Psychiatric comorbidities are often seen in individuals with chronic respiratory diseases. Depression, anxiety, sleep disturbances and cognitive impairment are prevalent among individuals diagnosed with chronic obstructive pulmonary disease and asthma. An integrated approach is needed to manage both conditions. The article reviews the link.

Psychiatric comorbidities are often seen in individuals with chronic somatic disorders. These comorbidities can greatly diminish the quality of life for these patients (Global Initiative for Asthma. (2005). Global strategy for asthma management and prevention. NIH Publication No 02–3659.). Conditions such as asthma and chronic obstructive pulmonary disease (COPD) represent a long-term health issue that affects the patient throughout their life, leading to considerable mental and social challenges alongside physical symptoms.

Emotional disorders, such as anxiety and depression, are found to be more common in individuals with COPD and asthma when compared to the general population (de Miguel Díez et al, 2011). The estimated prevalence of anxiety and psychological disorders among patients with bronchial asthma ranges from 30% to 52% (Trzcińska et al, 2012).

Depression and anxiety are prevalent among individuals diagnosed with chronic obstructive pulmonary disease (COPD). Patients suffering from COPD display significant symptoms of coexisting depression and anxiety. If left untreated, these mental health conditions are linked to a rise in acute exacerbations (AECOPD), increased use of emergency healthcare services, higher rates of hospital readmission, and an elevated risk of premature mortality (D.L. Matte, et al, 2016; Iyer et al, 2016; Vikjord et al, 2020).

The connection:

A cross-sectional survey study was conducted to assess and compare the prevalence of anxiety and depression among patients with COPD and asthma. The findings indicated that patients with uncontrolled asthma exhibited significantly poorer scores in both anxiety and depression across all scales (Beck-Anxiety, Hamilton-Anxiety, Beck-Depression, Hamilton-Depression). For the Beck scales, the average anxiety score was 14.3+7.0, with 18 patients (33.3%) experiencing anxiety, while the average depression score was 13.4+9.8, with 32 patients (59.3%) suffering from depression. In terms of the Hamilton scales, the average anxiety score was 14.4+10.4, with 20 patients (37%) reporting anxiety, and the average depression score was 9.5+6.3, with 30 patients (55.6%) indicating depression. A significant difference was observed between the anxiety and depression levels of patients with asthma and those with COPD. Notably, patients with COPD demonstrated significantly poorer emotional status scores. (Yusuf Aydemir, et al, 2016).

Abebaw and colleagues (2022) investigated the correlation between symptoms of COPD and anxiety (which includes tension/worry, fear/panic, and restlessness); primary depressive symptoms (anhedonia and sadness); physical impairment (psychomotor slowing, low energy, breathlessness, and activity limitation); cough (cough and phlegm); and the "impact of respiratory problems" (lack of confidence when going out, sleep disturbances, and chest tightness). They discovered that chest tightness was associated with acute anxiety, whereas cough and weakness were linked to core depressive symptoms. Furthermore, cough and phlegm were significantly related to chest tightness, sleep disturbances, and breathlessness, which in turn were associated with aspects related to physical and activity limitations. Acute anxiety (fear or panic) may serve as a response or trigger for dyspnoea, while chronic worries and tension reflect mixed presentations that include both depressive and anxiety symptoms. Additionally, the respiratory condition (asthma) is linked to a physical aspect of anxiety (activity limitations and reduced physical energy levels).

Hometowska and colleagues (2022) conducted a study involving 325 patients, comprising 159 women and 166 men, with a mean age of 63 years. They utilized the Modified Fatigue Impact Scale (MFIS) and the Hospital Anxiety and Depression Scale (HADS). The overall mean MFIS score for all participants was 33.03; however, patients diagnosed with asthma typically exhibited lower scores compared to those with Chronic Obstructive Pulmonary Disease (COPD) and asthma-COPD overlap (ACO). No significant statistical differences were observed in the HADS anxiety scores among the groups, although approximately half of the patients reported scores indicative of some level of disorder. It was established that patients with COPD and ACO experienced greater levels of depression than those with asthma. Furthermore, a significant positive correlation was found between the HADS and MFIS scores. The findings of the study indicated that patients suffering from COPD, asthma, and ACO generally experienced heightened levels of fatigue and depression, with anxiety levels being elevated across all groups. 

Smoking is commonly associated with COPD as a major risk factor. Research indicates that the progression rate of COPD can be mitigated when at-risk patients cease smoking, whereas individuals who smoke throughout their lives have a 50% chance of developing COPD at some point. Furthermore, it is noteworthy that the likelihood of developing COPD is reduced by approximately 50% upon quitting smoking (Laniado-Laborín et al. 2009). Both Chaiton et al. (2009) and Luger et al. (2014) provided evidence regarding the impact of smoking status on subsequent depression. In their studies, smokers exhibited approximately 60-70% higher odds of experiencing depression compared to non-smokers (OR (Luger) =1.62, 95% CI: 1.1 to 2.4; OR (Chaiton) =1.73, 95% CI: 1.32 to 2.4). 

Fluharty et al. (2017) conducted a systematic review of longitudinal studies examining the relationship between various aspects of smoking behaviour and the incidence of depression and anxiety. The findings were quite diverse, indicating that smoking is linked to both subsequent depression and anxiety, as well as the reverse. In summary, almost half of the studies indicated that initial depression or anxiety was correlated with some form of later smoking behaviour, while more than a third provided evidence that exposure to smoking was related to later depression or anxiety. Additionally, a report by Wotton et al. (2022) revealed that smoking elevates the risk of developing depression by 54% to 132% 

Patients diagnosed with COPD experience ongoing symptoms, including a persistent cough, difficulty in breathing, and an overproduction of sputum. COPD has emerged as the fourth leading cause of death worldwide and is anticipated to become the fifth leading cause of disability (Barnes, 2017). Asthma often occurs alongside allergies, with symptoms primarily stemming from airway hyperresponsiveness, which leads to bronchial constriction and airflow obstruction. Typically, asthma manifests as episodes or attacks. Symptoms such as wheezing, breathlessness, coughing, and chest tightness can be triggered by various factors, including respiratory infections, cold weather, tobacco smoke, air pollution, allergens, stress, physical activity, and other influences. The exact cause of asthma remains unclear, although genetic predispositions are thought to significantly contribute (Hikichi et al, 2018).

Fatigue is a distinctly subjective symptom that patients describe as a pervasive tiredness and a lack of energy, hindering their ability to carry out daily activities. This symptom frequently arises in the context of respiratory illnesses due to the effortful nature of breathing. Individuals suffering from asthma, COPD, or ACO may experience varying levels and frequencies of fatigue, which are contingent upon the underlying condition. It has been reported as the primary extrapulmonary symptom affecting between 70% and 95% of COPD patients, significantly impacting their prognosis. In cases of asthma, fatigue is primarily linked to exacerbation episodes, whereas those with COPD often endure fatigue daily. Psychosocial factors play a crucial role in the context of COPD. Given the chronic and progressive nature of the disease, patients face not only physical limitations but also frequently encounter reduced psychological and social functioning, which can implicitly influence the progression of the disease and the patient's social environment. Anxiety is a prevalent psychological issue among asthma patients, with a prevalence rate ranging from 16% to 52%. Likewise, approximately 40% of COPD patients report experiencing anxiety. The significance of depressive disorders is equally noteworthy, with studies indicating a 25% occurrence of depression in COPD patients and rates as high as 41% in those with asthma (Maurer et al. 2008; Szymanska-Chabowska et al, 2021).

Researchers indicate a connection between sleep quality and mental health in individuals suffering from COPD and asthma. According to Aldabayan (2023), sleep disorders are linked to the severity of asthma, while sleep quality in COPD patients plays a crucial role in determining their quality of life. In comparison to the general population, individuals with asthma and COPD experience nearly three times the rate of sleep disturbances, anxiety, and depression. The rates of poor sleep quality were found to be 17.5% and 32.6% among patients with asthma and COPD, respectively. The occurrence of anxiety and depression was reported at 38% and 49.5% among asthma patients, respectively. In patients with COPD, the prevalence rates were 48.9% and 34.7%, respectively.

Cognitive impairment is frequently observed in individuals suffering from chronic obstructive pulmonary disease (COPD). Elements such as reduced oxygen levels resulting from respiratory insufficiency, inflammation, and inflammatory agents like C-reactive protein (CRP) and interleukin-6 (IL-6), along with structural alterations in the brain, can influence cognitive impairment. Those with COPD who also experience cognitive impairment may face challenges in self-management, adherence to medication, and overall quality of life. In a systematic review conducted by Lone Schou and colleagues (2012), it was determined that cognitive impairment can be identified in patients with severe COPD. The interplay of various processes involved in daily cognitive tasks is intricate; however, cognitive ability is typically categorized into domains such as memory, learning capacity, attention/concentration, abstract reasoning, and problem-solving. 

In a systematic review, Torres-Sánchez et al. (2015) demonstrated a significant correlation between COPD and cognitive impairment. The cognitive domains that have been most extensively researched include memory and attention. Verbal memory and learning represent the second most frequently affected cognitive domain in individuals with COPD. The rates of impairment in visuospatial memory and intermediate visual memory are 26.9% and 19.2%, respectively. The authors concluded that cognitive impairment is linked to the severity profile of COPD and its associated comorbidities. Cognitive dysfunction diminishes the level of functioning as measured by activities of daily living and is linked to poor adherence to both medication and oxygen therapy, which in turn heightens the risk of acute exacerbations. The functioning of the brain may be negatively impacted by COPD, and magnetic resonance imaging (MRI) has revealed changes in cerebral perfusion in COPD patients exhibiting cognitive dysfunction as a clinical symptom (Ortapamuk & Naldoken, 2006). In a systematic review, Chen et al. (2024) explored whether COPD serves as an independent risk factor for cognitive impairment. When compared to individuals without COPD at baseline, those with COPD demonstrated an elevated risk of cognitive impairment. Subgroup analyses indicated that COPD is associated with a greater risk of non-amnestic mild cognitive impairment (na-MCI) compared to amnestic MCI.

At times, the connections between the two conditions remain unrecognized and untreated. Therefore, further research is essential to comprehend the relationship and determine the most effective management strategies. Improved identification and the dissemination of supportive services are crucial methods for enhancing the quality of patients' lives 

In promoting personalized care and treatment, the authors emphasize the significance of clinicians evaluating the connection between respiratory and mental health concerns, including anxiety, depression, sleep disturbances, and cognitive impairment.

Addressing mental health issues in individuals suffering from COPD and asthma necessitates a holistic approach that includes psychological treatments such as cognitive behavioural therapy (CBT) and medications such as antidepressants, as well as non-medical strategies like physical exercise, relaxation techniques, and pulmonary rehabilitation. 

Siraj (2025) presented findings that indicate pulmonary rehabilitation, as a non-pharmacological intervention, can enhance mood symptoms, improve functional capacity, and promote psychosocial resilience. Psychological therapies, including cognitive behavioural therapy (CBT), mindfulness-based strategies, and supportive counselling, have also shown effectiveness in alleviating emotional distress and enhancing coping strategies. Pharmacological treatments, especially selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are frequently prescribed for moderate to severe cases or when non-pharmacological methods are insufficient. Nevertheless, the evidence regarding their effectiveness in COPD populations is inconsistent, raising concerns about negative respiratory effects and high rates of discontinuation due to side effects.

Nursing management has been demonstrated to significantly enhance the quality of life, emotional well-being, and both pulmonary and physical capabilities in patients with COPD (Aranburu-Imatz et al, 2022).

The proactive engagement of pharmacists in the collaborative management of patients suffering from chronic respiratory conditions within clinical settings is crucial. According to Adisa et al. (2024), interventions led by pharmacists markedly improved medication adherence and the correct usage of inhalers among the cohort receiving the intervention. This was followed by a notable enhancement in asthma control and a decrease in the impact of COPD when compared to the control group. Pharmacists are uniquely positioned to offer information regarding disease awareness and risk prevention initiatives, as well as to promote lifestyle changes, such as quitting smoking. They frequently serve as the initial point of contact for patients within the healthcare system, thus enabling them to significantly contribute to the early detection of individuals with COPD. Pharmacists can aid patients by delivering guidance and education on medication dosage, inhaler usage, treatment expectations, and the significance of adherence, while also facilitating self-management, which includes recognizing and addressing COPD exacerbations. Additionally, they play a crucial role in monitoring patient adherence and the proper use of inhalers for those diagnosed with COPD (van der Molen et al, 2017).

It is crucial to uphold a healthy lifestyle that features balanced nutrition, sufficient sleep, and social engagement. Achieving this integrated care model requires collaboration between psychiatry and respiratory medicine. This comprehensive strategy ought to be executed in diverse environments, including acute or critical care settings, cases of substance use disorders coupled with respiratory diseases, chronic care facilities, psychiatric conditions associated with chronic respiratory illnesses, COVID-19, and psychiatry, particularly concerning the neuropsychiatric effects of COVID-19, the management of obstructive sleep apnoea (OSA) with psychiatric comorbidities, hyperventilation syndrome, and the pharmacological side effects of psychotropic medications (Bhattacharyya et al, 2022).

As stated by Cosio and colleagues (2025), a comprehensive integrated approach to managing COPD, asthma, and bronchiectasis that focuses on treatable traits, irrespective of the diagnostic label, leads to a more effective utilization of resources and improved clinical results. The involvement of a specialized respiratory nurse and a multidisciplinary team are crucial factors for enhancement.

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Author Contribution Statement: Both authors contributed to the literature search and to the writing up of the article and its review.