Sue Binnall, 61, a former administrative assistant and a grandmother of eight with a big laugh, always had been independent and upbeat. Then came a diagnosis in 1995 of chronic obstructive pulmonary disease. In 2000, after treatment for breast cancer, her COPD worsened, forcing her to use round-the-clock supplemental oxygen. Her doctors told her she had a genetic form of COPD known as alpha-1 antitrypsin deficiency alpha-1, or inherited emphysema. “I was still suffering the downside of cancer,” she says. “And then I was hit with alpha-1.” Binnall became depressed and began to spend days sitting and crying, not caring if her house was clean. Such feelings of sadness are common among people with COPD. Between 28 percent and 42 percent of people with COPD suffer from depression, more than the nearly 7 percent among the general population, notes Dr. Nicola Hanania, associate professor of medicine at Baylor College of Medicine in Houston, Texas. Anxiety is even more common, says Dr. Paul A. Pirraglia, assistant professor of medicine at Brown University in Providence, R.I., whose study of COPD, depression and anxiety appears in a 2011 issue of Journal of Psychosomatic Research. One-third to one-half of people with COPD experience anxiety, and sometimes anxiety and depression overlap, Pirraglia says. Depression isn’t correlated with the severity of lung disease, however. It’s the fatigue and restriction brought about by lung disease—moderate or severe—that increases the likelihood of depression.