Risk Factors for Anxiety and its Impacts on Acute Exacerbation in Chronic Obstructive Pulmonary Disease: A Prospective Cohort Study in Elderly COPD Patients in Shanghai

Background: We aimed to explore the relation between anxiety and its associated risk factors in elderly COPD patients in Shanghai and to illuminate the relation between anxiety and the risk of acute exacerbations in 12 months. Methods: 424 patients were included in our analysis. All participants were assessed by comprehensive questionnaires. Hamilton Anxiety Rating Scale (HAM-A) was used to assess all COPD patients. Acute exacerbations including the previous one year and one-year follow-up were recorded. Results: 424 patients including 380 males and 44 females were included in the final analysis. Of the 424 COPD patients, 19.81% (N=84) had anxiety symptoms and 80.19% (N=340) had no anxiety symptoms. There were increased pack-years, more comorbidities, and acute exacerbations in COPD patients with anxiety compared to those without anxiety. Meanwhile, a higher Modified Medical Research Council (mMRC), a higher COPD Assessment Test (CAT) score, and a shorter Six-Minute Walking Distance (6MWD) were found in COPD patients with anxiety. We found that the BODE index, mMRC, CAT score, comorbidities, and exacerbations were independently associated with a significantly higher risk of anxiety. Eventually, COPD patients with anxiety increased the risk of acute exacerbations in 12 months, especially moderate and severe exacerbations as compared with COPD patients without anxiety. Conclusion: Anxiety is a common comorbidity of individuals suffering from COPD, although it is frequently underdiagnosed and consequently undertreated. Physicians should more actively detect and manage anxiety by considering the associated factors. Mental health care should be paid more attention to decrease the risk of acute exacerbation in COPD patients.