People with severe asthma and comorbid anxiety and depression may have associated symptoms that include dyspnea, dysfunctional breathing, and obesity, according to study findings published in Respiratory Research.
The clinical characteristics of comorbid severe asthma and anxiety/depression have not been well understood. Therefore, investigators sought to assess these clinical characteristics, using between-group differences associated with anxiety vs depression as the primary endpoint. Secondary endpoints were associations between health-related quality of life (HRQoL), asthma control, and clinical characteristics with anxiety and depressive symptoms.
This cross-sectional study included 140 adult participants with severe asthma recruited from respiratory ambulatory care clinics at John Hunter Hospital, Newcastle, New South Wales, Australia, between July 2012 and October 2016. Individuals who were non-English speaking, less than 18 years of age, had a current diagnosis of lung cancer, lymphatic or solid organ malignancy or life expectancy of less than 3 months were excluded.
The 140 participants were mostly female (62%), middle aged, and overweight (mean body mass index, 30.4); most had also been prescribed high-dose inhaled corticosteroids and 29% used daily oral corticosteroids as maintenance therapy. All participants had experienced at least 2 exacerbations within the past year; about 25% were currently using antidepressant/anxiolytic medications. The subgroup with both anxiety and depression included 83.3% women compared with the subgroup with neither anxiety nor depression, which had 52.7% women. Between the 2 subgroups, total exacerbations within the past year differed significantly — from a median of 4.4 exacerbations (range, 0-14) in the depression only subgroup vs a median 2.5 exacerbations (range, 0-12) in the subgroup without anxiety and depression (P =.04). Asthma control and HRQoL were poor overall.
To measure study endpoints, the investigators used the Asthma Quality of Life Questionnaire (AQLQ) for HRQoL, the Asthma Control Questionnaire (ACQ7) for asthma control, and the Hospital Anxiety and Depression Scale (HADS) for anxiety and depressive symptoms. Based on their HADS scale subscores, study participants were divided into 4 subgroups: (1) those without anxiety or depression (53% of participants); (2) those with anxiety (7%); (3) those with depression (26%); and (4) those with both the anxiety and depression (13%).
People with severe asthma and anxiety and/or depressive symptoms have poorer QoL and asthma control. Dyspnoea, dysfunctional breathing and obesity are associated with these symptoms. These key clinical characteristics should be targeted in severe asthma management.
The investigators found that mean (SD) quality of life impairment was greater in participants with anxiety and depression (4.4 [1.1]) and in those with just depression (4.4 [1.2]). They noted worse asthma control in those with anxiety and depression (2.6 [1.0]) and in those with just depression (2.9 [1.1]).
Multivariate models revealed dyspnea was associated with depression (odds ratio [OR], 1.90, 95% CI, 1.10-3.25; P =.02). Obesity (OR, 1.17; 95% CI, 1.00-1.35; P =.04) and dysfunctional breathing (OR, 1.16; 95% CI, 1.04-1.23; P =.01) were associated with combined anxiety and depression. Dysfunctional breathing was associated with symptoms of anxiety (OR, 1.24; 95% CI, 1.01-1.53; P =.04).
Study limitations include the cross-sectional design, unaccounted for confounding variables, and the use of the Nijmegen Questionnaire (which was developed to assess hyperventilation syndrome associated with anxiety) to assess severe asthma.
Investigators concluded that “People with severe asthma and anxiety and/or depressive symptoms have poorer QoL and asthma control. Dyspnoea, dysfunctional breathing, and obesity are associated with these symptoms. These key clinical characteristics should be targeted in severe asthma management.”