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Chronic Obstructive Pulmonary Disease Patients With Psychiatric Disorders Are at Greater Risk of Exacerbations

From the Department of Psychology (C.L., K.L.L., G.D.), University of Québec at Montreal (UQAM); Montreal Behavioral Medicine Center, Division of Chest Medicine (C.L., K.L.L., S.L.B., M.L., A.C.), Hôpital du Sacré-Coeur de Montréal - a University of Montreal-affiliated hospital; Research Center, Montreal Heart Institute (C.L., K.L.L., G.D., S.L.B.) - a University of Montreal-affiliated hospital; Department of Exercise Science (C.L., S.L.B.), Concordia University.

Address correspondence and reprint requests to Kim L. Lavoie, Montreal Behavioral Medicine Center, Division of Chest Medicine, Hôpital du Sacré-Coeur de Montréal, 5400 boul. Gouin West, Montreal, Quebec, H4J 1C5, Canada. E-mail: k-lavoie{at}crhsc.rtss.qc.ca

Objective: To assess prospectively the impact of psychiatric disorders on risk for exacerbations. The course of chronic obstructive pulmonary disease (COPD) is punctuated by acute exacerbations. Although anxiety and mood disorders are common in patients with COPD, no studies have assessed prospectively the association between these disorders and exacerbations.

Methods: Psychiatric disorders were evaluated by a structured psychiatric interview in 110 patients (51% women, age (mean ± standard deviation) = 66 ± 8 years) with stable COPD and previous admission for exacerbations recruited from two outpatient clinics. Patients were followed for a mean of 2 years and both inpatient-treated (i.e., treated in the emergency department or hospital) and outpatient-treated (i.e., treated with medication in the patient’s own environment) exacerbations were recorded.

Results: Independent of covariates, patients with psychiatric disorders exhibited a significantly higher weighted annual rate of exacerbations treated in an outpatient setting after adjustment for covariates (3 versus 2, p = .003) than patients without psychiatric disorders, but no difference in exacerbations treated in the inpatient setting. They were also at a higher risk for any (relative risk (RR) = 1.56, 95% Confidence Interval (CI) = 1.02–2.37) and outpatient (RR = 1.68, 95% CI = 1.08–2.59) exacerbations, but not inpatient exacerbations (RR = 1.36, 95% CI = 0.82–2.25).

Conclusions: Patients with psychiatric disorders are at greater risk of exacerbations treated in an outpatient setting but not those treated in an inpatient setting. These outpatient-managed exacerbations account for a significant proportion of the healthcare burden for COPD, so interventions should target patients with psychiatric disorders to improve management of COPD.

Key Words: anxiety • COPD • depression • exacerbations • psychiatric disorders

Abbreviations: ADIS-IV = Anxiety Disorders Interview Schedule for DSM-IV; AECOPD = acute exacerbation of COPD; BMI = body mass index; CI = Confidence Interval; COPD = chronic obstructive pulmonary disease; DSM-IV = Diagnostic and Statistical Manual for Mental Disorders, 4th Edition; FEV₁ = forced expiratory volume in 1 second; MRC = Medical Research Council; PAR = population attributable risk; RR = relative risk.