ORIGINAL RESEARCHES 377 www.journals.viamedica.pl Address for correspondence: Sima Rafei, Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran; e-mail: sima.rafe@gmail.com DOI: 10.5603/ARM.a2020.0122 Received: 13.03.2020 Copyright © 2020 PTChP ISSN 2451–4934 Mohammad Ali Zohal 1 , Sima Rafiei 1, 2 , Nafise Rastgoo 1 , Sanaz Jamshidi 1 1 Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran 2 Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran Exposure to stressful life events among patients with chronic obstructive pulmonary disease: a prospective study Abstract Introduction: Although depression and anxiety have been widely investigated among patients with chronic obstructive pulmonary disease (COPD), experiencing stressful life events and its effect on increasing risk of exacerbations was rarely assessed. This study aimed to clarify the association between facing with stressful events among COPD patients and their disease severity leading to hospitalization. Material and methods: A prospective study was conducted among 128 COPD patients from the population of Qazvin, a north- west, industrialized city of Iran from December 2017 to December 2018. Patients were followed up for one-year and their related measures were gathered. To compare variables among patients stratifed by reporting stressful life conditions, Pearson’s chi- -square and Fisher’s exact tests were used. Furthermore, to assess the effect of several covariates on the response variable, a logistic regression modelling was applied. Results were reported in form of odds ratios and their 95% confdence intervals. Results: Study fndings affrmed that patients who had experienced stressful situation had lower BMI, were retired, experienced more frequent exacerbations, and reported higher levels of anxiety/ depression. Moreover, those with stressful conditions were among current or former smokers (p < 0.05). Logistic regression analysis revealed that facing with stressful situations was signifcantly associated with the severity of COPD disease (OR 1.9; 95% CI 2.5 to 5.6), smoking habit (OR 2.8; 95% CI 1.6 to 4.2; OR 1.5; 95% CI 1.4 to 2.2), and hospitalization during one-year follow up (OR 1.2; 95% CI 1 to 3.3). Conclusions: To improve health outcomes of COPD patients, close attention should be given to their psychological disorder and appropriate strategies should be applied to reduce patients’ exposure to stressful life events and subsequent anxieties. Key words: anxiety, depression, stressful life event, chronic obstructive pulmonary disease, severity Adv Respir Med. 2020; 88: 377–382 Introduction Chronic obstructive pulmonary disease (COPD) is defned as a disease leading to reduced air fow in pulmonary function, and shortness of breath which is largely due to an exposure to irritants like air pollution, noxious particles or tobacco smoking [1, 2]. It is anticipated that the disease will have become the fourth prominent death cause and the seventh prominent factor of disability worldwide by 2030. High blood pres- sure, diabetes mellitus, lung cancer, ischemic heart disease, anxiety disorder, and depression are among important comorbidities for advanced COPD. Literature has affrmed that COPD patients who suffer from comorbidities are more likely to be hospitalized in a frequent manner [3]. Psy- chological issues like anxiety and depression are key factors which cause signifcant burden of mortality, and morbidity, among patients [4]. Indeed, patients with symptoms of depression experience more frequent hospitalization, failure in smoking cessation, and worse prognosis of the disease. Furthermore, such mental disorders might lead to desperateness, and distress among patients which subsequently would lead to a defective cycle that perpetuates anxiety and depression [5, 6]. Thus, addressing psychological disorders in