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In 2015, Phyliss DiLorenzo prepared for worse news after spending several days in the hospital due to severe breathing problems. She suspected it was lung cancer because the disease ran in her family and was relieved when her doctor told her she had chronic obstructive pulmonary disease (COPD).
Then DiLorenzo thought about her grandmother, who was diagnosed with emphysema, COPD, years ago, and how the disease changed her.
“I watched my grandmother transform from a very active and spontaneous woman to a person who never left her house,” DiLorenzo said. “He even stopped walking his dog.”
It wasn’t until she received her diagnosis that DiLorenzo realized the connections between anxiety, depression, other mental health issues and her life with COPD. His shortness of breath increased his anxiety and he became depressed when fatigue prevented him from carrying out his daily work tasks. His health care team at the time could address his physical needs, DiLorenzo said, but they didn’t know what to do when he mentioned his depression.
The “vicious circle” of mental health
DiLorenzo is one of nearly 16 million Americans living with COPD, with estimates that another 15 million simply remain undiagnosed. COPD, a group of chronic diseases that restrict airflow to the lungs and make breathing difficult, is one of the top 10 causes of death in the United States. Emphysema and chronic bronchitis are among the diseases classified as COPD. Risk factors include, but are not limited to, long-term exposure to smoke, gases, dust and chemicals. Cigarette smoking is the most common risk factor for this disease.
After a COPD diagnosis, treatment options focus on making it easier for patients to breathe and preventing further lung damage. However, ignoring potential mental health problems may worsen overall clinical outcomes. It is estimated that up to 55% of COPD patients live with anxiety, and other studies estimate that COPD patients are more than twice as likely to suffer from depression as the general population. Research also suggests that between 26 and 43% of COPD patients experience anxiety and depression, leading to more severe physical and mental health symptoms.
“Physicians should understand the mental health concerns of their COPD patients,” said David Mannino, MD, medical director and co-founder of the COPD Foundation. “It can be difficult to figure out how much of what is happening to a patient is due to worsening COPD or related psychological problems.”
Anxiety, depression and other psychological problems in patients with COPD have several causes. There may be anger and frustration over the diagnosis, or sadness at no longer being able to breathe freely, move without fatigue, and do activities that once were fun. This causes some patients to become socially isolated. Patients may also suffer from sleep disorders and chronic stress due to their breathing problems. These feelings are not experienced exclusively by patients. Your caregivers may suffer stress, burnout, and other mental health issues as they try to help their loved ones.
Read: Caring for someone with COPD >>
In some cases, patients may experience anxiety or depression related to the external stigma of COPD. Because there is a significant association with smoking in COPD, some studies suggest that patients may blame themselves for causing the disease.
Mannino said the physical symptoms of COPD lead to mental health problems, and those problems can, in turn, lead to worsening of your physical health. COPD patients with mental health disorders may experience more severe attacks and higher hospitalization and mortality rates than COPD patients without mental health problems.
“Since one of the main symptoms of COPD is not being able to breathe, this could cause anxiety in people,” Mannino said. “Medications used to treat COPD increase the heart rate, which can also feel like a panic attack. COPD can reduce a person’s physical activity, which can lead to social isolation and depression. As COPD worsens, symptoms become more severe and physical activity tends to become more limited.”
In any disease, chronic stress weakens the immune system, which increases the susceptibility of COPD patients to respiratory infections and crises. Because depression reduces motivation and energy, patients may also have difficulty eating properly, exercising, adhering to their treatment plan, and getting enough rest. Anxiety related to breathing problems could prevent a patient from being physically active, which is crucial for conditioning the heart and lungs to better process oxygen.
“[Reducir la actividad física] “This is the worst thing patients can do,” he said. “We emphasize physical activity as a way to break this vicious cycle.”
DiLorenzo understands how shame and stigma can prevent patients from receiving the care they need. His grandmother, who had emphysema, never smoked, but his mother, who smoked, developed lung cancer.
“I believe my mother blamed herself and refused treatment out of shame and guilt,” DiLorenzo said. “I don’t want to have that attitude.”
Read: Stigma can be a barrier to COPD care >>
Treating all aspects of COPD
DiLorenzo, 68, has lived with COPD for more than a decade. She has had recent hospitalizations that increased her anxiety and depression as she now has greater difficulty doing housework, carrying groceries, or walking long distances. She said she is now slower, has more physical limitations and needs more breaks between tasks.
Still, he says he makes time for things he knows will improve his mental health, like meditation, exercise, outdoor activities, reading and listening to music. She was also committed to raising awareness of COPD and advocating for the rights of all patients with lung disease by serving on COPD Foundation committees and taking on leadership roles.
“Practicing meaningful activities that keep my mind active is key,” she said.
To maintain their physical and mental health, Mannino recommends patients talk to their doctors about their current COPD therapy to ensure it continues to work well for them, and to continue to seek therapeutic options as more new therapies become available. He said patients should continue to focus on areas they can control, such as diet, exercise, vaccinations and environmental avoidance, while continuing with their treatment plans.
“One of the best treatments is pulmonary rehabilitation, which emphasizes not only increasing physical activity but also creating a social network with other patients who also have breathing difficulties and may be socially isolated,” Mannino said.
Support networks play an important role in promoting mental health. In-person and virtual COPD support communities provide patients with connections to share their stories and receive accurate information, advice and support. DiLorenzo credits the care of his partner and family, as well as his current doctor.
“If a COPD patient is experiencing anxiety or depression, I recommend they talk to their doctor about it,” he said. “You should know that you are not alone.”
This educational resource was created with support from Sanofi and Regeneron.
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