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

Background 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. Methods 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. Results 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%). Conclusions 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.