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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In a personalized medicine setting&#44; a multidisciplinary approach to patients becomes increasingly necessary&#46; This may be of particular importance in highly prevalent chronic diseases such as chronic obstructive pulmonary disease &#40;COPD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> COPD&#44; like other chronic respiratory diseases&#44; is frequently associated with comorbidities&#44; such as depression&#44; that worsen patients&#8217; quality of life&#44; interfere with their perception of other symptoms&#44; and aggravate their prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Depression is more common in COPD patients than in the general population&#44; although its prevalence varies significantly depending on various factors&#44; such as the population under study or the methods and tools used for its diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Approximately 25&#37; of patients with COPD are estimated to have mild or subclinical forms of depression that often remain undetected by health professionals&#44; and as such&#44; remain untreated&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Several risk factors for developing depression have been identified in COPD patients&#44; including more severe dyspnea&#44; active smoking&#44; presence of other comorbidities&#44; low educational level&#44; low socioeconomic status&#44; and&#44; in general&#44; a poorer quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The pathophysiological mechanisms underlying the association between COPD and depression have not been clearly established&#44; although there appears to be a 2-way relationship between these entities that share common characteristics&#58; anhedonia&#44; apathy&#44; lack of motivation&#44; reduced physical activity&#44; social isolation&#44; and a feeling of loss of control over one&#8217;s life&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> COPD patients suffer from fatigue&#44; anorexia&#44; respiratory distress&#44; weight loss&#44; decreased physical activity&#44; and muscle weakness&#44; conditions that facilitate the appearance of depressive symptoms that are aggravated when patients lack social and emotional support&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;10</span></a> Depression&#44; in turn&#44; worsens functional capacity and predicts limitations in basic activities of daily living&#44; while the dependence it creates aggravates depressive symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> Other contributing factors may include changes in sleep and eating patterns&#44; or reduced physical activity&#44; leading to weakness&#44; loss of energy&#44; and deterioration of neurophysiological systems&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The high prevalence and potential negative impact of depression on COPD mean that depressive symptoms must be investigated in these patients&#46; Various methods are available for these purposes&#44; including a series of scales that have been validated to evaluate depression in COPD&#44; and that allow detection of both patients with established depression and those at risk of depression&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;9&#44;14</span></a> These include the Patient Health Questionnaire &#40;PHQ-9&#41;&#44; the Hospital Anxiety and Depression Scale &#40;HAD&#41;&#44; the Zung and Conde Self-rating Depression Scale &#40;SDS&#41;&#44; or the Center for Epidemiological Studies Depression Scale &#40;CES-D&#41;&#46; They consist of a variable number of items that evaluate mood&#44; activities performed&#44; and certain cognitive and emotional aspects in the days prior to the interview&#44; and are easily self-administered&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">To improve treatment outcomes&#44; intervention should be early and multidisciplinary&#46; According to some authors&#44; antidepressant drugs appear to be less effective in people with COPD&#44; possibly because of their persistent chronic respiratory symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> However&#44; pharmacological treatment could be useful in many patients&#44; so not only should it not be excluded&#44; it should be offered as part of the therapeutic strategy&#46; Offering advice on healthy living habits&#44; including proper diet and exercise and methods for controlling dyspnea&#44; and providing emotional and psychological support improves treatment compliance and encourages patients to stop smoking&#44; a habit that is related to COPD progression and the severity of depressive symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;15</span></a> Interventions based on patient cooperation&#44; such as respiratory rehabilitation&#44; improve dyspnea&#44; increase tolerance to exertion&#44; decrease anxiety&#44; improve depression&#44; promote health&#44; and reduce the frequency of emergency visits and the number of hospitalizations&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">It is therefore up to us to make an effort to offer an individualized&#44; patient-centered clinical approach to COPD that also explores the psychological aspects that may interfere with or affect the course and prognosis of their disease&#46;</p></span>"
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Editorial
COPD is more than just lung function: Let’s not forget depression
EPOC más allá de la función pulmonar: no se olviden de la depresión
María-Teresa García-Sanza,
Corresponding author
maytegsanz@gmail.com

Corresponding author.
, Francisco-Javier González-Barcalab
a Atención Primaria, EOXI Pontevedra-Salnés, Ribadumia, Spain
b Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Spain
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      "es" => array:1 [
        "titulo" => "EPOC m&#225;s all&#225; de la funci&#243;n pulmonar&#58; no se olviden de la depresi&#243;n"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In a personalized medicine setting&#44; a multidisciplinary approach to patients becomes increasingly necessary&#46; This may be of particular importance in highly prevalent chronic diseases such as chronic obstructive pulmonary disease &#40;COPD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> COPD&#44; like other chronic respiratory diseases&#44; is frequently associated with comorbidities&#44; such as depression&#44; that worsen patients&#8217; quality of life&#44; interfere with their perception of other symptoms&#44; and aggravate their prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Depression is more common in COPD patients than in the general population&#44; although its prevalence varies significantly depending on various factors&#44; such as the population under study or the methods and tools used for its diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Approximately 25&#37; of patients with COPD are estimated to have mild or subclinical forms of depression that often remain undetected by health professionals&#44; and as such&#44; remain untreated&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Several risk factors for developing depression have been identified in COPD patients&#44; including more severe dyspnea&#44; active smoking&#44; presence of other comorbidities&#44; low educational level&#44; low socioeconomic status&#44; and&#44; in general&#44; a poorer quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The pathophysiological mechanisms underlying the association between COPD and depression have not been clearly established&#44; although there appears to be a 2-way relationship between these entities that share common characteristics&#58; anhedonia&#44; apathy&#44; lack of motivation&#44; reduced physical activity&#44; social isolation&#44; and a feeling of loss of control over one&#8217;s life&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> COPD patients suffer from fatigue&#44; anorexia&#44; respiratory distress&#44; weight loss&#44; decreased physical activity&#44; and muscle weakness&#44; conditions that facilitate the appearance of depressive symptoms that are aggravated when patients lack social and emotional support&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;10</span></a> Depression&#44; in turn&#44; worsens functional capacity and predicts limitations in basic activities of daily living&#44; while the dependence it creates aggravates depressive symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> Other contributing factors may include changes in sleep and eating patterns&#44; or reduced physical activity&#44; leading to weakness&#44; loss of energy&#44; and deterioration of neurophysiological systems&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The high prevalence and potential negative impact of depression on COPD mean that depressive symptoms must be investigated in these patients&#46; Various methods are available for these purposes&#44; including a series of scales that have been validated to evaluate depression in COPD&#44; and that allow detection of both patients with established depression and those at risk of depression&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;9&#44;14</span></a> These include the Patient Health Questionnaire &#40;PHQ-9&#41;&#44; the Hospital Anxiety and Depression Scale &#40;HAD&#41;&#44; the Zung and Conde Self-rating Depression Scale &#40;SDS&#41;&#44; or the Center for Epidemiological Studies Depression Scale &#40;CES-D&#41;&#46; They consist of a variable number of items that evaluate mood&#44; activities performed&#44; and certain cognitive and emotional aspects in the days prior to the interview&#44; and are easily self-administered&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">To improve treatment outcomes&#44; intervention should be early and multidisciplinary&#46; According to some authors&#44; antidepressant drugs appear to be less effective in people with COPD&#44; possibly because of their persistent chronic respiratory symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> However&#44; pharmacological treatment could be useful in many patients&#44; so not only should it not be excluded&#44; it should be offered as part of the therapeutic strategy&#46; Offering advice on healthy living habits&#44; including proper diet and exercise and methods for controlling dyspnea&#44; and providing emotional and psychological support improves treatment compliance and encourages patients to stop smoking&#44; a habit that is related to COPD progression and the severity of depressive symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;15</span></a> Interventions based on patient cooperation&#44; such as respiratory rehabilitation&#44; improve dyspnea&#44; increase tolerance to exertion&#44; decrease anxiety&#44; improve depression&#44; promote health&#44; and reduce the frequency of emergency visits and the number of hospitalizations&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">It is therefore up to us to make an effort to offer an individualized&#44; patient-centered clinical approach to COPD that also explores the psychological aspects that may interfere with or affect the course and prognosis of their disease&#46;</p></span>"
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Article information
ISSN: 15792129
Original language: English
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