Montreal Behavioural Medicine Centre, Research Centre, Division of Chest Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.
Ther Adv Respir Dis. 2011 Feb;5(1):3-18. doi: 10.1177/1753465810382818. Epub 2010 Nov 8.
exacerbations are common in chronic obstructive pulmonary disease (COPD) and contribute significantly to COPD morbidity and mortality. COPD is also associated with high levels of psychological distress, which has been shown to be associated with higher exacerbation rates. However, the existing literature on the association between psychological distress and exacerbation risk remains largely misunderstood.
to critically review the current literature on the association between psychological distress (defined as anxiety and depressive symptoms or anxiety and depressive disorders) and COPD exacerbations in COPD patients, to highlight the limitations of the existing literature, and to provide recommendations for future research.
a critical review of English-language peer-reviewed longitudinal and retrospective studies was conducted. The Ovid portal to Medline, EMBASE, and PsycINFO databases were accessed.
some acceptable evidence suggested that psychological distress confers greater risk for exacerbations, more specifically symptom-based exacerbations or those treated in the patient's own environment. However, most studies showed an absence of a positive association, especially with exacerbations leading to hospitalization.
methodological weaknesses and the use of a wide range of psychological tools mean that there is an inconsistent association between psychological distress and exacerbations in the current literature. However, psychological distress may confer greater risk for symptom-based rather than event-based defined exacerbations. Further studies are needed to more comprehensively assess the question, particularly in light of the high levels of both anxiety and depression in COPD patients.
在慢性阻塞性肺疾病（COPD）中，恶化是常见的，并且对 COPD 的发病率和死亡率有重大影响。COPD 还与高水平的心理困扰相关，而心理困扰已被证明与更高的恶化率有关。然而，关于心理困扰与恶化风险之间关联的现有文献在很大程度上仍被误解。
批判性地回顾当前关于心理困扰（定义为焦虑和抑郁症状或焦虑和抑郁障碍）与 COPD 患者 COPD 恶化之间关联的文献，强调现有文献的局限性，并为未来的研究提供建议。
对英语同行评审的纵向和回顾性研究进行了批判性审查。访问了 Ovid 门户到 Medline、EMBASE 和 PsycINFO 数据库。
一些可接受的证据表明，心理困扰使恶化的风险更大，更具体地说是基于症状的恶化或在患者自己的环境中治疗的恶化。然而，大多数研究表明没有积极的关联，尤其是与导致住院的恶化。
方法上的弱点和广泛使用各种心理工具意味着，在当前文献中，心理困扰与恶化之间的关联不一致。然而，心理困扰可能使基于症状的恶化而不是基于事件的恶化的风险更大。需要进一步的研究来更全面地评估这个问题，特别是考虑到 COPD 患者中焦虑和抑郁的高发生率。
