Anxiety, depression, physical disease parameters and health-related quality of life in the BronchUK national bronchiectasis cohort.

BACKGROUND

Bronchiectasis is associated with psychological comorbidity and poor quality of life (QoL), yet guidelines lack focus on psychological morbidity. Using data obtained from the BronchUK database (1341 patients), we examined the link between anxiety/depression and physical disease severity, QoL and long-term outcomes in bronchiectasis.

METHODS

Computed tomography-confirmed bronchiectasis patients enrolled in the BronchUK study with Hospital Anxiety and Depression Scale (HADS-A/D) data were studied. HADS-A/D scores ≥8 indicated anxiety/depression. QoL was measured by the St George's Respiratory Questionnaire and QoL-Bronchiectasis Questionnaire. Exacerbations during annual follow-up were analysed by negative binomial regression with time in study as an offset adjusted for age, body mass index, sex, infection, diabetes and forced expiratory volume in 1 s (FEV). Cox regression determined probability of hospitalisation using time to first exacerbation.

RESULTS

1341 patients were included; 418 had anxiety (31%), 269 (20%) had depression and 201 (15%) had both conditions. HADS-A/D ≥8 was associated with worse QoL (p<0.0001) and clinical severity ( Bronchiectasis Severity Index, FEV and Medical Research Council dyspnoea score (all p<0.01). HADS-A/D ≥8 each was associated with exacerbation (rate ratio (RR) 1.42, 95% CI 1.32-1.52 for HADS-A; RR 1.45, 95% CI 1.34-1.56 for HADS-D, both p<0.0001) and hospitalisation risk (RR 1.58, 95% CI 1.29-1.92 for HADS-A; RR 1.76, 95% CI 1.43-2.17 for HADS-D, both p<0.001). HADS-A/D ≥8 each predicted future hospitalisation (HR 1.30, 95% CI 0.98-1.72, p=0.067 for HADS-A; HR 1.40 95% CI 1.04-1.88, p=0.027 for HADS-D).

INTERPRETATION

Anxiety and depression are common in bronchiectasis, correlate with disease severity and predict poor outcomes. Consideration of psychological comorbidities should be evaluated in routine bronchiectasis care.