Chronic shortness of breath ("dyspnea") is a heavy burden of constant discomfort, and dyspnea exacerbations for whatever reason can be extremely distressing and frightening. And dyspnea limitations that force patients to withdraw from favorite activities with friends and family often causes COPD patients to feel withdrawn and isolated, and suffer from feelings of hopelessness. It is therefore perfectly understandable that anxiety and depression is a common added burden for many COPD patients.
This module will give you some guidelines to help you work through these problems.
Remember, there is an intimate link between anxiety, and particularly anxiety that produces so-called "Panic Attacks," and the production or worsening of acute dyspnea attacks. This is because anxiety often produces rapid breathing (as part of the "Rescue Breathing Pattern") which in turn causes the physiologic "Dynamic Hyperinflation" problem, which makes breathing much more difficult. Be sure to again review the module on Dynamic Hyperinflation if you are uncertain about this critically important topic.
The end physical result is chronic shortness of breath, acute dyspnea attacks with effort, and deconditioned leg and other peripheral muscles that work inefficiently, and as a result require more ventilation for a given level of effort.
The question then becomes one of: how do you reverse these physical problems, in order to reverse these normal and understandable psychological anxiety and depression problems.
Essentially, from a physical point of view, what you have here are two problems:
1.) Breathing problems, of two general types:
A.) Chronic breathing problems, and
B.) Acute dyspnea attacks, usually brought on by exertion.
2.) Deconditioned and weak muscles, mainly leg muscles, that make getting about difficult, and requiring an excessive amount of breathing if you do move about.
These two general problems are related and intertwined among each other, and produces a classic "What came first, the Chicken or the Egg" situation. Or in this case, what is the priority problem, and what do we do first to correct the situation.
The majority of formal pulmonary rehabilitation programs have a primary exercise focus, to recondition the legs and other peripheral muscles, make these muscles more efficient as to oxygen needs and getting rid of waste carbon dioxide, and thereby require relatively less breathing with exertion to satisfy these oxygen and carbon dioxide requirements. Considerable research has been done in this approach, and there is no question that this is an effective strategy to get patients ambulated, and to reduce their overall level of dyspnea. And as patients feel more comfortable, and are able to get about more easily, there is a powerful positive influence on the anxiety and depression situation.
The other general approach, and the one that I personally favor, is a primary breathing training strategy. Ask COPD patients what their major concern is, and very few will complain about the inability to exercise, though indeed exertion is a very common reason for acute dyspnea. COPD patients dominant concern is mainly about shortness of breath ("dyspnea"), and the large majority here are concerned about acute dyspnea attacks. Acute dyspnea is a very distressing experience, and COPD patients live in constant fear of these attacks. It makes logical sense that initial therapy should therefore concentrate on the patient's primary complaint of dyspnea, and in particular acute dyspnea attacks.
Remember Willie Sutton, the famous bank robber? As Willie Sutton allegedly said, when asked why he robbed banks, ".....Because that's where the money is." Think of the primary breathing control focus in COPD rehabitation as the Sutton approach to pulmonary rehabilitation.
Teach COPD patients breathing control and their overall breathing comfort improves. But more important, If patients know how to recognize an impending acute breathing attack and prevent the attack, or if having an attack how to control the attack, they will then lose their fear of exerting themselves. If patient feel they are in control of their breathing, it then takes only a little encouragement to get them to be more active, because patients usually want to be more active. And with increased activity, their leg and other peripheral muscles will become reconditioned, and strength will improve, and their overall rehabilitation program be therefore enhanced.
Chronic dyspnea, and especially acute dyspnea attacks, are psychologically very debilitating. Perhaps even more psychologically debilitating is so-called psychological "loss of control." Improve the breathing comfort for a COPD patient, and restore their physiologic control over their dyspnea, and this will greatly restore their psychological loss of control. In turn, this will usually have a very powerful positive influence on their anxiety and depression.
However, this will not resolve the anxiety and depression problems in all patients. These patients should be referred for appropriate professional psychiatric or psychology help, such as consultation and possible psychoactive medications, or referral to appropriate support services.
And there is on-line information and help in this matter of COPD anxiety and depression. I would suggest you visit the web site of psychologist Dr. Vijai Sharma. Dr. Sharma has a particular interest in COPD, and counseling patients with COPD. His general web site also has much information about a variety of psychological topics at http://www.mindpub.com/
COPD patients with concerns about anxiety and depression should be sure to look at his extensive (59 pages) downloadable PDF file "Anxiety and Panic Attacks in Emphysema & Other Chronic Obstructive Pulmonary Diseases (COPD)." at: http://www.mindpub.com/PanicAttacksinCOPD.pdf Anxiety and depression, and self-help measures to deal with these problems are thoroughly discussed, and much of what Dr. Sharma describes intermingles with what has been previously discussed under the topics of the Rescue Breathing Pattern and Dynamic Hyperinflation.