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Original Research: PULMONARY REHABILITATION |

The Impact of Anxiety and Depression on Outcomes of Pulmonary Rehabilitation in Patients With COPDAnxiety/Depression and Pulmonary Rehabilitation

Andreas von Leupoldt, PhD; Karin Taube, MD; Kirsten Lehmann; Anja Fritzsche, PhD; Helgo Magnussen, MD
Author and Funding Information

From the Department of Psychology (Drs von Leupoldt and Fritzsche), University of Hamburg; the Department of Systems Neuroscience (Dr von Leupoldt), University Medical Center Hamburg-Eppendorf; and Atem-Reha GmbH (Dr Taube and Ms Lehmann), Hamburg; and the Pulmonary Research Institute at Hospital Grosshansdorf (Dr Magnussen), Grosshansdorf, Germany.

Correspondence to: Andreas von Leupoldt, PhD, Department of Psychology, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany; e-mail: andreas.vonleupoldt@uni-hamburg.de


Funding/Support: This study was supported by a stipend [Heisenberg-Stipendium, LE 1843/9-1] from the German Research Society (Deutsche Forschungsgemeinschaft) (to A. v. L.).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(3):730-736. doi:10.1378/chest.10-2917
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Background:  Anxiety and depression are prevalent comorbidities in COPD and are related to a worse course of disease. The present study examined the impact of anxiety and depression on functional performance, dyspnea, and quality of life (QoL) in patients with COPD at the start and end of an outpatient pulmonary rehabilitation (PR) program.

Methods:  Before and after PR, 238 patients with COPD (mean FEV1 % predicted = 54, mean age = 62 years) underwent a 6-min walking test (6MWT). In addition, anxiety, depression, QoL, and dyspnea at rest, after the 6MWT, and during activities were measured.

Results:  Except for dyspnea at rest, improvements were observed in all outcome measures after PR. Multiple regression analyses showed that before and after PR, anxiety and depression were significantly associated with greater dyspnea after the 6MWT and during activities and with reduced QoL, even after controlling for the effects of age, sex, lung function, and smoking status. Moreover, before and after PR, anxiety was related to greater dyspnea at rest, whereas depression was significantly associated with reduced functional performance in the 6MWT.

Conclusions:  This study demonstrates that anxiety and depression are significantly associated with increased dyspnea and reduced functional performance and QoL in patients with COPD. These negative associations remain stable over the course of PR, even when improvements in these outcomes are achieved during PR. The results underline the clinical importance of detecting and treating anxiety and depression in patients with COPD.


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