Perceived Stress Linked to Worse Outcomes in Severe COPD, suggests study

A new study published in the Journal of the COPD Foundation showed that perceived stress significantly worsens respiratory symptoms and increases the risk of exacerbations, especially in individuals with severe chronic obstructive pulmonary disease (COPD). Higher stress scores correlated with poorer respiratory health, suggesting that managing psychosocial stress may be a valuable therapeutic strategy to improve outcomes and quality of life in COPD patients.

High levels of perceived stress are linked to poorer outcomes in cardiovascular disease, and biopsychosocial pathways have been found to be predictive of disease outcomes. It is unclear whether high perceived stress levels in people with COPD affect respiratory outcomes, and little is known about the ways in which psychosocial variables contribute to COPD.

Social determinants of health have been linked to worse respiratory outcomes and disproportionately impact those with chronic obstructive pulmonary disease (COPD). The relationship between perceived stress and respiratory outcomes as well as specific biological pathways in ex-smokers with COPD is assessed in this study.

The participants were evaluated at baseline, 3 months, and 6 months. Surveys evaluated respiratory symptoms, the frequency of COPD exacerbations, and perceived stress (as measured by the Perceived Stress Scale, or [PSS]). The relationship between PSS score and COPD outcomes and biomarkers of inflammation, oxidative stress (urine thiobarbituric acid reactive substances [TBARS], 8-hydroxydeoxyguanosine, and 8-isoprostane), and platelet activation (urine 11-dehydro-thromboxane B2 [11dTxB2]) was assessed using generalized linear mixed models.

The median PSS score for all visits among the 99 participants was 13 (interquartile range: 8–18). Point estimates for high perceived stress were more than clinically significant differences, and they were linked to lower respiratory health status and respiratory-related quality of life when compared to low perceived stress (PSS 0–13), moderate perceived stress (PSS 14–26), and high perceived stress (PSS 27–40).

The only factor linked to more moderate/severe exacerbations was high PSS. High stress was linked to increased 8-isoprostane and decreased TBARS when compared to mild stress. In mild-to-moderate COPD patients, moderate and high levels of stress were linked to greater 11dTxB2 than low levels.

Overall, perceived stress was linked to poorer respiratory morbidity, particularly in those with severe COPD, and to higher levels of systemic platelet activation and lipid peroxidation in people with mild-moderate COPD. This study implies that those with milder COPD may have a link between psychological stress and unfavorable biological systems that might be therapeutic targets.

Source:

Offor, O., Eakin, M. N., Woo, H., Belz, D., Williams, M., Raju, S., McCormack, M., Hansel, N. N., Putcha, N., & Fawzy, A. (2025). Perceived stress is associated with health outcomes, platelet activation, and oxidative stress in COPD. Chronic Obstructive Pulmonary Diseases (Miami, Fla.), 12(2), 98–108. https://doi.org/10.15326/jcopdf.2024.0561