Pulmonary rehabilitation helps improve functional abilities for individuals with chronic obstructive pulmonary disease (COPD). But if someone is depressed, they often have trouble sticking to the rehab program.
Researchers from The Miriam Hospital, a teaching affiliate of Brown University’s Alpert Medical School, found that depression may significantly blunt rehabilitation programs — especially among women. This has led experts to recommend that screening and treatment for depression should be incorporated into the rehabilitation regimen.
The study and its findings are published in the journal Respiratory Medicine.
COPD is a common and often disabling inflammatory lung disease characterized by a progressive airway obstruction that is not fully reversible.
It is often a result of long-time cigarette smoking. Asthma, and long-term exposure to other lung irritants such as air pollution or chemical fumes may also contribute to the illness.
An important component of non-medication treatment for COPD is multidisciplinary pulmonary rehabilitation (PR), which improves exercise tolerance, shortness of breath, depression and anxiety, and quality of life.
However, as many as 30 percent of patients who begin PR programs drop out prematurely, and depressed mood has been associated with PR non-completion.
“Given its prevalence and disease burden, there has been relatively little research on COPD,” said lead researcher Andrew Busch, Ph.D.
In the new study, Busch and colleagues sought to uncover how depression interacts with medical care of those with COPD.
“Depression interferes with COPD treatment, so it may be particularly important for those with COPD and depression to receive adequate depression treatment,” Busch said.
“Depression is more common in women than men with COPD, and historically, women with COPD have been understudied.”
Busch led a study of 111 COPD patients who enrolled in the outpatient pulmonary rehabilitation program.
Those who attended 20 or more sessions were designated “completers.” Depression was measured using a standard self-report scale. The researchers analyzed whether depressed mood predicted completion of PR.
The analysis found 68 percent of patients completed PR. Across the whole group, lower depressed mood independently predicted finishing PR.
However, when men and women were looked at separately, lower depressed mood was an independent predictor of PR completion for women, but not for men.
“Depression predicts earlier mortality in those with COPD,” Busch said. “Our results suggest that non-completion of pulmonary rehabilitation may be one variable that explains this relationship, and we plan to use these results to help design and implement treatment for depression among those with COPD.”