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Am Fam Physician. 2003;67(6):1378-1379

A common reason for medical emergency treatment is the acute exacerbation of obstructive pulmonary disease. Relapses in acute asthma and decompensated chronic obstructive pulmonary disease (COPD) are often the cause of these return visits to the emergency department and do not correlate with the severity of the patient’s disease. One study found that psychosocial factors, such as being widowed or divorced, were closely related to relapses in male patients with COPD. Dahlén and Janson conducted a study to determine if psychologic factors predicted outcome after emergency treatment of patients with acute exacerbations of obstructive pulmonary disease.

The study population consisted of patients 18 years of age or older with an acute exacerbation of obstructive pulmonary disease, asthma, or COPD, who presented to an emergency department at a university hospital. Patients were excluded from the study if they were immediately admitted to the hospital or if they were unable to perform pulmonary function tests. Patients underwent spirometry, blood sampling, and pulse oximetry. In addition, breathing rate, pulse rate, and dyspnea score were measured before and during emergency treatment. All participants received basic emergency treatment for the exacerbation of obstructive pulmonary disease. The psychologic status of each patient was assessed at follow-up four weeks after the initial emergency treatment. The hospital anxiety and depression (HAD) questionnaire was used. At the follow-up visit, researchers also reviewed hospital records to identify any relapses that required treatment of obstructive pulmonary disease.

The study evaluated 43 patients (mean age: 65.3 years), and approximately 40 percent (17 patients) of these patients were identified by the HAD questionnaire as having anxiety and/or depression. Patients who were found to have anxiety or depression were significantly more likely to be admitted to the hospital or to have a relapse within one month of the initial emergency department visit. Patients who had a relapse within one month had significantly higher scores on the HAD scale than those who did not have a relapse. When adjustments were made for variables such as age, gender, atopic status, treatment, and pack-years, the association between treatment failure and anxiety and/or depression remained significant.

The authors conclude that anxiety and depression are related to the outcome of emergency treatment in patients with acute exacerbations of obstructive pulmonary disease. The authors add that additional research should be conducted to determine if the treatment of anxiety and depression in these patients can reduce the number of relapses of acute exacerbations of their obstructive pulmonary disease.

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