the past two decades there has been increasing recognition that patients with chronic obstructive pulmonary disease (COPD) with three or more comorbidities are more likely to be frequently hospitalized and may die prematurely compared to COPD patients without comorbidities . in individuals with COPD have deleterious effects on physical functioning and on sociable interaction increases fatigue and healthcare utilization [3 4 Major depression and panic are challenging to LGK-974 identify and treat because their symptoms often overlap with those of COPD . Identifying depressive disorder stress and developing appropriate treatment strategies are crucial to improve COPD patients’ quality of life and reducing healthcare utilization. This editorial synthesizes the current understanding of the prevalence and potential mechanism of association and discusses implications for treatment in patients with COPD with comorbid depressive disorder and stress symptoms. What do we know about depressive disorder and stress? Mental health related disorders are the leading causes of increased disability and impaired quality of life in older people worldwide. Specifically mood disorders [major depressive disorder dysthymias (chronic depressive symptoms of moderate severity) minor depressive disorder and stress disorders (generalized anxiety disorder phobias and panic disorders) are common in patients Rabbit polyclonal to SERPINB6. with COPD [6 7 The incidence of depressive disorder in a recent longitudinal study by Schneider (n = 35 0 COPD) with a follow-up of 10 years  was 16.2 cases per 1000 person-years in the COPD group compared to 9.4 cases per 1000 person-years in the non-COPD control group. In addition those with severe COPD were twice as likely to develop depressive disorder [7 8 compared to patients LGK-974 with moderate COPD. To date there are no studies that have examined the incidence of stress disorders in patients with COPD in a longitudinal study. However a recent cross-sectional study by Einser and colleagues  reported that COPD patients are 85% more likely to develop stress disorders compared to healthy matched controls (controlling for confounding variables such as demographic characteristics and disease severity). In addition the prevalence of clinical stress in COPD outpatients ranges between 13% and 46% . Furthermore COPD patients with comorbid stress disorders are twice as likely to exhibit LGK-974 self-reported functional limitations poorer exercise tolerance and higher frequency of acute exacerbations compared to those without stress symptoms. Indeed stress disorders are disabling and unless properly treated they can become chronic lower self-esteem predispose to suicidal ideation and increase the risk of hospitalization [5 6 8 Mechanism of potential association with COPD A recent systematic review and meta-analysis of 25 studies with long-term follow-up  revealed that the relationship between COPD and depressive disorder is likely bi-directional as depressive disorder may be both a cause and a consequence of COPD. However the exact mechanisms linking COPD with depressive disorder and LGK-974 stress have not been recognized. The inter-relationship between smoking depressive disorder and/or stress and COPD is usually unclear. Smoking increases the risk and severity of COPD makes daily activities effortful and nerve-racking and increases the risk of depressive disorder or stress in patients with COPD. Associations between stress disorders and COPD appear to be largely explained by confounding factors such as previous history of cigarette smoking and nicotine dependence . However the relationship of mood disorders to COPD appears to be largely accounted for by nicotine dependence. Thus these cross-sectional associations do not allow inference about causality but point out to the need for specifically designed studies. Depressive disorder and stress may lead to fear panic and hopelessness low self- esteem interpersonal isolation and dependency on caregivers initiating a vicious circle that perpetuates stress and depressive disorder. There is emerging evidence to suggest that low-grade chronic inflammation mediates in part the association of depressive symptoms and pulmonary function. Increased inflammatory markers have been documented in both late-life depressive disorder  and COPD . In a recent study of a populace sample of older adults elevated levels of the inflammatory biomarkers interleukin-6 and C-reactive protein accounted in part for the association of depressive symptoms with pulmonary obstruction ..