7 Stress Management Tips for COPD

Stress due to chronic obstructive pulmonary disease (COPD) is different from the occasional stress many people experience. When you live with COPD, the anxiety caused from being short of breath is always with you.

Stress and COPD are closely linked. Everybody has an alarm system deep in their brains that detects a breathing problem. If this alarm system detects that you’re not getting enough air, it sends out a warning that feels like a sudden rush of anxiety. When you have COPD, you’re always struggling to get enough air, so your alarm system can become hyperactive. That can be a constant source of stress. It can also lead to a vicious cycle, according to the U.S. National Library of Medicine: Stress can make you breathe faster, which can make you feel short of breath — which in turn can make you feel more stressed.

“Shortness of breath can make normal stress much worse and can even lead to panic attacks,” notes Jessica Bon Field, MD, MS, an associate professor of medicine and the director of the Pulmonary and Critical Care Medicine Fellowship Program at the University of Pittsburgh.

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The Fallout From COPD Stress

Chronic stress can take its toll on mental health and may contribute to depression and anxiety, according to the National Institute of Mental Health. One review of multiple studies on COPD, anxiety, and depression found that people who have COPD were nearly twice as likely to develop depression and 85 percent more likely to develop anxiety than people who don’t have COPD.

Researchers are still trying to understand the relationship between COPD and depression. A COPD diagnosis alone might be part of what triggers depression, says Giora Netzer, MD, a pulmonologist and clinical professor of medicine at the University of Maryland Medical Center in Baltimore.

Dr. Netzer and his colleagues have published a study review showing that depression risk increases immediately after a COPD diagnosis and also after hospitalizations for COPD.

But that’s just part of the story. Netzer adds that depression and anxiety continue to be a risk for people with COPD over the years and can increase as COPD progresses. The review found that people with severe COPD were twice as likely to develop depression as people with mild COPD.

Depression and anxiety can also worsen COPD symptoms like breathlessness and impair exercise tolerance.

“We know that the breathlessness associated with COPD can make people less active,” says Netzer. Becoming inactive results in being less fit, which can make you feel short of breath — and therefore more stressed — more often. “All this can contribute to depression and anxiety,” says Netzer.

“I think people with COPD or any serious medical illness should be screened on a regular basis for depression,” says David Mischoulon, MD, PhD, director of the depression clinical and research program at Massachusetts General Hospital in Boston. “When you can’t breathe properly, that can make you depressed and anxious.”

Dr. Mischoulon recommends being alert for symptoms of depression or anxiety specifically related to managing COPD. For example, signs of depression might include not being motivated to take medications or check in with your doctor, wondering why you should bother with your doctor’s recommendations for managing COPD, or starting to feel hopeless about the course of your disease.

“I want people to know that depression is common, it’s treatable, and they should talk to their doctors about it,” Netzer adds.

How to Manage Stress

Even if you didn’t have COPD, stress would probably be part of your life. But when you do have COPD, it becomes even more important to get stress under control.

Start by identifying all the stressors in your life. Maybe you need to work on relationships or money problems or do a better job of pacing yourself and setting priorities. Whatever your stressors, you have to know what they are before you can figure out which ones you can reduce or avoid.

Once you’ve done that, consider these COPD stress management tips to help you cope:

• Learn COPD breathing exercises. Specialized breathing exercises can help reduce stress and any fear of being short of breath. Participating in a pulmonary rehabilitation program, where you can learn some of these exercises, has been shown to significantly ease depression and anxiety symptoms in people with COPD, according to a research review. Pulmonary rehabilitation “gives people a sense of mastery and control over their condition,” Netzer says. “And at the same time [by doing this with others who have COPD], you get the social aspect of realizing you aren’t the only one with COPD.”
• Stay active. Exercise is a proven way to reduce stress, boost mood, and fight symptoms of anxiety and depression, according to the American Psychological Association. In people with COPD, research suggests that exercise-based pulmonary rehab programs are the most effective way to improve mood. Improving your fitness optimizes oxygen use, helping you to breathe more easily, which, in turn, may help relieve stress and anxiety symptoms. An exercise specialist who works with people who have COPD can teach you appropriate workouts and breathing techniques. And keep in mind, even gentle activities that don’t affect your breathing are beneficial. “Many people with COPD benefit from an exercise like yoga that combines movement with focused breathing,” says Dr. Bon Field.
• Try relaxation techniques. A small study found that people with COPD who participated in just one meditation-style relaxation training that taught mindful breathing techniques had better mood and decreased anxiety. Ways to defuse stress on your own include mindfulness practices, meditation, deep breathing, guided muscle relaxation, or any activity you enjoy that helps you relax.
• Get restful sleep. Sleeping well is often a problem for people with COPD, due to both symptoms and COPD medications, according to the SleepFoundation.org. Developing good sleep habits can help: Stick to a sleep schedule; take naps as needed, but not too close to bedtime; avoid drinking caffeine and exercising later in the day; and limit your bedroom to sleeping — no work or late-night TV watching.
• Eat a nutritious, COPD-friendly diet. Foods high in simple carbs can drain your energy and even make it harder to breathe, adding to stress. Simple carbs — found in sweet treats, soda, and highly processed foods — create the most carbon dioxide per the amount of oxygen used, requiring you to breathe more, according to the American Lung Association. The right mix of nutrients (whole grains, protein, veggies, and fruits) can help you to breathe easier.
• Keep your lungs smoke-free. This one might seem obvious, but it bears repeating —especially since some people turn to cigarettes when they’re stressed: Don't light up, don’t vape, and try to avoid exposure to secondhand smoke.
• Ask your doctor for help. When stress leads to depression or anxiety that makes your COPD worse, the COPD Foundation advises letting your doctor know about your mood or worries. Your doctor might recommend a mental health counselor, who can help you to change negative thinking patterns and reduce anxiety while improving your overall quality of life. “Medications may also be helpful at times,” Bon Field says. “Antidepressants called SSRIs have been found to be helpful for depression.”
• Have a good support system. Sometimes you need assistance with daily living. Ask your friends and loved ones to become part of your COPD support system. Let them help you lighten your load. Bon says that “joining a COPD support group is another good way to reduce stress,” an idea endorsed by the COPD Foundation.

The bottom line? Don’t let COPD stress get the better of you. It can be more constant and more dangerous than simple stress because it can complicate your condition. If you’re feeling the stress of COPD, work with your doctor on a stress-relief plan tailored to your needs.

Additional reporting by Colleen de Bellefonds.