' s response to reviews Title : Disease knowledge level is a noteworthy determinant of anxiety and depression in patients with Chronic Obstructive Pulmonary Disease : a cross-sectional studies

1. General comment: The central premise of the study/article is identification of determinants of anxiety and depression in patients with COPD, and this term is used throughout the manuscript. However, “determinant” implies a causal relationship, and this is a cross-sectional study. This may be an artifact of language, but the most this study can do is identify factors associated with anxiety and depression in these patients. This confusion and mis-use of the word “determinant” exists throughout the manuscript (including Background) and should be clarified.