Links Between COPD and Anxiety

Studies show that 13-45% of COPDers also experience anxiety. In fact, COPDers are 85% more likely to be diagnosed with anxiety compared with the general population. Despite this, less than a third of COPDers experiencing anxiety are properly diagnosed and treated for that anxiety. That said, here’s what to know about links between COPD and anxiety.^1-2

What is anxiety?

Anxiety is best defined by Merriam-Webster as “An abnormal and overwhelming sense of apprehension and fear often marked by physical signs (such as tension, sweating, and increased pulse rate), by doubt concerning the reality and nature of the threat, and by self-doubt about one's capacity to cope with it.”³

It’s apprehension. It’s constantly worrying about what might happen in the future, or what might not happen. For instance, it’s worrying that you might become short of breath or that you will get worse. It can even be feeling regret about something you did in the past, such as smoking cigarettes.

While it may be common, it is not normal to constantly worry in this way. However, anxiety is a real medical condition with real treatments. Getting proper treatment begins with a proper diagnosis.

Why is a proper diagnosis important?

People with COPD who also have anxiety (compared to those who have COPD and do not have anxiety) are less likely to be compliant with their treatment programs. They are less likely to stay physically active and, therefore, have less tolerance for exercise. They also have an increased risk for flare-ups and increased doctor and emergency room visits for COPD. ^1-2

Furthermore, untreated anxiety can lead to a lowered self-esteem and even depression. The combination of these may lead to a reduced overall quality of life.¹

Why is anxiety often undiagnosed?

There are various theories explaining this. One is that the link between anxiety and COPD is a relatively new concept, and so this may explain why it’s so often overlooked by physicians. Another theory might be reluctance on the part of people to share with their doctors how they are feeling. And I think this is normal. I think the solution to both these theories is proper education of both physicians and patients alike.

Researchers also think that anxiety may often go overlooked because its symptoms are similar to COPD symptoms. ^1-2 For example, the Mayo Clinic lists feeling nervous, sweating, trembling, trouble sleeping, feeling tired, constant worrying, and stomach problems as symptoms of anxiety. ⁵ These are symptoms that are also often associated with COPD.

What causes COPD related anxiety?

One modern theory is that it might be due to the same chemicals (chemokines, cytokines) that cause airway inflammation in COPD. The theory holds that these inflammatory chemicals may get into your systemic bloodstream and make their way to your brain cells and cause changes resulting in anxiety.¹ If this theory holds true, a medicine to block the effects of these chemicals may prove helpful for both COPD and anxiety.

Another theory is that the chemicals in cigarette smoke, such as nicotine, may contribute to anxiety. Yet another theory is that COPD causes people to become less able to do things, such as exercise and stay physically and socially active. These may contribute to anxiety.¹

All of these theories highlight the need for further studies.

What is the proper treatment for anxiety?

At this point in time, researchers are not sure what the best treatment is for anxiety in those diagnosed with COPD. Medicine, such as anti-anxiety medicine, remains an option worth trying. Another option that might help is psychological therapy, such as seeing a counselor. Pulmonary rehabilitation may help teach strategies for staying physically and socially active, thereby helping to reduce both COPD and anxiety symptoms. There may also be other options your doctor might talk to you about once the discussion begins. ¹

How should we move forward?

The more researchers learn about COPD-related anxiety the better capable physicians will be at helping their patients living with COPD. For instance, as researchers learn more, it’s highly likely that anxiety will be better addressed in future COPD guidelines. This might entail strategies for screening for, diagnosing and treating anxiety. And, of course, as doctors learn more, patients will learn more as well.

In the meantime, keep in mind that the medical community at large is becoming increasingly aware of the links between COPD and anxiety. For those who have both, a proper diagnosis and treatment may go a long way to helping you live better with COPD.