The Clinical Challenge of Co-Occurring COPD and PTSD

Researchers investigating the link between chronic obstructive pulmonary disorder (COPD) and post-traumatic stress disorder (PTSD) have found that “there is inconclusive evidence to support the co-occurrence of COPD and PTSD.”

Thad Abrams, MD, MPH, and colleagues reviewed the existing literature with three goals: to find out if there is enough evidence to support a co-occurrence between COPD and PTSD, investigate clinical considerations for managing the impact of PTSD on COPD, and to identify areas where further research is required. Their review was published in Dove Medical Press online on October 15, 2015.

The researchers examined 598 articles in their initial review. After limiting their search to include studies in English, regarding adults, and those that included “some type of nonreversible obstructive lung pathology” they narrowed the review to 19 articles.

Although a number of studies have examined the relationship between COPD and such psychiatric conditions as anxiety and depression, few, if any, address the association between PTSD and COPD.

Among the 19 articles included in the review, six focused on veterans, and two of those “used a prospective study design with samples of veterans recruited from outpatient clinics and tested for the co-occurrence between COPD and PTSD.”

However, those two studies produced conflicting results. During this review, the researchers found that “the lack of structured illness assessments for both PTSD and COPD in both studies may have contributed to the disparate findings.”

Three studies examined the link between PTSD and a broader group of respiratory illnesses. One focused on the “rates of hospital readmission and mortality among a group of veterans admitted for an exacerbation of COPD.” The results suggested a “non-significant co-occurrence with COPD.”

Finally, the researchers reviewed a study that examined a group of ambulatory veterans who were using outpatient services. That study did not differentiate between COPD and other, related respiratory disorders, but did show a higher rate of chronic lung conditions among veterans with PTSD compared to those without it.

The researchers looked at a second set of studies that focused on non-veteran populations. There were 10 studies that included “community-dwelling adults, clinical samples, or health system enrollees.” Again, there was not conclusive evidence to show a “clear co-occurrence of PTSD and COPD.”

Even though the review did not show a clear connection between PTSD and COPD co-occurrence, “there is some evidence that PTSD plays a role in the perception of COPD illness burden.” The researchers concluded that it is “incumbent upon clinicians to utilize adequate mental health screening approaches” until future studies address current limitations.