Effect of symptoms of anxiety and depression on exercise performance and quality of life in chronic obstructive pulmonary disease

ABSTRACTObjective: Depression and anxiety are diagnosed much less than expected in patients with COPD. Depression and anxiety negatively affects exercise capacity and quality of life in patients with COPD. In this study we aim to determine the prevalence of symptoms of anxiety and depression associated with COPD and to investigate the relationship between severity of shortness of breath of the patient, stage of disease, quality of life, exercise capacity and symptoms of depression and anxiety.Material and Method: Patients who have been admitted to chest diseases outpatient clinic of Çanakkale Onsekiz Mart University Faculty of Medicine between February 2010 ? April 2012 were assessed and ninety patients of them with stabil COPD were invited by phone or verbally and recruited to this study. Hospital Anxiety and Depression Scale for anxiety and depression screening, St. George Respiratory Questionnaire (SGRQ) for assessing quality of life, six minute walk test for exercise performance, spirometry and Medical Research Council (MRC) dyspnea scale for assessing severity of dyspnea were performed.Results: 18,9% of patients participating in the study was stage 1 COPD, 64,4% stage 2, 15,6% stage 3 and 1,1% stage 4 COPD, respectively. Minimum age of patients was 39, maximum age was 78 and mean age was 62,92±8,49. 26,7% (24 patient) had depression symptoms and 12,2% (11 patient) had anxiety symptoms of 90 patients performed Hospital Anxiety and Depression Scale. The cut-off point for anxiety was 10 and for depression 7 in Hospital Anxiety and Depression Scale. Minimum six minute walk distance was 180 m, maximum 6 minute walk distance was 671 m and mean distance was 494,16± 88,57 m. SGRQ mean symptom score was 55,56±20,11; mean activity score 45,50±13,38; mean impact score 28,79±20,35 and mean total score 38,31± 16,75 as well. 21,1% of patients was MRC stage 1, 55,6% MRC stage 2, 20% MRC stage 3, 3,3% MRC stage 4 as well.A significant correlation was found between anxiety and depression and quality of life in patients with stage 1 COPD (18,9%) and between depression and quality of life in patients with stage 2 COPD (64,4%). A significant negative correlation was found between depression and six minute walk distance in patients with stage 2 COPD. A significant correlation was found between dyspnea severity and SGRQ scores in patients with stage 1, 2, 3 COPD. A significant negative correlation was found between dyspnea severity and six minute walk distance in patients with stage 2 COPD and between six minute walk distance and SGRQ scores in patients with stage 1, 2 COPD.Conclusion: A correlation was found between anxiety and/or depression and quality of life, dyspnea level and quality of life, dyspnea level and exercise performance, quality of life and exercise performance in patients with mild or moderate (FEV1?50%) COPD. A correlation was also found between dyspnea level and depression in patients with moderate COPD. 84% of patients participating in this study consisted of patients with mild to moderate COPD. Besides a correlation was found between quality of life and depression in COPD patients between the ages of 53-78. Each of the measures consists of dyspnea severity, airway obstruction level, depression and anxiety symptoms, exercise performance and quality of life is a part of the whole and associated with each other. When evaluating a patient one or more of these components should not be focused on, all components should be viewed as a whole.Key Words: COPD, Anxiety and depression, Dyspnea, Exercise Capacity, Quality of Life.