Negative mood worsens dyspnoea in COPD

A negative affective state can aggravate dyspnoea in patients with chronic obstructive pulmonary disease (COPD), a study has shown. This suggests that reducing the likelihood of negative mood or improving the mood can help in managing morbidities associated with dyspnoea in COPD.

“Dyspnoea is a debilitating symptom in individuals with COPD and a range of other chronic cardiopulmonary diseases and is often associated with anxiety and depression,” the authors said.

In this study, 20 adults with mild to severe COPD (aged 57‒79 years) attended three experimental sessions on separate days following familiarization. Two 5-min treadmill exercise tests, separated by a 30-min interval on each day, were conducted.

During each exercise test, a set of positive, negative, or neutral images obtained from the International Affective Picture System (IAPS) were shown to the participants, who then rated dyspnoea or leg fatigue from 0 to 10. The authors measured heart rate (HR) and peripheral oxygen saturation (SpO₂) at 1-min intervals and obtained mood valence ratings using Self-Assessment Manikin (SAM) scale (1‒9).

Participants registered significantly higher mood valence ratings when viewing positive (end-exercise mean 7.6) versus negative IAPS images (mean 2.4; p<0.001). On the other hand, dyspnoea intensity (mean 5.8) and dyspnoea unpleasantness (mean 5.6) were significantly higher when viewing negative images compared to positive images (4.2 vs 3.4; p=0.004 vs p=0.003). [Respirology 2024;29:201-208]

Seventeen participants (85 percent) met the minimal clinically important difference (MCID) criteria for both dyspnoea intensity and unpleasantness. No significant differences were seen in HR, SpO₂, and leg fatigue between conditions.

“[T]he findings from this study indicate that standardized mood-modulating IAPS stimuli are effective in altering the perception of concurrent exertional dyspnoea through a change in affective states,” the authors said.

“The fact that, as with our previous studies, leg fatigue was not affected by different affective states suggests that these primary exercise-limiting symptoms result from different patterns of neural processing,” they added.

Mental health

Apart from COPD, chronic dyspnoea is also associated with anxiety and depression. [Chest 2008;134:43S-56S; ASCO Annual Meeting Proceedings 2014;220; Psychosomatics 2006;47:430-434]

“There is substantial evidence that the prevalence of anxiety and depression is higher in individuals with COPD compared to the general population,” the authors said.

“Moreover, a significant positive correlation between depression and dyspnoea severity has been reported in COPD, and there is evidence that both anxiety and depression are causal of dyspnoea and that dyspnoea is a determinant of anxiety,” they added. [Nepal Med Coll J 2018;20:155-162; Arch Bronconeumol 2008;44:127-134]

Treating depression and anxiety, as well as improving mood state, could result in better quality of life and exercise tolerance, but it remains in doubt whether such improvements are due to the alleviation of dyspnoea, according to the authors.

“Nonetheless, these studies support the idea that mood-enhancement psychotherapeutic techniques can alleviate dyspnoea in clinical populations,” they said.

“The findings from the current study warrant further clinical trials aimed at exploring the efficacy of mood enhancements in alleviating chronic dyspnoea in clinical populations,” the authors said.