Chest

Chest

Volume 139, Issue 3, March 2011, Pages 609-616
Journal home page for Chest

Original Research
Diffuse Lung Disease
Depression and Functional Status Are Strongly Associated With Dyspnea in Interstitial Lung Disease

https://doi.org/10.1378/chest.10-0608Get rights and content

Background

Little is understood about the characteristics of dyspnea in patients with interstitial lung disease (ILD), and its severity is likely influenced by multiple factors. Depression and functional status are known to influence dyspnea in patients with COPD. The aim of this study was to determine the relationship of dyspnea with clinical parameters, including depression and functional status, in patients with ILD.

Methods

Dyspnea was measured with the Baseline Dyspnea Index and the University of California San Diego Shortness of Breath Questionnaire. Clinical parameters were recorded. Regression analysis was performed to determine independent correlates of dyspnea.

Results

Fifty-two subjects were enrolled. The two dyspnea scales were strongly correlated (r = −0.79; P < .00005). The mean levels of dyspnea were 6.5 and 41.0, representing a moderate degree of dyspnea. Clinically meaningful depressive symptoms were found in 23% of subjects. Independent correlates of dyspnea severity for each dyspnea scale were depression score (P = .002 and P < .0005), 4-m walk time (P = .001 and P = .06), FVC (P = .07 and P = .004), and diffusing capacity of the lung for carbon monoxide (P = .007). BMI had borderline significant association with the Baseline Dyspnea Index (P = .10).

Conclusions

In patients with ILD, dyspnea is associated with depression score, functional status, and pulmonary function. These results suggest that attention to depression and functional status is important in these patients and that treatment directed at these comorbidities may improve dyspnea and quality of life.

Section snippets

Study Subjects

Subjects were prospectively identified through the University of California San Francisco (UCSF) ILD program between 2007 and 2009. Subjects were included if they had been given a diagnosis of ILD and the ability to provide informed consent. The final diagnosis was made by multidisciplinary review according to established criteria, taking clinical, radiologic, and pathologic findings into consideration.13, 14, 15 Subjects who were unable to read and write English were excluded. The study design

Study Subjects

Fifty-two subjects were enrolled. Their demographic and clinical characteristics are summarized in Table 1. The most common diagnosis was IPF (n = 20; 38% of the study population), followed by connective tissue disease-associated ILD (n = 17; 33%) and chronic hypersensitivity pneumonitis (n = 7; 13%). Other subtypes of ILD included sarcoidosis (n = 4), idiopathic nonspecific interstitial pneumonia (n = 3), and organizing pneumonia (n = 1). On average, subjects were aged 64 years, predominantly

Discussion

This study demonstrates that dyspnea is common in patients with ILD and is strongly correlated with depression and 4-m walk time (a measure of functional status). Further, this study illustrates the prevalence of clinically significant depressive symptoms in patients with ILD. Depression and functional status may be common modifiable therapeutic targets in ILD, a disease group that often lacks effective disease-modifying therapy. Treatment directed at these targets may improve dyspnea and by

Conclusion

In summary, dyspnea in ILD is common and strongly correlated with depression and functional status. Future longitudinal assessment of the interactions of dyspnea, depression, and functional status should investigate whether and how changes in these variables are interrelated and whether treatment of depression and functional status can improve quality of life. The strong association between dyspnea and depression suggests that treatment of depression in patients with ILD may improve not only

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    Funding/Support: This study was supported by the Association of Specialty Professors/CHEST Foundation Geriatric Development Research Award.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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    Copyright © 2011 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.