Anxiety, depression, and asthma control: Changes after standardized treatment

Publication date: Available online 15 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Joaquin Sastre, Astrid Crespo, Toni Fernandez-Sanchez, Manuel Rial, Vicente Plaza
BackgroundIt has been documented that anxiety and depression are prevalent in patients with asthma and are associated with greater frequency of exacerbations, increased use of health-care resources, and poor asthma control.ObjectivesOur study examined not only the association of asthma diagnosis with symptoms of depression/anxiety and asthma control at baseline, but also over a 6-month period of specialist supervision.MethodsWe enrolled 3,182 patients with moderate-severe asthma. All were evaluated with spirometry, ACT, and HADS (Hospital Anxiety and Depression Scale) at baseline and at 6 months. Treatments were decided by specialists according to published guidelines.ResultsAt baseline, 24.2% and 12% of patients were diagnosed with anxiety and depression, respectively, according to HADS. After 6 months, anxiety and depression improved, affecting 15.3% and 8.1% of patients, respectively (p<0.001); mean FEV1 and asthma control also improved (FEV1 from 81.6±20.9% to 86±20.8%; ACT from 15.8 ±4.7 to 19.4± 4.4; both p<0.001).Patients with anxiety and depression used significantly more health-care resources and had more exacerbations. A multivariate analysis showed that patients with anxiety, depression, and lower FEV1 (OR 0.20, 0.34, 0.62; p<.001, respectively) were independently associated with poor asthma control. A multiple linear regression analysis showed that anxiety had a nearly four-fold greater influence over asthma control than depression (0.326 / 0.85 = 4.075)ConclusionsUnder standardized asthma care and after a specific visit with the specialist, patients present significant improvement in these psychological disorders and exhibit better asthma control and functional parameters.