ANXIETY AND LOW SOCIAL SUPPORT ARE RISK FACTORS OF DEVELOPING SEVERE ACUTE EXACERBATIONS IN PATIENTS WITH COPD

TOPIC: Obstructive Lung Diseases TYPE: Original Investigations PURPOSE: Psychological symptoms of anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD). Lack of social support may be an additive burden to these elevated psychological symptoms. We examined the effect of anxiety, depression, and social support on risk of severe acute exacerbations in patients with COPD. METHODS: We analyzed baseline data from Veteran patients with COPD who participated in a 1-year observational study. Patients were aged 40 ≥ years with post-bronchodilation forced FEV1/FVC (forced expiratory volume in one second over forced vital capacity) less than 0.7 who had experienced acute exacerbation in the preceding year. Depressive and anxiety symptoms were measured using Hospital Anxiety Depression Scale (HAD). Dyspnea was assessed by modified Medical Research Council scale and social support by the Medical Outcome Study Social Support Scale. Participants completed phone assessments every 2-weeks reporting exacerbations. We used negative binomial regression to model the risk of severe acute exacerbations which we defined as COPD hospitalizations. RESULTS: 410 COPD patients had mean age 69.6 years, FEV1= 44.9% predicted, 96% male. The prevalence of anxiety symptoms (HAD-anxiety ≥8) was 32%, and depressive symptoms (HAD-depression ≥8) was 27%. 67(16%) participants experienced ≥ 1 COPD hospitalization. After adjusting for age, sex, COPD severity and comorbidity, in a model with both anxiety and depression, only baseline anxiety was related with increased risk of COPD hospitalization (Table 1). In adjusted models examining social support, living alone and lower emotional support were related with the risk of severe acute exacerbations in patients with COPD. CONCLUSIONS: 1. Approximately one third of COPD patients in this predominately male sample had clinically significant anxiety or depressive symptoms. 2. Patients with elevated anxiety and low emotional support each independently are twice as likely to be at the risk of developing COPD hospitalization. 3. Living alone was associated with 70% increase in rate of COPD exacerbations compared to those living with others. CLINICAL IMPLICATIONS: COPD patients with elevated anxiety symptoms, those with a lower emotional support and living alone may require closer medical follow-up and monitoring, with an appropriate treatment plan to reduce the risk of acute exacerbations. DISCLOSURES: No relevant relationships by Catherine Battaglia, source=Web Response No relevant relationships by Jeffrey Edelman, source=Web Response No relevant relationships by Vincent Fan, source=Web Response No relevant relationships by John Fortney, source=Web Response No relevant relationships by Paul Hebert, source=Web Response No relevant relationships by Emily Locke, source=Web Response No relevant relationships by Tracy Simpson, source=Web Response No relevant relationships by Erik Swenson, source=Web Response No relevant relationships by Ranak Trivedi, source=Web Response No relevant relationships by Abebaw Yohannes, source=Web Response