Factors associated with poor health status in COPD patients with comorbid depression or anxiety

Introduction: Increased scores in the COPD Assessment test (CAT) and the Clinical COPD Questionnaire (CCQ) are associated with not only increased risk of exacerbations and mortality, but also comorbid depression/anxiety. The aims of this study were to assess the CAT/CCQ scores in Swedish COPD patients and to investigate the associations between patient-related, clinical factors and increased CAT/CCQ scores in patients with comorbid depression/anxiety. Methods: This cross-sectional study included 2245 randomly selected primary and secondary care patients with a doctor’s diagnosis of COPD. Patient self-completion questionnaires were used to collect COPD-related clinical data, including information about depression/anxiety- (diagnosis and frequency of current symptoms) and CAT/CCQ forms. Lung function data were extracted from medical records. Results: The 524 COPD patients (23.3%) who reported a history of depression/anxiety had higher mean CCQ scores (2.37 vs. 1.82, P <0.001) and CAT scores (18.5 vs. 15.0, P <0.001), adjusted for age, sex, and lung function, than patients without depression/anxiety. Of patients with depression/anxiety, 48% had CAT ≥20, and 57% had CCQ ≥2. Factors associated with CAT ≥20: COPD diagnosed before 60 years of age (OR=2.62 [95% CI 1.37-5.04]), frequent symptoms of depression during the previous 3 months (2.59 [1.55-4.30]), one or more COPD exacerbations during the previous 6 months (2.37 [1.41-4.00]), physical inactivity (1.89 [1.11-3.22]) and FEV1, % of predicted (0.98 [0.97-1.00]) (adjusted odds ratios; Table 1). Factors associated with CCQ ≥2 were the same as for CAT ≥20 except for physical inactivity (Table 1). Discussion: Approximately a half of COPD patients with comorbid depression/anxiety reported significantly poor COPD-related health status. As COPD patients with comorbid depression/anxiety should be considered a particularly vulnerable and high-risk group, clinicians should work proactively to treat depression and anxiety, prevent exacerbations and stimulate physical activity in these patients.