[The influence of anxiety and depression on COPD exacerbations].

INTRODUCTION

Exacerbations are common during the course of chronic obstructive pulmonary disease (COPD) and contribute to its morbidity and mortality. COPD is also associated with high prevalence of anxiety and depression.

OBJECTIVES

A systematic literature review of data on the association between anxiety and/or depression and COPD exacerbations.

DOCUMENTARY SOURCES

Medline search, for the 1980-2017 period, with the following keywords: "chronic obstructive pulmonary disease" or "COPD" and "exacerbation" and "anxiety" or "depression"; limits: "title/abstract"; the selected languages were English or French.

RESULTS

Among 152 articles, 77 abstracts have been preselected for a dual reading and 30 studies have been finally selected. The prevalence of anxiety and depression ranged from 6.7 to 58% and 5.5 to 51.5%, respectively. Among the 30 studies included in this review, 19 (63.3%) revealed positive associations between anxiety and/or depression and increased risk for exacerbations, although 11 (36.7%) failed to support such an association. The association between anxiety and/or depression and an increased risk of COPD exacerbations was more frequently observed in studies using an event-based definition (85.7%) than in those using a symptom-based definition (14.3%). The main limitation of this review is the high heterogeneity of the studies included. Another limitation is the low rate of women included in this review (32.6%).

CONCLUSION

Anxiety and/or depression are associated with a greater risk for exacerbations to occur in COPD. However, a high heterogeneity across the published studies makes it difficult to draw any firm conclusions on the amplitude of this increased risk.