Chronic obstructive lung disease and posttraumatic stress disorder: current perspectives.
BACKGROUND
Several studies have reported on the co-occurrence of chronic obstructive pulmonary disease (COPD) and psychiatric conditions, with the most robust evidence base demonstrating an impact of comorbid anxiety and depression on COPD-related outcomes. In recent years, research has sought to determine if there is a co-occurrence between COPD and posttraumatic stress disorder (PTSD) as well as for associations between PTSD and COPD-related outcomes. To date, there have been no published reviews summarizing this emerging literature.


OBJECTIVE
The primary objective of this review was to determine if there is adequate evidence to support a co-occurrence between PTSD and COPD. Secondary objectives were to: 1) determine if there are important clinical considerations regarding the impact of PTSD on COPD management, and 2) identify targeted areas for further research.


METHODS
A structured review was performed using a systematic search strategy limited to studies in English, addressing adults, and to articles that examined: 1) the co-occurrence of COPD and PTSD and 2) the impact of PTSD on COPD-related outcomes. To be included, articles must have addressed some type of nonreversible obstructive lung pathology.


RESULTS
A total of 598 articles were identified for initial review. Upon applying the inclusion and exclusion criteria, n=19 articles or abstracts addressed our stated objectives. Overall, there is inconclusive evidence to support the co-occurrence between PTSD and COPD. Studies finding a significant co-occurrence generally had inferior methods of identifying COPD; in contrast, studies that utilized more robust COPD measures (such as a physician exam) generally failed to find a relationship. Among studies that examined the impact of PTSD on COPD-related outcomes, there was more consistent evidence that PTSD affects the perception of respiratory symptom burden and management. In addition, methods for measuring an important confounder (smoking) were generally lacking.


CONCLUSIONS
There is inconclusive evidence to support the co-occurrence of COPD and PTSD. There was stronger evidence implicating PTSD as an important comorbidity impacting COPD management. Further research is needed to: 1) determine whether or not COPD and PTSD are likely to be comorbid, and 2) further elucidate the mechanisms connecting PTSD and COPD-related outcomes.
Department of Internal Medicine, University of Iowa, Iowa City, IA, USA ; Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, University of Iowa, Iowa City, IA, USA.
Thad E
TE
Abrams
Department of Internal Medicine, University of Iowa, Iowa City, IA, USA ; Hardin Health Sciences Library, University of Iowa, Iowa City, IA, USA.
Amy
A
Blevins
Department of Internal Medicine, University of Iowa, Iowa City, IA, USA ; Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, University of Iowa, Iowa City, IA, USA ; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA.
Mark W Vander
MW
Weg
D015897:Comorbidity; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000503:physiopathology
Veterans; WTC cough syndrome; chronic lung disease; nonproductive cough; posttraumatic stress disorder