Depression in COPD: Treatments Reduce Visits to Emergency Department
Background: Depression is common in any chronic illness, including COPD. For example, in a three year study of 1,589 individuals with COPD about 1 in 4 individuals with COPD had persistent symptoms of depression over a three year period (CHEST 2016; volume 149: pages 916-926). Those with persistent or new-onset depression experienced more flare-ups (exacerbations) and a reduced walking distance.
Study: Dr. Albrecht and colleagues from the University of Maryland School of Medicine reported on adherence to medications prescribed to treat both COPD and depression in the same individuals. Adherence refers to whether you are taking the medications on schedule as prescribed by your health care professional.
The authors examined a random sample of those receiving Medicare who had two or more prescriptions filled for both COPD maintenance medications and anti-depressants. These individuals were followed for 12 months.
The study was published on-line in the journal Respiratory Medicine.
Results: Of the 16,075 individuals receiving Medicare, only 21% took their medications at least 80% of the time for COPD, and only 55% took their anti-depressants at least 80% of the time. Compared to no use of medication and controlling for adherence to anti-depressants, higher levels of taking COPD medications were associated with a decreased risk of going to the Emergency Department (ED) and hospitalization. Also, higher levels of taking anti-depression medications led to fewer visits to the ED and hospitalizations compared to no use.
Conclusions: Depression in COPD is common. Taking prescribed daily medications for both conditions – COPD and depression – can reduce the need for emergency visits and hospitalizations.
My Comments: There are many different reasons why someone does not take medications as prescribed even to help relieve symptoms (COPD → difficulty breathing; depression → feeling bad).
Some of the common reasons shared by patients in my practice for not taking medications are: cost (“It is very expensive”), lack of efficacy (“It doesn’t seem to work”), “I forget to take it,” and concern of side effects (“The TV add says that it may cause death”).
However, I often explain why I prescribe a particular medication, and review how to use a specific inhaler correctly. I ask the person to try the inhaler for 2-3 weeks (I usually give a sample), and that I will prescribe a different inhaler if it does not help with shortness of breath and/or reduce flare-ups (exacerbations).