The prevalence of panic disorder in chronic obstructive pulmonary disease: a systematic review, meta-analysis, and meta-regression

TL;DR

This study finds that panic disorder is more common in people with COPD than in healthy individuals, but less than previously thought.

Contribution

The study provides updated pooled prevalence estimates of panic disorder in COPD patients using systematic review and meta-analysis.

Findings

Panic disorder prevalence in COPD patients was 12.5% before outlier removal and 8.1% afterward.

PD was more common in COPD patients (9.7%) than in healthy controls (2.8%).

PD prevalence in COPD was not higher than in other medical conditions.

Abstract

Chronic obstructive pulmonary disease (COPD) symptoms of dyspnea and chest tightness overlap with some symptoms of panic attacks, the hallmark feature of panic disorder (PD). Our objective was to quantify PD prevalence in COPD from a systematic review and meta-analysis.

A database search from inception to January 2025 was performed using five electronic databases. Eligible studies utilized structured clinical psychiatric interviews to identify PD in adult populations with COPD derived from inpatient, outpatient, or general population sampling.

Twenty-one studies met inclusion criteria, with most from Asia (k = 9), reporting data from 1847 persons with COPD, 860 healthy controls, and 450 persons with comorbidities other than COPD. The prevalence of PD in persons with COPD was 12.5% (95% confidence interval [CI] 8.2–18.7, I2 = 90%), revised to 8.1% (95% CI 5.7–11.6, I2 = 73%) after the exclusion of k = 5 outliers. In case-control studies, PD was more prevalent in COPD patients (k = 9, 9.7%; 95% CI 5.9–15.4, I2 = 69%) than healthy controls (k = 6, 2.8%; 95% CI 1.7–4.6, I2 = 0%). There was no evidence to suggest a higher PD prevalence than in other medical conditions (k = 5, 4.8%; 95% CI 1.8–12.0, I2 = 47%).

The pooled estimates of PD in COPD were higher than the general population but markedly lower than suggested by prior narrative reviews. Further research needs to elucidate whether the characteristic symptoms of panic in COPD are similar to PD in non-COPD populations and, secondly, whether they lead to differential healthcare resource utilization and portend a higher risk for adverse outcomes.

CRD42024559743.

The online version contains supplementary material available at 10.1186/s13643-026-03102-3.

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