INTERACTION BETWEEN CLINICAL AND PSYCHOLOGICAL CHANGES AMONG PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND PULMONARY TUBERCULOSIS CO-MORBIDITY

The association of chronic obstructive pulmonary disease and pulmonary tuberculosis is an important medical and social problem with a significant burden interms of morbidity and mortality. The course and prognosis of chronic diseases such as chronic obstructive pulmonary disease and pulmonary tuberculosis is greatly influencednot only by the clinical features but also by the psychological characteristics of the patient.The aim: To study the interaction between clinical changes and psychological characteristics considering gender differences among patients with chronic obstructive pulmonarydisease in association with pulmonary tuberculosis.Materials and methods: We studied 41patients with chronic obstructive pulmonary disease (grade 2, 3, groups А, B, С, D) and infiltrative pulmonary tuberculosis co-morbidity(11 women and 30 men). All patients underwent general clinical examination, Acid-Fast Bacillus Testing, spirometry, Spielberg anxiety scale, Beck depression scale.Results: Patients with chronic obstructive pulmonary disease and pulmonary tuberculosis co-morbidity with more severe symptoms (according to Assesment Test scores)were older and, regardless of it, showed elevated depression and personal anxiety scores while situational anxiety scores were significantly lower compared to thosewith less severe symptoms. The correlation between symptoms severity and airflow limitation or smoking history was very mild. The elevated depression and personalanxiety could cause more severe symptoms. The revealed discrepancy between the symptoms severity and low levels of situational anxiety may be due to adaptation withdisplacement mechanisms to illness related chronic life stressors. We also observed elevated personal anxiety and depression scores together with less severe symptomsamong female versus male chronic obstructive pulmonary disease/pulmonary tuberculosis patients, possibly reflecting physically ill women’s higher risk for depressiveand anxiety related symptomatology relative to ill men.Conclusions: We revealed that among patients with chronic obstructive pulmonary disease and pulmonary tuberculosis co-morbidity symptoms severity was largely influencedby the patients’ age, gender and psychological factors (depression and personal anxiety), but, unexpectedly, much less – by airflow limitation and smoking history. We alsofound higher emotional distress, namely elevated personal anxiety and depression scores, in combination with less severe symptoms among female versus male patients withchronic obstructive pulmonary disease and pulmonary tuberculosis co-morbidity.