Depression, anxiety and chronic pain in patients with chronic obstructive pulmonary disease: the influence of breath

Abstract

Chronic obstructive pulmonary disease (COPD) is a major public health problems, causing significant mortality and morbidity in the world. It is a complex and progressive disease, characterized by chronic inflammation and dysfunction of the respiratory airways. The article reviews the available information on the potential role of the diaphragm in this disease. The purpose is to identify a potential correlation between symptoms such as depression, anxiety and chronic pain, frequently observed in COPD, with the activity of the diaphragm. The morphology and metabolism of the diaphragm are usually modified in the presence of COPD: a correlation between this symptoms and a pathological adaptation of breathing can be hypothesized. The management of these conditions should always be multidisciplinary, in order to have a global vision of the patient.

Network of Breathing. Multifunctional Role of the Diaphragm: A Review

“…For example, we find symptoms like chronic pain, anxiety and depression in chronic conditions such as COPD (chronic obstructive pulmonary disease) and CHF (chronic heart failure) [3]. Equally, we find chronic diaphragm dysfunction in these diseases.…”

“…The diaphragm has other properties related to the emotional sphere and the threshold of pain. The pain perception is reduced in inspiratory apnea, when the diaphragm is lowered [3]. A theory that would explain this phenomenon is the intervention of baroreceptors, which are found in the aortic arch and in the glomus caroticum.…”

“…The pressure generated by inhalation could affect the blood redistribution, which could be probably correlated with the response of baroreceptors and the reduction of pain perception [4]. The same perception of pain, particularly of the chronic type, can alter the function of the diaphragm, in a biunivocal relationship [3].…”

Ageing of the Diaphragm Muscle

“…They are sensitive and visceral afferents that make up the vagal information from the diaphragm [32]. The vagal diaphragmatic information reaches the nucleus of the solitary trait and will eventually be brought to the vestibular and limbic area [33]. The vagal efferences of the esophageal breath, derived from the rostral area from the level of obex within the lateral regions of the nucleus of the dorsal motor, are of the cholinergic and excitatory type and are independent of cardiac and respiratory activity [32].…”

Network of Breathing. Multifunctional Role of the Diaphragm: A review. Response to the Letter to Editor of Prof. Bordoni

“…An abnormal tension of the diaphragm in the region of the vagus nerve could cause a compression of the nerve, limiting its antinociceptive and anti-inflammatory ability. If the sympathetic nerves are compressed in the region of the diaphragm, their function and morphology can change, negatively affecting the innervated tissues [3].…”