxine • Effexor
• Warfarin • Coumadin

Disclosure

The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.