As a person with asthma, not being able to breathe is terrifying. Watching someone not being able to breathe, as I witnessed when a family member was dying from chronic obstructive pulmonary disease (COPD), is equally terrifying.
In this post, I will focus on people who have COPD and asthma. A future post will focus on these issues in caregivers of those with COPD and anxiety.
COPD is a progressive lung disease involving, in part, thickened and inflamed airways. A majority of COPD cases are attributed to smoking, with other causes being air pollution and genetics. Symptoms include shortness of breath, wheezing, chronic coughing, and fatigue. It is most common in people over the age of 60. As of 2015, COPD affected 175.4 million people in the world (Vos, et al. 2016).
Asthma is a long-term inflammatory lung disease which involves bronchospasm (a tightening of the muscles that line the lung's airways). Symptoms include shortness of breath, coughing, wheezing, and tightness in the chest. The causes of asthma are genetic and environmental. There have been many genes associated with asthma; it is an inherited disease. Environmental triggers increasing the incidence of asthma include cold weather, exercise, smoke, animal dander, and pollen. Poverty and obesity are also risk factors for asthma (Barros et al. 2017; Akinbami et al. 2015). Asthma affects over 300 million people worldwide (Pawankar 2014).
In a study by Bratek, et al. (2015), depression was found in 33 percent of COPD patients and 29 percent of asthma patients, as opposed to just .05 percent of controls. In the same study, anxiety was found in 42 percent of COPD patients and 41 percent of asthma patients, compared to 17 percent of controls.
In a study of patients with COPD, 33.3 percent met diagnostic criteria for PTSD, and moderate to severe depression in 48.5 percent, and moderate to severe anxiety in 69.7 percent (Yohannes & Hanania, 2017).
Trauma can increase respiratory difficulties with asthma. In Damascus, Syria, 70 percent of children in a shelter reported a worsening of symptoms, and 94.4 percent reported a decrease in their health-related quality of life (Mohammad, et al. 2017). A higher percentage of children with asthma also met criteria for PTSD compared to non-asthmatic children (Mohammad, et al. 2017).
What is the solution? First, anxiety, depression, and COPD need to be accepted widely as common concurrences with respiratory diseases such as COPD and asthma. Next, respiratory disease patients should be screened for anxiety, depression, PTSD, and other disorders as soon as possible. Then appropriate treatment, whether individual or group therapy should be provided.
With treatment of co-occurring anxiety, depression, and PTSD, stress-related exacerbations of lung disease symptoms may improve. This leads to an improved quality of life for patients.
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Akinbami, L. J., Simon, A. E., & Rossen, L. M. (2015). Changing trends in asthma prevalence among children. Pediatrics, peds-2015.
Barros, R., Moreira, P., Padrão, P., Teixeira, V. H., Carvalho, P., Delgado, L., & Moreira, A. (2017). Obesity increases the prevalence and the incidence of asthma and worsens asthma severity. Clinical Nutrition, 36(4), 1068-1074.
Bratek, A., Zawada, K., Beil-Gawełczyk, J., Beil, S., Sozańska, E., Krysta, K., ... & Pierzchała, W. (2015). Depressiveness, symptoms of anxiety and cognitive dysfunctions in patients with asthma and chronic obstructive pulmonary disease (COPD): possible associations with inflammation markers: a pilot study. Journal of neural transmission, 122(1), 83-91.
Mohammad, Y., Rafea, S., Latifeh, Y., Khaddam, A., Sawaf, B., Zakaria, M. I., ... & El-Tarcheh, H. (2017). Uncontrolled and under-diagnosed asthma in a Damascus shelter during the Syrian crisis. Journal of Thoracic Disease, 3(2).
Pawankar, R. (2014). Allergic diseases and asthma: a global public health concern and a call to action. World Allergy Organization Journal, 7(1), 12.
Vos, T., Allen, C., Arora, M., Barber, R. M., Bhutta, Z. A., Brown, A., ... & Coggeshall, M. (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1545.
Yohannes, A. M., & Hanania, N. A. (2017). Depression and Anxiety in Adult Patients with Asthma. In Depression and Anxiety in Patients with Chronic Respiratory Diseases (pp. 73-84). Springer New York.