Randomized trial of paroxetine in end-stage COPD.
BACKGROUND
Although the underlying pathology is initially confined to the lungs, the associated emotional responses to chronic obstructive pulmonary disease (COPD) contribute greatly to the resulting morbidity. The objective of this study was to examine the effect of an antidepressant drug on disease-specific quality of life in patients with end-stage COPD who present significant depressive symptoms.


METHODS
We conducted a 12-week, randomized double-blind placebo-controlled trial of Paroxetine in which quality of life measured by the Chronic Respiratory Questionnaire (CRQ), an evaluative COPD-specific quality-of-life questionnaire, was the primary outcome.


RESULTS
23 patients were randomized and 15 completed the trial (8 on Paroxetine; 7 on placebo). In the per-protocol analysis, we observed statistically and clinically significant improvements favoring the active treatment in 2 of the 4 domains of the CRQ: emotional function (adjusted mean difference: 1.1; 95% confidence interval [CI]: 0.0 - 2.2) and mastery (difference: 1.1; CI: 0.4 - 1.8). Dyspnea and fatigue improved, but to an extent that did not reach statistical significance. In the intention-to-treat analysis, none of the differences in CRQ scores was significant. Paroxetine was not associated to any worsening of respiratory symptoms.


CONCLUSIONS
The results of this small randomized trial indicated that patients with end-stage COPD may benefit from antidepressant drug therapy when significant depressive symptoms are present. This study underlined the difficulties in conducting experimental studies in frail and elderly patients with COPD.
Lacasse
Y
Y
Centre de recherche, Centre de Pneumologie, Hôpital Laval, Institut universitaire de cardiologie et de pneumologie de l'Université Laval, Québec, Canada. Yves.Lacasse@med.ulaval.ca
Beaudoin
L
L
Rousseau
L
L
Maltais
F
F
D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D017374:Paroxetine / Q000627:therapeutic use*; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology*; D011788:Quality of Life; D011792:Quebec; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D017374:Paroxetine