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Anxiety in Patients With Respiratory Disorders: How to Help

(PSYCHIATRIC TIMES) - Q: What are the safest treatment options for anxiety in adults with chronic respiratory insufficiency? A: Anxiety is a common and troubling symptom in many patients with chronic obstructive pulmonary disease (COPD), even when their degree of respiratory impairment is only mild to moderate. Anxiety may also accompany other chronic, progressive pulmonary disorders, such as interstitial fibrosis and cystic fibrosis, and a wide variety of other, less common diseases that are characterized by progressive dyspnea on exertion. The scope of the problem. My colleagues and I noted a high level of anxiety, depression, and somatic preoccupation among the patients in our comprehensive care program for severe COPD.1 The anticipation of an event, such as a sudden attack of uncontrolled dyspnea in business or social situations, caused the most intense anxiety. Panic attacks were also common, and they could be exacerbated during smoking cessation attempts, probably as a result of nicotine withdrawal. We found that patients’ anxiety, depression, and somatic preoccupation improved significantly during the course of our pulmonary rehabilitation program, most likely because of the extensive counseling that was a feature of the program.2 We used few anxiolytic drugs. Other researchers have also found that both anxiety and panic disorder are prevalent among patients with symptomatic COPD.3,4 How to manage these perplexing symptoms has been a challenge, because some of the medications used in COPD—such as β-agonists, anticholinergics, theophylline and, above all, systemic corticosteroids— may aggravate anxiety.5

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