Non-respiratory symptom dominance linked with depression in patients with COPD

In a new study, a non-respiratory symptom-dominant elevation in the COPD assessment test total score was associated with depression in adults with COPD, researchers reported in Respiratory Medicine.

The researchers aimed to evaluate characteristics of the COPD assessment test to determine whether non-respiratory symptom-dominant status is linked with depression status in patients with COPD. They noted that “there is no established method to distinguish patients whose [COPD assessment test] scores are high because of their depressive symptoms from patients whose [COPD assessment test] scores are high because they have severe respiratory symptoms caused by COPD.

The researchers analyzed data from 226 patients in the KYOTO cohort (mean age, 71.6 years; 93.8% men) in Japan and 924 patients in the Korea COPD Subgroup Study (KOCOSS) cohort (mean age, 69.2 years; 98.1% men).

Nearly one-quarter (23.5%) of patients in the KYOTO cohort and 11.2% in the KOCOSS cohort had a depression diagnosis (Patient Health Questionnaire-9 score 5 or Beck Depression Inventory-II score 17, respectively).

Non-respiratory symptom dominance was observed among 24.3% of patients in the KYOTO cohort and 26.9% of patients in the KOCOSS cohort. Patients in both cohorts had a significantly higher prevalence of depression compared with patients with respiratory symptom dominance, according to the researchers.

Researchers reported that both the COPD assessment test score and non-respiratory symptom dominance were significantly associated with depression in both cohorts. In addition, symptomatic patients with a COPD assessment test score of 10 or more also experienced preserved and significant associations, the researchers wrote.

“Patients with COPD and depression had a higher sum score for the last 4 items (Q5-Q8; Q5678, non-respiratory symptoms) than they did for the first four items (Q1-Q4; Q1234, respiratory symptoms). This ‘non-respiratory symptom-dominant’ status, Q1234 Q5678, could be a significant suspicious feature for depression in patients with COPD,” Yoko Hamakawa, MD, from the department of respiratory medicine at the Graduate School of Medicine at Kyoto University, Japan, and colleagues wrote.

The researchers noted that screening tools that are easy to administer are “essential for detecting depression” in this patient population.

“Depression negatively affects the course of COPD, and regular treatment for COPD using bronchodilators and/or inhaled corticosteroids cannot always relieve depressive symptoms,” Hamakawa and colleagues wrote. “Therefore, determining and providing adequate treatment is vital. Treatment for depression is important for mental health but is a ‘treatable trait’ for patients with COPD.”