Anxiety and depression impact exertional breathlessness in daily life and during exercise testing: the CanCOLD study

Background Exertional breathlessness is a major limiting symptom that often coexists with anxiety and depression. We tested the hypothesis that anxiety and depression negatively impact exertional breathlessness in both daily life and during standardized cardiopulmonary exercise testing (CPET). Methods Analysis of people aged ≥40 years undergoing incremental cycle CPET. Exertional breathlessness in daily life was assessed using the Medical Research Council (MRC) scale, and using CPET normative reference equations. Abnormal exertional breathlessness on CPET was defined as a breathlessness (Borg 0–10) intensity rating above the upper limit of normal at peak exercise. Associations of anxiety and depression (Hospital Anxiety and Depression Scale (HADS)) with exertional breathlessness were analyzed using multivariable regression models adjusting for anthropometrics, smoking, comorbidities, and lung function at rest and during CPET. Results Across 1155 participants (42% women; aged 66±10 years), anxiety and depression (HADS≥8) were present in 12% and 6%, exertional breathlessness in daily life (MRC≥3) in 5%, and abnormal breathlessness on CPET in 22% by W and 16% by V’ E . Worse anxiety and depression scores were independently associated with perceiving worse breathlessness in daily life ([odds ratio] 1.08 [95%CI, 0.98–1.19] and 1.18 [1.06–1.31]) and more abnormal breathlessness on CPET both in relation to W and V’ E (p<0.001 for all analyses). Conclusion This is the first study to show that the association between anxiety and depression and worse breathlessness in daily life holds on standardized CPET, independent of a wide range of markers of disease severity – making these psychological symptoms important therapeutical targets.