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Associations of comorbid heart disease and depression/anxiety with multidimensional breathlessness in COPD – A cross-sectional study

Eliason, Gabriella ; Ekström, Magnus LU orcid ; Montgomery, Scott ; Giezeman, Maaike ; Hasselgren, Mikael ; Janson, Christer ; Kisiel, Marta A. ; Lisspers, Karin ; Nager, Anna and Sandelowsky, Hanna , et al. (2025) In Respiratory Medicine 241.
Abstract

Background: Comorbid conditions and breathlessness are associated with poor outcomes in chronic obstructive pulmonary disease (COPD). We evaluated the associations of comorbid heart disease and depression/anxiety with breathlessness in daily life among people with COPD. Methods: Cross-sectional analysis from the PRAXIS cohort in central Sweden. Data on patient characteristics and the modified Medical Research Council (mMRC) and Dyspnea-12 breathlessness instruments (D-12) were obtained from questionnaires in 2022. Lung function data were collected from record review. Outcome variables were clinically significant breathlessness defined as mMRC≥2 and D-12 total (>2.7), physical (>1.4) and affective (>1.2) scores above published... (More)

Background: Comorbid conditions and breathlessness are associated with poor outcomes in chronic obstructive pulmonary disease (COPD). We evaluated the associations of comorbid heart disease and depression/anxiety with breathlessness in daily life among people with COPD. Methods: Cross-sectional analysis from the PRAXIS cohort in central Sweden. Data on patient characteristics and the modified Medical Research Council (mMRC) and Dyspnea-12 breathlessness instruments (D-12) were obtained from questionnaires in 2022. Lung function data were collected from record review. Outcome variables were clinically significant breathlessness defined as mMRC≥2 and D-12 total (>2.7), physical (>1.4) and affective (>1.2) scores above published minimal clinical important differences. Associations of heart disease and depression/anxiety with each outcome were analyzed using multivariable Poisson regression adjusted for relevant confounders. Results: In 522 included patients, mMRC ≥2 was present in 59 % and increased D-12 total, physical and affective domain scores in 69 %, 74 %, and 50 %, respectively. Heart disease was independently associated with mMRC (relative risk ratio [95 % confidence interval] 1.34 [1.17–1.53]), D12 physical domain (1.12[1.02–1.24]) and D-12 affective domain (1.20[1.02–1.42]). Depression/anxiety was independently associated with increased D-12 affective domain (1.25[1.04–1.49]). In addition, previous exacerbations and GOLD stage 3–4 were associated with mMRC and D-12, respectively. Conclusion: In COPD, comorbid heart disease is associated with both activity-related breathlessness and with physical and affective domains of breathlessness while depression/anxiety is associated with the affective domain of breathlessness. As the influence of different dimensions of breathlessness may differ according to comorbidity the D-12 instrument adds more information when assessing breathlessness in patients with COPD.

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organization
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type
Contribution to journal
publication status
published
subject
keywords
Activity-related breathlessness, Anxiety, Depression, Dyspnea, Dyspnea dimensions, Heart disease
in
Respiratory Medicine
volume
241
article number
108053
publisher
Elsevier
external identifiers
  • pmid:40157398
  • scopus:105001706007
ISSN
0954-6111
DOI
10.1016/j.rmed.2025.108053
language
English
LU publication?
yes
id
ed36633e-5db8-43f5-a983-28d0ad1c59cf
date added to LUP
2025-08-18 13:55:58
date last changed
2025-10-27 20:07:37
@article{ed36633e-5db8-43f5-a983-28d0ad1c59cf,
  abstract     = {{<p>Background: Comorbid conditions and breathlessness are associated with poor outcomes in chronic obstructive pulmonary disease (COPD). We evaluated the associations of comorbid heart disease and depression/anxiety with breathlessness in daily life among people with COPD. Methods: Cross-sectional analysis from the PRAXIS cohort in central Sweden. Data on patient characteristics and the modified Medical Research Council (mMRC) and Dyspnea-12 breathlessness instruments (D-12) were obtained from questionnaires in 2022. Lung function data were collected from record review. Outcome variables were clinically significant breathlessness defined as mMRC≥2 and D-12 total (&gt;2.7), physical (&gt;1.4) and affective (&gt;1.2) scores above published minimal clinical important differences. Associations of heart disease and depression/anxiety with each outcome were analyzed using multivariable Poisson regression adjusted for relevant confounders. Results: In 522 included patients, mMRC ≥2 was present in 59 % and increased D-12 total, physical and affective domain scores in 69 %, 74 %, and 50 %, respectively. Heart disease was independently associated with mMRC (relative risk ratio [95 % confidence interval] 1.34 [1.17–1.53]), D12 physical domain (1.12[1.02–1.24]) and D-12 affective domain (1.20[1.02–1.42]). Depression/anxiety was independently associated with increased D-12 affective domain (1.25[1.04–1.49]). In addition, previous exacerbations and GOLD stage 3–4 were associated with mMRC and D-12, respectively. Conclusion: In COPD, comorbid heart disease is associated with both activity-related breathlessness and with physical and affective domains of breathlessness while depression/anxiety is associated with the affective domain of breathlessness. As the influence of different dimensions of breathlessness may differ according to comorbidity the D-12 instrument adds more information when assessing breathlessness in patients with COPD.</p>}},
  author       = {{Eliason, Gabriella and Ekström, Magnus and Montgomery, Scott and Giezeman, Maaike and Hasselgren, Mikael and Janson, Christer and Kisiel, Marta A. and Lisspers, Karin and Nager, Anna and Sandelowsky, Hanna and Ställberg, Björn and Sundh, Josefin}},
  issn         = {{0954-6111}},
  keywords     = {{Activity-related breathlessness; Anxiety; Depression; Dyspnea; Dyspnea dimensions; Heart disease}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Respiratory Medicine}},
  title        = {{Associations of comorbid heart disease and depression/anxiety with multidimensional breathlessness in COPD – A cross-sectional study}},
  url          = {{http://dx.doi.org/10.1016/j.rmed.2025.108053}},
  doi          = {{10.1016/j.rmed.2025.108053}},
  volume       = {{241}},
  year         = {{2025}},
}