Former Smokers

The new information that stresses the need for increased mental health care for current and former smokers, especially those who suffer from chronic obstructive pulmonary disease. In the group of more than 5,000 smokers with and without COPD from the multisite, longitudinal genetic epidemiology of COPD Gene study.
Of those with elevate symptoms, two-thirds were not receiving any type of medication to treat these symptoms such as an anti-anxiety or anti depressant medication. There are many non-pharmacological treatment options, too; but medications are cornerstone therapy for clinically elevate symptoms. Iyer add that these symptoms were not only a problem for smokers with end-stage COPD.

The depressive symptoms

While depressive symptoms were most frequent in those with the most severe cases of COPD, anxiety symptoms were similar in frequency between smokers with and without COPD, so the problem seems to start a lot earlier in the disease,” Iyer said. They also identify several characteristics that were associate with having unmedicated symptoms namely African American race, male gender and lack of health insurance.

According to Iyer, who is also part of the UAB Lung Health Center, untreat emotional symptoms leave a major gap in COPD care that warrants early palliative care or primary palliative care. He says emotional symptoms have been shown to impact many COPD-relate outcomes.

They have previously found that depression predicts hospital readmissions in COPD, and others have found associations with exacerbations and poor adherence to medications,” Iyer said. “Clinically, they treat many COPD patients and smokers who have borderline COPD and also have clinically important emotional symptoms that would warrant treatment.”

The primary care clinicians

Iyer add that pulmonary and primary care clinicians do not assess these symptoms often enough; which leaves many patients potentially not being treat for elevate emotional symptoms; so a major gap in comprehensive COPD care; also it is not clear who is in charge of managing those symptoms primary care or pulmonologists.

Since the elevate emotional symptoms they discover were also present in smokers who had milder COPD; hence earlier assessment and triage in the primary care setting is need; so potentially even early palliative care, they said. So, does smoking cause anxiety or depression? Iyer says that relationship can be tricky, but seems to be bidirectional.

There are similar receptors in the brain functioning in smokers addict; so to cigarettes and who have anxiety and depression, Iyer said. In fact, most of the smoking cessation medications; frequently use to help patients quit are antidepressants too. Imagine someone who is anxious and self-medicating that anxiety with cigarettes; which they obviously don’t want,” they said.
There are many phenotypes in COPD, such as someone with chronic cough or emphysema or high eosinophil count; also all of these warrant unique patient center approaches. Our research adds to the growing literature on a possible unique COPD psychiatric phenotype; who is at high risk for exacerbations and poor quality of life.