Although the estimates of prevalence vary, there is convincing evidence that patients with chronic obstructive pulmonary disease (COPD) are at increased risk for depression. Moreover, depression has been associated with diminished functional status, increased symptoms, and increased mortality in patients with COPD. Encouraging news comes from Nguyen and Carrieri-Kohlman, who report that a dyspnea self-management program that includes exercise can reduce both dyspnea and depressed mood in these patients. They evaluated 3 versions of a self-management program in 100 patients with moderate to severe COPD. The program included patient education and demonstration of dyspnea self-management strategies, an individualized home-based walking prescription, and exercise self-monitoring that included the use of a pedometer and an exercise log. The 3 versions of this program differed with respect to the amount of supervised exercise: no, 4, or 24 sessions. All 3 programs resulted in a significant improvement in depressed mood. For patients who were at high risk for depression at the beginning of the study, the program that included 24 sessions led to a greater reduction in dyspnea than the other 2 programs. The authors recommend that patients with COPD be screened for depression and that their exercise regimens be tailored accordingly, with more exercise supervision for patients with depressed mood.
