How Depression Leads to COPD Medication Non-Adherence

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that still does not have a cure. The World Health Organization predicts that COPD will become the fourth leading cause of death worldwide by 2030. The predominant cause for COPD is tobacco smoking. Most symptoms are irreversible, as there have been no developments in medication or treatments that can fix the damage to the airways and lungs. An individual's quality of life is severely impaired if he or she has COPD. Some of its impact on patients’ lives is through restriction of activities, interference with sleep, and limitation of social life. This poor quality of life can be a risk factor for the development of depression. The association between COPD, anxiety, and depression is well recognized. Although COPD cannot be cured, optimal management provides symptom control, slows progression of the disease, and may improve the quality of life.

Patients with COPD having three or more co-morbidities are more likely to be frequently hospitalized and may die prematurely than those COPD patients without co-morbidities. Anxiety and depression are some of the co-morbidities of COPD that notably impairs an individual’s lifestyle and reduces adherence to treatment. Untreated depression or anxiety in COPD patients can have harmful effects on the physical health and social functioning of the individual. In patients with COPD it is often difficult and challenging to identify depression and anxiety because their symptoms often overlap with those of COPD. Generally, less than one-third of patients with COPD are receiving appropriate treatment for their depression or anxiety symptoms. Various factors contribute to lack of treatment for depression and they include patient perceived barriers, poor treatment compliance, and scarcity of adequate resources for mental health treatment.

One must consider the following factors to determine quality of life:

• Emotional functioning
• Social-role functioning
• Activities of daily living
• Recreational past times

Many debilitating physical illnesses result in the rise of depression symptoms. In the case of COPD, many studies have found a high incidence rate of depression and anxiety among patients with the condition. Prevalence of depression in COPD tends to vary but it increases with the severity of COPD, and it is reported that patients with severe COPD have twice the greater risk of developing depression. There is a higher likelihood of exacerbations reported in COPD patients with depressive symptoms. Depression is a common and extremely serious mood disorder that can affect the way an individual may feel, think, and handle ordinary activities. Management of the COPD condition is complex, and with lifestyle and behavioral changes that one must commit to, the individual will eventually display signs of depression as they can no longer live as freely as they used to. When the patient is depressed, he or she may be less likely to follow the orders of the doctor, which will negatively affect their well-being and potentially be the cause of their death.

Patients with COPD must adhere to all prescribed medications and regimens, especially if he or she has developed the long-term symptoms of the condition. Adhering to inhaled medications is of paramount importance in the management of patients with COPD. One of the reasons for patients with COPD being particularly vulnerable to adherence problems is because of the chronic nature of the disease, use of multiple medications, and periods of symptom remission. The individual must change his or her behavior, such as following strict diet and executing lifestyle changes, to help manage the condition.

Individuals’ suffering from COPD have been known to be non-adherent with their recommended treatment both unintentionally and intentionally. Poor adherence to disease management programs and drug therapy have been noted as major factors that result in emergency hospitalization among patients with COPD.

Types of Non-Adherence Therapy

• Underuse
• Improper use
• Overuse

Adherence to medication is now such a prevalent problem that the World Health Organization has termed it as “a new pharmacological problem”. In patients with COPD it is important to quickly identify those who are non-compliant with medication. Since depression is one common factor among COPD patients it is important that it is identified early and treated. This will help improve the way of life for the patient. Individuals are more willing to adhere to treatments that make sense to them and treatments that align with their own beliefs about the illness, and their experience with past illnesses. It is imperative that individuals who have been diagnosed with depression, while also having COPD, seek proper treatment. Mental illness can deter the patient from making rational decisions about medications and treatments.

A large proportion of patients with COPD are noted to be clinically depressed or experience moderate to high levels of anxiety. Whether it is the depression or anxiety that caused the disease or the disease brings it on is still cause for debate. The effects of depression and anxiety on the mental health of the patient can result in lower health status and greater functional impairments. This can lead to lower adherence and worsening of symptoms for COPD. Social support also plays an important role. A stable family life with members who provide support and encouragement is associated with improved adherence.

Although COPD is a lifestyle change, patients should focus on their treatments and their medications habitually. If medications and treatments are followed appropriately, it can help make living easier and ultimately alleviate certain symptoms caused by depression. It is imperative that each patient manage the symptoms of both illnesses to improve his or her quality of life.

Conclusions

The lives of patients with COPD are significantly affected if they suffer from depression. It may also be associated with higher mortality rate. In fact, it may also negatively affect compliance to medication and smoking cessation. It is thus important that depression in COPD patients be evaluated and monitored along with regular follow-ups and counseling on medical adherence.

Depression responds to treatment, and for patients with COPD it is worth considering psychological therapy like cognitive behavioral therapy or counseling. This may improve depressive and anxiety symptoms in these patients and have a positive impact on their way of life.