With other chronic conditions, it has been reported
that the ways in which patients cope with a stressful encounter seem to be influenced by the nature of the stressful event itself, their interpretation of the event, and their appraisal of their own emotional reactions to the event. Therefore, coping has been considered as a mediator in the relationship between stress and an adaptational outcome such as psychological distress. It is generally accepted that patients with COPD frequently have psychological distress, primarily depression and anxiety. Increased rates of psychological distress have been found in patients with COPD compared with healthy individuals and those with other medical conditions. In a previous study in hospitalized patients with acute COPD, the prevalence of psychological distress was 58%.