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Lee Y, Lee SK, Park SY, Kim MH, Kang SY, Ban GY, Nam YH, Kim JH, Rhee CK, Song WJ, Kwon JW, Lee T, Kim SR, Park HW, Cho YS, Koh YI, Yoo KH, Lee BJ, Yoon HJ, Park HS, Kim SH. Work-related asthma in adults with severe asthma from the Korean Severe Asthma Registry (KoSAR). World Allergy Organ J 2024; 17:100903. [PMID: 38818085 PMCID: PMC11137527 DOI: 10.1016/j.waojou.2024.100903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 06/01/2024] Open
Abstract
Background Exposure to allergens or irritants in the workplace may affect asthma control and the quality of life (QoL) of patients with asthma. Objective To examine the prevalence and characteristics of work-related asthma (WRA) in adult patients with severe asthma. Methods We analyzed data from the Korean Severe Asthma Registry (KoSAR), which is a nationwide multicenter observational study on severe asthma in Korea. Severe asthma was defined according to the American Thoracic Society (ATS) and the European Respiratory Society (ERS) guidelines. WRA was identified on the basis of asthma symptom aggravation at the workplace, as indicated by responses to a structured questionnaire. We compared the demographic and clinical characteristics and QoL between adult patients with severe asthma and WRA and those without WRA. Results Among 364 patients with severe asthma who were employed at the time of enrollment, 65 (17.9%) had WRA. There were no significant differences in age, sex, obesity, or smoking history between the WRA and non-WRA groups. However, individuals with WRA exhibited a higher prevalence of anxiety (7.7% vs 2.4%, P = 0.046) and depression (12.3% vs 3.7%, P = 0.010) than those without. The levels of asthma control, lung function, and frequency of asthma exacerbations were similar between the two groups, but patients with WRA reported lower QoL, as determined by the Quality of Life Questionnaire for Adult Korean Asthmatics (56.6 ± 14.6 vs. 63.5 ± 13.9, P < 0.001). Conclusion Patients with severe asthma and WRA are more likely to experience anxiety and depression and have lower QoL than those without WRA.
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Affiliation(s)
- Youngsoo Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Sun-Kyung Lee
- Department of Mathematics, College of Natural Sciences, Hanyang University, Seoul, South Korea
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - So-Young Park
- Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, South Korea
| | - Min-Hye Kim
- Department of Internal Medicine, Ewha Woman's University College of Medicine, Seoul, South Korea
| | - Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Ga-Young Ban
- Department of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Young-Hee Nam
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea
| | - Joo-Hee Kim
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, South Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae-Woo Kwon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Taehoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - So Ri Kim
- Division of Respiratory Medicine and Allergy, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, South Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Il Koh
- Division of Allergy, Asthma and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea
| | - Kwang-Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Byung-Jae Lee
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ho Joo Yoon
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Sang-Heon Kim
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
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Dill-McFarland KA, Altman MC, Esnault S, Jarjour NN, Busse WW, Rosenkranz MA. Molecular pathways underlying lung-brain axis signaling in asthma: Relevance for psychopathology and neuroinflammation. J Allergy Clin Immunol 2024; 153:111-121. [PMID: 37730134 PMCID: PMC10841090 DOI: 10.1016/j.jaci.2023.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Accumulating evidence indicates that asthma has systemic effects and affects brain function. Although airway inflammation is proposed to initiate afferent communications with the brain, the signaling pathways have not been established. OBJECTIVE We sought to identify the cellular and molecular pathways involved in afferent lung-brain communication during airway inflammation in asthma. METHODS In 23 adults with mild asthma, segmental bronchial provocation with allergen (SBP-Ag) was used to provoke airway inflammation and retrieve bronchoalveolar lavage fluid for targeted protein analysis and RNA sequencing to determine gene expression profiles. Neural responses to emotional cues in nodes of the salience network were assessed with functional magnetic resonance imaging at baseline and 48 hours after SBP-Ag. RESULTS Cell deconvolution and gene coexpression network analysis identified 11 cell-associated gene modules that changed in response to SBP-Ag. SBP-Ag increased bronchoalveolar lavage eosinophils and expression of an eosinophil-associated module enriched for genes related to TH17-type inflammation (eg, IL17A), as well as cell proliferation in lung and brain (eg, NOTCH1, VEGFA, and LIF). Increased expression of genes in this module, as well as several TH17-type inflammation-related proteins, was associated with an increase from baseline in salience network reactivity. CONCLUSIONS Our results identify a specific inflammatory pathway linking asthma-related airway inflammation and emotion-related neural function. Systemically, TH17-type inflammation has been implicated in both depression and neuroinflammation, with impacts on long-term brain health. Thus, our data emphasize that inflammation in the lung in asthma may have profound effects outside of the lung that may be targetable with novel therapeutic approaches.
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Affiliation(s)
| | - Matthew C Altman
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Wash; Systems Immunology Program, Benaroya Research Institute, Seattle, Wash
| | - Stephane Esnault
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin-Madison, Madison, Wis
| | - Nizar N Jarjour
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin-Madison, Madison, Wis
| | - William W Busse
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin-Madison, Madison, Wis
| | - Melissa A Rosenkranz
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, Wis; Department of Psychiatry, University of Wisconsin-Madison, Madison, Wis.
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Lin ERH, Roeckner AR, Fani N, Merrill N, Gillespie CF, Ely TD, Bradley B, Michopoulos V, Powers A, Jovanovic T, Stevens JS. Association between dimensions of trauma-related psychopathology and asthma in trauma-exposed women. Front Behav Neurosci 2023; 17:1268877. [PMID: 38025383 PMCID: PMC10648896 DOI: 10.3389/fnbeh.2023.1268877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Exposure to traumatic events and stressful life experiences are associated with a wide range of adverse mental and physical health outcomes. Studies have found post-traumatic stress disorder (PTSD), depression, and anxiety sensitivity occurrence to be common in addition to inflammatory diseases like asthma, especially in women. Moreover, overlapping neurobiological mechanisms have been linked to both PTSD and asthma. Methods In the current study, n = 508 women reported on presence of lifetime asthma diagnosis and symptoms of trauma-related psychopathology including PTSD and depression. A separate group of female participants (n = 64) reported on asthma, PTSD, depression and anxiety sensitivity, and underwent functional MRI scans during a fearful faces task, and their anterior insula responses were analyzed. Results Overall, PTSD and depression severity were significantly higher in those with asthma versus those without asthma. There was a positive association between anterior insula response to social threat cues and depression symptoms only among individuals without a lifetime presence of asthma. Discussion These findings provide continued evidence on the interactions between stress, neural mechanisms involved in interoception and salience detection, and trauma-related psychopathology.
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Affiliation(s)
- Esther R.-H. Lin
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Alyssa R. Roeckner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Natalie Merrill
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Charles F. Gillespie
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Timothy D. Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
- Atlanta VA Health Care System, Atlanta, GA, United States
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Tanja Jovanovic
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
- Atlanta VA Health Care System, Atlanta, GA, United States
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Bai L, Xu Y, Pan T, Zhang Y, Zhou X, Xu J. Leukotriene Receptor Antagonists and Risk of Neuropsychiatric Entities: A Meta-Analysis of Observational Studies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:844-854.e9. [PMID: 36473625 DOI: 10.1016/j.jaip.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Leukotriene receptor antagonists (LTRAs) are commonly prescribed to patients with allergic diseases. Several case reports and pharmacovigilance studies have indicated that LTRAs might increase the risk of neuropsychiatric (NP) entities. However, the results are mixed in observational studies. Thus, the association between LTRAs and NP entities remains controversial. OBJECTIVE To quantitatively evaluate the NP risk with LTRAs based on current observational studies to provide a reference for clinical practice. METHODS We systematically reviewed the literature in Medline, Embase, Web of Science, Cochrane Library, Scopus, and PsycINFO. A meta-analysis of observational studies that investigated the association between LTRA use and the risk of NP entities was performed. Odds ratios (OR) with 95% confidence intervals (CI) were used to measure the effect; heterogeneity was evaluated using I-squared (I2) statistics. Subgroup and sensitivity analyses were conducted to assess bias. RESULTS Eleven articles were included in the primary analysis. No significant association was found between LTRA use and NP entities (OR: 1.08, 95% CI: 0.93-1.24, I2 = 93.7%). In patients with allergic rhinitis (AR), a mildly increased NP risk was found (OR: 1.099, 95% CI: 1.004-1.202). The association between LTRA use and NP entities was not significant in patients with asthma (OR: 1.06, 95% CI: 0.90-1.26). LTRAs increased the risk of NP entities in a single study using data from an asthma clinic (OR: 9.00, 95% CI: 1.20-69.50), but not in studies from databases (OR: 1.07, 95% CI: 0.93-1.23). CONCLUSION At the population level, LTRAs and NP entities were unrelated. However, the association may exist in particular groups (eg, patients with AR or NP history). Subject-specific studies are required to further examine the relationship between LTRAs and NP entities and identify the underlying mechanisms.
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Affiliation(s)
- Le Bai
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yong Xu
- School of Chinese Medicine, School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Tingyu Pan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Ying Zhang
- Department of Stomatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xianmei Zhou
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Respiratory Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China.
| | - Jie Xu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Respiratory Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
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MacNeil A, Li G, Jiang Y, de Groh M, Fuller-Thomson E. Incident and recurrent depression among older adults with asthma during the COVID-19 pandemic: Findings from the Canadian Longitudinal Study on Aging. Respir Med 2023; 213:107003. [PMID: 36641372 PMCID: PMC9834561 DOI: 10.1016/j.rmed.2022.107003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/17/2022] [Accepted: 09/24/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVES (1) In a subsample of older adults with asthma without a history of depression, to determine the factors associated with developing depression during the COVID-19 pandemic; (2) in a subsample of older adults with asthma with a history of depression, to identify factors associated with recurrent depression during the pandemic. METHODS Data came from four waves (Baseline [2011-2015], Follow-up 1 [2015-2018]; COVID Spring 2020, COVID Autumn 2020) of the Canadian Longitudinal Study on Aging's comprehensive cohort (n = 2,047 with asthma). The outcome of interest was a positive screen for depression based on the CES-D-10 during the autumn of 2020. Bivariate and multivariate logistic regression analyses were conducted. RESULTS Among older adults with asthma without a history of depression (n = 1,247), approximately 1 in 7 (13.5%) developed depression for the first time during the COVID-19 pandemic. Among those with a history of depression (n = 770), approximately 1 in 2 (48.6%) experienced a recurrence of depression. The risk of incident depression and recurrent depression was higher among those who were lonely, those experiencing family conflict during the pandemic, and those who had difficulty accessing healthcare resources during the pandemic. The risk of incident depression only was higher among those who had difficulty accessing resources and/or loss of income during the pandemic. The risk of recurrent depression only was higher among those with functional limitations. CONCLUSIONS There is a need for targeted interventions to support the mental health of older adults with asthma who have the above identified vulnerabilities during the pandemic.
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Affiliation(s)
- Andie MacNeil
- Factor-Inwentash Faculty of Social Work, University of Toronto, Canada,Institute for Life Course and Aging, University of Toronto, Canada
| | - Grace Li
- Department of Sociology, University of Victoria, Canada
| | - Ying Jiang
- Applied Research Division, Center for Surveillance and Applied Research, Public Health Agency of Canada, Canada
| | - Margaret de Groh
- Applied Research Division, Center for Surveillance and Applied Research, Public Health Agency of Canada, Canada
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Canada,Institute for Life Course and Aging, University of Toronto, Canada,Corresponding author. Institute for Life Course & Aging, Factor-Inwentash Faculty of Social Work, Cross-appointed to Faculties of Medicine & Nursing, University of Toronto, 246 Bloor St. West, Toronto, ON, M5S 1V4, Canada
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Feldman JM, Becker J, Arora A, DeLeon J, Torres-Hernandez T, Greenfield N, Wiviott A, Jariwala S, Shim C, Federman AD, Wisnivesky JP. Depressive Symptoms and Overperception of Airflow Obstruction in Older Adults With Asthma. Psychosom Med 2021; 83:787-794. [PMID: 33938504 PMCID: PMC8419010 DOI: 10.1097/psy.0000000000000951] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Older adults are at increased risk for depression and poor asthma outcomes. We examined whether depressive symptoms are associated with overperception of airflow obstruction and a pattern of worse asthma control, but not pulmonary function. METHODS We recruited a cohort of adults with asthma 60 years and older in East Harlem and the Bronx, New York. Baseline measures included the Geriatric Depression Scale, Asthma Control Questionnaire, and Mini Asthma Quality of Life Questionnaire. Spirometry was conducted at baseline to assess pulmonary function. Perception of airflow obstruction was assessed for 6 weeks following baseline by participants entering estimates of peak expiratory flow (PEF) into a programmable peak flow meter followed by PEF blows. Participants were blinded to actual PEF values. The percentage of time that participants were in the overperception zone was calculated as an average. RESULTS Among the 334 participants (51% Hispanic, 25% Black), depressive symptoms were associated with overperception of airflow obstruction (β = 0.14, p = .029), worse self-reported asthma control (β = 0.17, p = .003), and lower asthma-related quality of life (β = -0.33, p < .001), but not with lung function (β = -0.01, p = .82). Overperception was also associated with worse self-reported asthma control (β = 0.14, p = .021), but not lung function (β = -0.05, p = .41). CONCLUSIONS Depressive symptoms were associated with greater perceived impairment from asthma, but not pulmonary function. Overperception of asthma symptoms may play a key role in the relationship between depression and asthma outcomes in older adults.
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Affiliation(s)
- Jonathan M Feldman
- From the Ferkauf Graduate School of Psychology (Feldman, Greenfield, Wiviott), Yeshiva University; Division of Academic General Pediatrics, Department of Pediatrics (Feldman, DeLeon, Torres-Hernandez), Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx; Division of General Internal Medicine (Becker, Arora, Federman, Wisnivesky), Icahn School of Medicine at Mount Sinai, New York; Division of Allergy/Immunology, Department of Medicine (Jariwala), Albert Einstein College of Medicine/Montefiore Medical Center; Division of Pulmonary Medicine, Department of Medicine (Shim), Jacobi Medical Center/Albert Einstein College of Medicine, Bronx; and Division of Pulmonary, Critical Care and Sleep Medicine (Wisnivesky), Icahn School of Medicine at Mount Sinai, New York, New York
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Depression Levels Influence the Rate of Asthma Exacerbations in Females. J Pers Med 2021; 11:jpm11060586. [PMID: 34205619 PMCID: PMC8235599 DOI: 10.3390/jpm11060586] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Anxiety and depression are common psychological disturbances among asthmatic patients. The aim of the present study is the assessment of anxiety and depression in asthmatic patients and their correlation with symptoms control level and number of exacerbations per year. Methods: One hundred patients with asthma diagnosis, according to the Global Initiative for Asthma (GINA), aged > 18 years old, having a stable disease, were included. Emotional status was evaluated using the Hospital Anxiety Depression Scale (HADS). Patients were followed up for a year to assess the number and severity of exacerbations. Results: Most of our patients were female (58%), middle-aged (mean = 54 ± 13), and married (81%), with low frequency of smoking habits (smokers, ex-smokers and non-smokers were 26%, 30% and 37%, respectively) and low levels of both anxiety and depression [median (interquartile range (IQR)) = 4(2) and median (IQR) = 4(2), respectively]. At the low and moderate level of the depression subscale, female patients experienced asthma exacerbations more frequently compared to male patients (adjusted Incidence Rate Ratio (aIRR) = 4.30; 95% Confidence Interval (CI): 1.94–9.53 and aIRR = 1.82; 95% CI: 1.07–3.13, respectively). Conclusions. Clinicians should evaluate asthma patients for depression, as gender differentially influences outcomes among those with low and moderate levels of depression, with female asthmatics presenting more frequent exacerbations.
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Win-Shwe TT, Yanagisawa R, Koike E, Takano H. Dietary exposure to bisphenol A affects memory function and neuroimmune biomarkers in allergic asthmatic mice. J Appl Toxicol 2021; 41:1527-1536. [PMID: 33474794 DOI: 10.1002/jat.4143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/28/2020] [Accepted: 01/13/2021] [Indexed: 01/24/2023]
Abstract
Bisphenol A (BPA) is a raw material of polycarbonate and epoxy resin. It is used for various household electrical appliances, electronic equipment, office automation equipment, medical equipment, mobile phones, paints for automobiles, internal surface coating of cans, and adhesives for civil engineering and construction. BPA is a well-known endocrine-disrupting chemical, and it was reported that BPA has an adverse effect on the nervous and immune systems. However, BPA-induced memory impairment and changes in neuroimmune biomarkers in the allergic asthmatic subject are not known yet. We aim to investigate the dietary exposure effect of BPA on brain function and biomarkers using allergic an asthmatic mouse model. Five-week-old male C3H/HeJSlc mice were fed two doses of BPA [0.901, 9.01 μg/kg/day] contained chow diet from 5 to 11 weeks old and ovalbumin (OVA) was given by intratracheal instillation every 2 weeks. Memory function was determined by a novel object recognition test. Genes related to memory and immune markers in the hippocampus were investigated with the real-time polymerase chain reaction (RT-PCR) method. In this study, impaired novel object recognition occurred in BPA-exposed mice in the presence of an allergen. Moreover, upregulation of expression level of neuroimmune biomarkers such as N-methyl-D-aspartate receptor, tumor necrosis factor-α, ionized calcium-binding adapter molecule-1, cyclooxygenase-2, and heme oxygenase-1 in the hippocampus was observed in BPA-exposed allergic asthmatic mice. These findings show that BPA exposure can induce neuroinflammation and which triggers impairment of memory function in mice with allergic asthma. Our study indicated that dietary exposure to BPA may affect higher brain functions by modulating neuroimmune biomarkers in allergic asthmatic subjects.
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Affiliation(s)
- Tin-Tin Win-Shwe
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan
| | - Rie Yanagisawa
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan
| | - Eiko Koike
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan
| | - Hirohisa Takano
- Graduate School of Global Environmental Studies, Kyoto University, Kyoto, Japan
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Tel BC, Telli G, Onder S, Nemutlu E, Bozkurt TE. Investigation of the relationship between chronic montelukast treatment, asthma and depression-like behavior in mice. Exp Ther Med 2020; 21:27. [PMID: 33262813 PMCID: PMC7690246 DOI: 10.3892/etm.2020.9459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/26/2020] [Indexed: 12/13/2022] Open
Abstract
In 2008, the Food and Drug Administration of the US issued a warning about the neuropsychiatric side effects of montelukast. Previous clinical studies on montelukast have reported conflicting results and, to the best of our knowledge, no experimental studies concerning these side effects had been conducted. In the current study, the effect of montelukast on depression-like behavior in an ovalbumin (OVA)-induced mouse model was investigated. A total of 3 OVA challenges were applied at 2 week intervals for the persistence of asthma. Depression-like behavior was assessed using forced swim tests following each challenge and locomotor activities were evaluated using open field tests. At the end of the current study, plasma montelukast concentrations were measured and the development of asthma and effect of montelukast treatment were histopathologically examined. Inflammation scores that were increased in the OVA mice following all challenges were indicated to be reduced by montelukast treatment. The immobility time of mice increased beginning with the first challenge and this was also reduced by montelukast treatment. Montelukast administration to the control mice did not alter immobility times. Moreover, motor activity of the OVA and montelukast-treated mice were not altered. The results indicated there was no association between chronic montelukast treatment and depression. Furthermore, the chronic administration of montelukast to non-asthmatic mice did not increase immobility. However, depressive behavior increased at all time points in the OVA mice. These results indicated that chronic montelukast treatment is not associated with depression-like behavior and confirmed the association between asthma and depression. Further studies are required to provide an improved understanding of the neuropsychiatric side effects of montelukast.
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Affiliation(s)
- Banu Cahide Tel
- Department of Pharmacology, Hacettepe University Faculty of Pharmacy, Ankara, Sihhiye 06100, Turkey
| | - Gokcen Telli
- Department of Pharmacology, Hacettepe University Faculty of Pharmacy, Ankara, Sihhiye 06100, Turkey
| | - Sevgen Onder
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Sihhiye 06100, Turkey
| | - Emirhan Nemutlu
- Department of Analytical Chemistry, Hacettepe University Faculty of Pharmacy, Ankara, Sihhiye 06100, Turkey
| | - Turgut Emrah Bozkurt
- Department of Pharmacology, Hacettepe University Faculty of Pharmacy, Ankara, Sihhiye 06100, Turkey
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Robinson R, Barber K, Jones G, Blakey J, Burhan H. Exploring the relationship between generalised anxiety/depression scales and asthma-specific quality of life/control questionnaires in a specialist asthma clinic. J Asthma 2020; 58:912-920. [PMID: 32186425 DOI: 10.1080/02770903.2020.1744640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Psychological issues are common in patients with chronic disabling diseases such as asthma. National guidance recommends that specialist asthma clinic attendees should complete questionnaires screening for psychological comorbidities. However, completing these in addition to asthma specific questionnaires can be burdensome. In order to investigate whether anxiety and depression questionnaires can be used in a targeted manner, this study investigates the correlation between the respective scores. We hypothesize that there is correlation between asthma-specific and anxiety/depression questionnaire scores. METHODS Three-hundred individuals with poorly controlled asthma attending a specialist clinic were asked to complete Asthma Control Questionnaire (ACQ), mini-Asthma Quality of Life Questionnaire (mini-AQLQ), Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaires (PHQ-9). A Pearson correlation coefficient was generated and area under ROC and confusion matrices were used to assess correlation. RESULTS 49% and 47% of patients completing the GAD-7 or PHQ-9 questionnaires, respectively had scores above the screening level for co-morbid anxiety and depression. Additional questionnaires were often incomplete (GAD-7 = 150 and PHQ-9 = 140). GAD-7 and PHQ-9 correlated with ACQ and mini-AQLQ (all p = <0.001, r values 0.53-0.65). Asthma-specific questionnaire scores were predictive of GAD-7 and PHQ-9 scores (AUCs of 0.78 to 0.84). 75% of patients with a mini-AQLQ score of <3 met the threshold GAD-7 and PHQ-9 score of 10. CONCLUSIONS ACQ and mini-AQLQ correlate with GAD-7 and PHQ-9 amongst specialist asthma clinic attendees. A mini-AQLQ >3 suggests patients are unlikely to have anxiety or depression. These findings could be used to identify patients requiring formal screening for psychological co-morbidity.
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Affiliation(s)
- R Robinson
- Respiratory Medicine, Royal Liverpool University Hospital, Liverpool, UK
| | - K Barber
- Respiratory Medicine, Countess of Chester Hospital, Chester, UK
| | - G Jones
- Respiratory Medicine, Royal Liverpool University Hospital, Liverpool, UK
| | - J Blakey
- Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia.,Curtin University Medical School, Perth, Australia
| | - H Burhan
- Respiratory Medicine, Royal Liverpool University Hospital, Liverpool, UK
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11
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Sohn KH, Song WJ, Kim SH, Jang HC, Kim KW, Chang YS. Chronic cough, not asthma, is associated with depression in the elderly: a community-based population analysis in South Korea. Korean J Intern Med 2019; 34:1363-1371. [PMID: 31610633 PMCID: PMC6823556 DOI: 10.3904/kjim.2018.187] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 09/27/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIMS Depression and allergic diseases, including asthma, are frequently reported as comorbid conditions. However, their associations have been rarely examined in community-based elderly populations. METHODS The analyses were performed using the baseline data set of the Korean Longitudinal Study of Health and Aging, which consists of 1,000 elderly participants (aged > 65 years) randomly recruited from an urban community. Depression was assessed using the Geriatric Depression Scale, Center for Epidemiologic Studies Depression Scale, and Hamilton Rating Scale for Depression. Major and minor depressive disorders were diagnosed by psychiatrists. Allergic conditions were assessed using structured questionnaires, lung function, and skin prick test. Quality of life and comorbidities were assessed using structured questionnaires. RESULTS Prevalence of asthma and major depressive disorder were 5.4% and 5.3%, respectively. The rate of depression was not significantly different between the non-asthmatic and asthmatic groups. No correlation was observed between the scores obtained using the depression scales and self-reported asthma. However, chronic, frequent, and nocturnal cough were significantly associated with depression and scores obtained using the depression scales, which remained significant in multivariate logistic regression analyses (chronic cough: odds ratio [OR], 3.23; 95% confidence interval [CI], 2.57 to 12.74; p = 0.04). Rhinitis was independently associated with high Mini-Mental State Examination scores (OR, 1.11; 95% CI, 1.05 to 1.17; p < 0.001) and low 36-item short-form (OR, 0.96; 95% CI, 0.80 to 0.98; p = 0.002). CONCLUSION Depression may not be significantly associated with asthma and allergic diseases in elderly populations, but cough is a significant factor affecting depression.
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Affiliation(s)
- Kyoung-Hee Sohn
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Woo-Jung Song
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Allergy and Immunology, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hak-Chul Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Correspondence to Yoon-Seok Chang, M.D. Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7023 Fax: +82-31-716-8349 E-mail:
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12
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Win-Shwe TT, Yanagisawa R, Koike E, Takano H. Memory Function, Neurological, and Immunological Biomarkers in Allergic Asthmatic Mice Intratracheally Exposed to Bisphenol A. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193770. [PMID: 31597243 PMCID: PMC6801617 DOI: 10.3390/ijerph16193770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/29/2019] [Accepted: 10/04/2019] [Indexed: 01/07/2023]
Abstract
Bisphenol A (BPA) is a major constituent of plastic products, including epoxy resin containers, mobile phones, dental sealants, as well as electronic and medical equipment. BPA is recognized as an endocrine system-disrupting chemical which has toxic effects on the brain and reproductive system. However, little is known about the effects of co-exposure of BPA with allergens on the memory function and neurological as well as immunological biomarker levels. In this study, we examined the effects of intratracheal instillation of BPA on the memory function and neuroimmune biomarker levels using a mouse model of allergic asthma. Male C3H/HeJ Jcl mice were given three doses of BPA (0.0625 pmol, 1.25 pmol, and 25 pmol BPA/animal) intratracheally once a week, and ovalbumin (OVA) intratracheally every other week from 5 to 11 weeks old. At 11 weeks of age, a novel object recognition test was conducted after the final administration of OVA, and the hippocampi and hypothalami of the animals were collected after 24 h. The expression levels of the memory function-related genes N-methyl-D-aspartate (NMDA) receptor subunits, inflammatory cytokines, microglia markers, estrogen receptor-alpha, and oxytocin receptor were examined by real-time RT-PCR (real-time reverse transcription polymerase chain reaction) and immunohistochemical methods. Impairment of the novel object recognition ability was observed in the high-dose BPA-exposed mice with allergic asthma. In addition, the allergic asthmatic mice also showed downregulation of neurological biomarkers, such as NMDA receptor subunit NR2B in the hippocampus but no significant effect on immunological biomarkers in the hypothalamus. These findings suggest that exposure to high-dose BPA triggered impairment of memory function in the allergic asthmatic mice. This is the first study to show that, in the presence of allergens, exposure to high-dose BPA may affect memory by modulating the memory function-related genes in the hippocampus.
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Affiliation(s)
- Tin-Tin Win-Shwe
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan.
| | - Rie Yanagisawa
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan.
| | - Eiko Koike
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan.
| | - Hirohisa Takano
- Environmental Health Sciences, Graduate School of Global Environmental Studies, Kyoto University, Kyoto 615-8540, Japan.
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13
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Feldman JM, Zeigler AE, Nelson K, Morales-Raveendran E, Pelletier T, Roizen G, Ren Z, Jerschow E. Depression symptoms and quality of life among individuals with aspirin-exacerbated respiratory disease. J Asthma 2019; 56:731-738. [PMID: 29972652 PMCID: PMC6467719 DOI: 10.1080/02770903.2018.1490754] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/08/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Patients with aspirin-exacerbated respiratory disease (AERD) have high disease burden due to the severity of asthma and sinonasal symptoms. There is limited research on the psychological well-being and subjective experiences of patients with AERD. This study examined levels of depression symptoms, asthma-related quality of life and asthma control among AERD patients. METHODS Thirty-two adults with AERD and 39 patients without AERD (asthma-only) were recruited from outpatient asthma/allergy clinics. The sample was largely comprised of ethnic minority, inner-city patients who ranged in age from 19 to 84 years old. Participants completed the Beck Depression Inventory (BDI), the Mini Asthma Quality of Life Questionnaire (Mini AQLQ), a self-report rating of asthma severity and spirometry testing. Asthma control and severity were determined following national guidelines. RESULTS AERD patients reported lower levels of depression symptoms (p = 0.049), better overall asthma-related quality of life (p < 0.001), and perceived their asthma to be less severe (p = 0.01) compared to asthma-only patients. However, clinician ratings of asthma severity were more severe for AERD than asthma-only patients (p = 0.006). No significant differences were found between the groups on asthma controller medications or oral corticosteroid bursts for asthma. CONCLUSIONS AERD patients may be resilient given their low levels of depression symptoms and positive views of asthma-related impairment despite higher clinician-rated asthma severity. The adult onset nature of asthma in AERD might be a protective factor on mental health. Future studies should explore mechanisms linking AERD and positive psychological health outcomes and subjective perception of asthma.
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Affiliation(s)
- Jonathan M Feldman
- a Ferkauf Graduate School of Psychology , Yeshiva University , Bronx , NY , USA
- b Albert Einstein College of Medicine/Montefiore Medical Center , Bronx , NY , USA
| | - Ariel E Zeigler
- a Ferkauf Graduate School of Psychology , Yeshiva University , Bronx , NY , USA
| | - Krista Nelson
- a Ferkauf Graduate School of Psychology , Yeshiva University , Bronx , NY , USA
| | | | | | - Gigia Roizen
- b Albert Einstein College of Medicine/Montefiore Medical Center , Bronx , NY , USA
| | - Zhen Ren
- d Washington University School of Medicine , St. Louis , MO , USA
| | - Elina Jerschow
- b Albert Einstein College of Medicine/Montefiore Medical Center , Bronx , NY , USA
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14
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Veenendaal M, Westerik JAM, van den Bemt L, Kocks JWH, Bischoff EW, Schermer TR. Age- and sex-specific prevalence of chronic comorbidity in adult patients with asthma: A real-life study. NPJ Prim Care Respir Med 2019; 29:14. [PMID: 31036820 PMCID: PMC6488608 DOI: 10.1038/s41533-019-0127-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 03/29/2019] [Indexed: 11/10/2022] Open
Abstract
The presence of comorbidity can be associated with poorer asthma outcomes. Previous prevalence studies focused on a limited selection of comorbid conditions in asthma only. We aimed to determine age- and sex-specific prevalence estimates for the full range of chronic comorbid conditions in adult asthma patients by performing a retrospective cohort study based on 32,787 medical records of patients aged ≥16 years with asthma from 179 general practices in the Netherlands. Age- and sex-specific prevalence estimates of 76 chronic comorbidities and 14 disease categories based on International Classification of Primary Care codes were determined. Chronic comorbidity was present in 65.3% of male asthma patients and 72.8% of female asthma patients, with female patients having a higher mean (SD) of 2.0 (2.1) comorbidities compared to male patients (1.7 (2.0)). This mean increased to 5.0 (2.7) conditions in the 75+ age group. Most prevalent comorbidities were hypertension (20.1%), osteoarthritis (11.5%), eczema (11.5%) and dyspepsia (10.7%). Compared to male asthma patients, female asthma patients showed higher odds for the presence of other chronic conditions in eight disease categories. Neurological (odds ratio [OR]; 95% confidence interval 2.01; 1.76-2.29), blood forming/lymphatics (OR 1.83; 1.38-2.42) and musculoskeletal diseases (OR 1.82; 1.69-1.95) showed the highest association with female sex. In conclusion, the presence of chronic comorbidity is the norm in adults with asthma and it is more prevalent in female than in male asthma patients. The odds of having a specific comorbid condition may differ between the sexes. Attention in guidelines on how to handle comorbidities may lead to a more targeted treatment for comorbidities and more patient-centred asthma management.
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Affiliation(s)
- Mathijs Veenendaal
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janine A M Westerik
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lisette van den Bemt
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janwillem W H Kocks
- Department of Inhalation Medicine, Observational Pragmatic Research Institute, Singapore, Singapore
| | - Erik W Bischoff
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tjard R Schermer
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
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15
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Vargas PA, Robles E. Asthma and allergy as risk factors for suicidal behavior among young adults. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2019; 67:97-112. [PMID: 29652637 DOI: 10.1080/07448481.2018.1462822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/15/2018] [Accepted: 04/05/2018] [Indexed: 06/08/2023]
Abstract
UNLABELLED An association between allergic disease, depression and suicidality has been reported. OBJECTIVE To explore the relationships between suicidality and asthma, allergy, internet addiction, stress, sleep quality, pain/discomfort, and depression, among emerging adults. PARTICIPANTS 929 college students completed an online survey between October 2015 and April 2017. METHODS A cross-sectional study using multivariate analysis techniques was implemented. RESULTS Using structural equation modeling, we found that allergies and stress were directly related to pain/discomfort; pain/discomfort was associated to poor sleep, depression, and suicidality. Sleep quality was also affected by stress; while sleep, stress, pain/discomfort, and internet addiction were directly related to depression (all p < .05). Ultimately, four factors impacted suicidality: stress, pain/discomfort, depression, and, indirectly, sleep quality (all p < .05). Although allergy had some effects, these did not reach statistical significance (p < .09). CONCLUSION Findings suggest that allergy might impact suicidality indirectly through increased pain/discomfort, poor sleep, and depression.
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Affiliation(s)
- Perla A Vargas
- a School of Social and Behavioral Sciences, Arizona State University , Glendale , Arizona , USA
| | - Elias Robles
- a School of Social and Behavioral Sciences, Arizona State University , Glendale , Arizona , USA
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16
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Oh H, Stickley A, Singh F, Koyanagi A. Self-reported asthma diagnosis and mental health: Findings from the Collaborative Psychiatric Epidemiology Surveys. Psychiatry Res 2019; 271:721-725. [PMID: 30791347 DOI: 10.1016/j.psychres.2018.12.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 12/27/2022]
Abstract
Historically, asthma has had a mixed association with mental health. More research is needed to examine the associations between asthma and specific psychiatric disorders, and whether these associations hold true across racial groups in the general population of the United States. Using the Collaborative Psychiatric Epidemiology Surveys, we examined the associations between lifetime asthma and specific DSM-IV psychiatric disorders, adjusting for sociodemographic characteristics and smoking status. We found that when looking at the entire sample, self-reported diagnosis of asthma was associated with greater odds of reporting mood disorders (AOR: 1.36; 95% CI: 1.05-1.74). Asthma was not significantly associated with total anxiety disorders (AOR 1.25; 95% CI: 0.98-1.60), though it was specifically associated with generalized anxiety disorder. Asthma was associated with greater odds of having alcohol use disorders (AOR: 1.71; 95% CI: 1.24-2.37), but was not associated with total eating disorders (AOR:1.36; 95% CI: 1.17-2.51) (though it was significantly associated with higher odds for binge eating disorder, but lower odds of reporting bulimia). The strength and the significance of the associations between asthma and psychiatric disorders varied when stratified by race, underscoring the importance of examining race as a potential explanation for the mixed findings observed previously in the literature.
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Affiliation(s)
- Hans Oh
- University of Southern California, School of Social Work, 669W. 34 th St., University of Southern California, Los Angeles, CA 90089 - 0411.
| | - Andrew Stickley
- The Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge, 141 89, Sweden; Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo 1878553, Japan
| | - Fiza Singh
- University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA 92093-0810, USA
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Deu, Barcelona, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
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17
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Abstract
Asthma is a serious global health issue and asthma guidelines recommend a stepwise approach to management with goals to achieve control and minimize future risk. Prior to escalation of pharmacotherapy, steps to confirm accurate diagnosis as well as address comorbidities and triggers are critical to effective asthma management. This article provides readers with a structured approach to evaluation and management of asthma of varying severity.
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Affiliation(s)
- Sandhya Khurana
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mary Parkes Center for Asthma, Allergy and Pulmonary Care, University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY 14642, USA.
| | - Nizar N Jarjour
- University of Wisconsin School of Medicine and Public Health, K4/914 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-9988, USA
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18
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Ioachimescu OC, Desai NS. Nonallergic Triggers and Comorbidities in Asthma Exacerbations and Disease Severity. Clin Chest Med 2018; 40:71-85. [PMID: 30691718 DOI: 10.1016/j.ccm.2018.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Asthma triggers are exogenous or endogenous factors that could worsen asthma acutely to cause an exacerbation, or perpetuate chronic symptoms and airflow limitation. Because it is well known that recent asthma exacerbations and poor symptom control are strong predictors of future disease activity, it is not surprising that the number of (allergic or nonallergic) asthma triggers in the environment correlates with the disease-related quality of life. There is a need to identify and avoid specific triggers as the centerpiece of disease management, especially in those with heightened sensitivity to certain factors.
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Affiliation(s)
- Octavian C Ioachimescu
- Pulmonary, Critical Care and Sleep Medicine, Emory University, Atlanta VA Medical Center, Atlanta, GA, USA
| | - Nikita S Desai
- Pulmonary and Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
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19
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Akula M, Kulikova A, Khan DA, Brown ES. The relationship between asthma and depression in a community-based sample. J Asthma 2018; 55:1271-1277. [PMID: 29336633 PMCID: PMC6212321 DOI: 10.1080/02770903.2017.1418885] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/07/2017] [Accepted: 12/14/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Asthma is an increasingly prevalent disease that is associated with substantial physical and financial burdens. Additionally, asthma is linked to psychiatric disorders. This study examines the relationship between asthma diagnosis, current depressive symptoms, and lifetime psychiatric disorder history in a large, community-based sample. METHODS We analyzed data from 2168 participants in the Dallas Heart Study, a large, diverse, community-based sample of people designed to be representative of the Dallas County population. Logistic regressions analyzing the relationship between asthma diagnosis and history of a psychiatric disorder, as well as between asthma diagnosis and the Quick Inventory of Depressive Symptomatology (QIDS) scores were performed, controlling for demographic data. RESULTS 13.4% of the sample had an asthma diagnosis. Asthma diagnosis was significantly associated with a history of nervous, emotional, or mental health disorder diagnosis [OR 1.810 (95% CI 1.280-2.559) p = 0.001], and with QIDS scores consistent with moderate or greater current depressive symptom severity [OR 1.586 (95%CI 1.106-2.274) p = 0.012]. The relationships were not moderated by age, gender, race, smoking status, or Body Mass Index. CONCLUSIONS A diagnosis of asthma may be associated with current clinically significant levels of depressive symptoms and a lifetime psychiatric disorder. The current report adds to the existing literature in this area by assessing both current and lifetime symptoms and by using a large and diverse population. The findings highlight the clinical importance of considering the possibility of psychiatric illness in asthma patients and suggest further research in this area is needed.
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Affiliation(s)
- Mahima Akula
- Departments of Psychiatry, The University of Texas Southwestern Medical Center; Dallas, Texas, USA
| | - Alexandra Kulikova
- Departments of Psychiatry, The University of Texas Southwestern Medical Center; Dallas, Texas, USA
| | - David A. Khan
- Internal Medicine, The University of Texas Southwestern Medical Center; Dallas, Texas, USA
| | - E. Sherwood Brown
- Departments of Psychiatry, The University of Texas Southwestern Medical Center; Dallas, Texas, USA
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20
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Perla A V. The link between allergic disease and depression in young adults: A structural equation modelling analysis. ACTA ACUST UNITED AC 2018. [DOI: 10.17352/2455-5460.000033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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21
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Blais L, Salah Ahmed SI, Beauchesne MF, Forget A, Kettani FZ, Lavoie KL. Risk of Postpartum Depression Among Women with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:925-933.e2. [PMID: 30292921 DOI: 10.1016/j.jaip.2018.09.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several epidemiological studies have suggested that the risk of depression is increased in patients with asthma, but the impact of asthma during pregnancy on postpartum depression remains unknown. OBJECTIVE To assess the association between maternal asthma and postpartum depression in a population-based cohort study retrieved from administrative databases. METHODS A cohort of 35,520 pregnancies in women with asthma during pregnancy and 197,057 pregnancies in women without asthma who delivered between 1998 and 2009 was extracted from the Quebec Asthma and Pregnancy Database. They were followed from the day of delivery up to 1 year postpartum. A generalized estimating equation model was used to estimate the adjusted odds ratios of postpartum depression with 95% CIs in women with asthma during pregnancy versus women without asthma. RESULTS Postpartum depression within 1 year after delivery occurred in 6.1% of women with asthma versus 2.9% of women without asthma. After adjusting for several potential confounders, including depression/postpartum depression up to 10 years before pregnancy, we found that women with asthma were 58% more likely to experience postpartum depression within 1 year after delivery than women without asthma during pregnancy (adjusted odds ratio, 1.58; 95% CI, 1.50-1.67). CONCLUSIONS Our findings suggest that women with asthma are more likely to suffer from postpartum depression. A close monitoring of signs of depression for pregnant women with asthma is indicated, allowing prompt and efficient interventions if needed.
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Affiliation(s)
- Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Research Center, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Ile-de-Montréal, Montréal, Québec, Canada.
| | | | - Marie-France Beauchesne
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Research Center, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Amélie Forget
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
| | | | - Kim L Lavoie
- Research Center, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Ile-de-Montréal, Montréal, Québec, Canada; Montreal Behavioral Medicine Center, Montréal, Québec, Canada; Psychology Department, Université du Québec à Montréal, Montréal, Québec, Canada
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22
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Neuropsychiatric Events Associated with Leukotriene-Modifying Agents: A Systematic Review. Drug Saf 2018; 41:253-265. [PMID: 29076063 DOI: 10.1007/s40264-017-0607-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Leukotriene-modifying agents (LTMAs) including montelukast, zafirlukast, and zileuton are approved by the US Food and Drug Administration (FDA) for the treatment of asthma and allergic rhinitis. Various neuropsychiatric events (NEs) have been reported; however, the evidence of the association is conflicting. This systematic review investigates the association between NEs and LTMAs by assessing the relevant published literature. METHODS PubMed, EMBASE, MEDLINE, and Cochrane Library were searched using keywords. Studies designed to investigate the association were eligible for inclusion without restriction to any study design or language. The primary outcome was defined as suicidal conditions, while secondary outcomes included all other NEs. RESULTS Thirty-three studies were included for a narrative review. Four observational studies did not find a significant association, while ten pharmacovigilance studies using different global databases detected the signals. Notably, some studies suggest that the FDA warning issued in 2008 might have influenced the reporting rate of NEs as a result of increased awareness. LIMITATIONS The risk of NEs was not quantified, because of the lack of randomized controlled trials and observational studies investigating the association. CONCLUSION Many pharmacovigilance studies have been conducted to determine the association between NEs and LTMAs, but there is limited evidence from observational studies. High-quality epidemiological studies should be conducted to evaluate the association and quantify the risk, not only in children, but also in adults.
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23
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Alexeeva I, Martin M. Evidence for mood-dependent attentional processing in asthma: attentional bias towards health-threat in depressive mood and attentional avoidance in neutral mood. J Behav Med 2018; 41:550-567. [PMID: 29626313 PMCID: PMC6061078 DOI: 10.1007/s10865-018-9919-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 03/16/2018] [Indexed: 11/26/2022]
Abstract
Attentional biases have been observed in populations with psychological disorders, but have been under-investigated in populations with physical illnesses. This study investigated potential attentional biases in asthma as a function of mood. Asthma (N = 45), and healthy (N = 39) participants were randomly allocated to a depressed or a neutral mood state induction. They completed a visual probe task that measured participants’ reaction times to health-threat and neutral pictures and words. Compared to the healthy controls, the asthma group showed attentional bias towards health-threat pictures in depressed mood, and avoidance of health-threat pictures in neutral mood. Attentional biases were found in a group with a physical illness as a function of induced mood. It is suggested that attentional processes in people with physical illness may be important in relation to symptom perception and illness management.
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Affiliation(s)
- Iana Alexeeva
- Medical Sciences Division, Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - Maryanne Martin
- Medical Sciences Division, Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
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24
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Lu Z, Chen L, Xu S, Bao Q, Ma Y, Guo L, Zhang S, Huang X, Cao C, Ruan L. Allergic disorders and risk of depression: A systematic review and meta-analysis of 51 large-scale studies. Ann Allergy Asthma Immunol 2018; 120:310-317.e2. [PMID: 29508718 DOI: 10.1016/j.anai.2017.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/22/2017] [Accepted: 12/19/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have suggested that allergic disorders are associated with an increased risk of depression. However, the results are conflicting. OBJECTIVE To determine the association between allergic disorders and depression based on large-scale studies. METHODS We reviewed relevant articles obtained from PubMed and Embase. Studies were eligible if they reported an association between allergic disorders and depression and provided available data. Study selection, data extraction, and analyses were undertaken. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated. RESULTS Of 1,827 studies identified, 51 including more than 2.5 million participants met our inclusion criteria. Overall, the results showed that allergic disorders were associated with a significant increased risk of depression (pooled RR 1.59, 95% CI 1.48-1.71). A higher risk of depression also was observed in patients with asthma (RR 1.59, 95% CI 1.46-1.74) and those with allergic rhinitis (RR 1.57, 95% CI 1.27-1.93). Subgroup analyses were conducted based on sex and age. Children (RR 1.66, 95% CI 1.41-1.96) and adults (RR 1.58, 95% CI 1.44-1.74) with allergic disorders had a higher risk of depression than controls. However, no significant association was found between allergic disorders and risk of depression in male subjects (RR 1.37, 95% CI 0.98-1.91), but a positive association was detected in female subjects (RR 1.65, 95% CI 1.44-1.89). CONCLUSION The results from our study showed that allergic disorders significantly increased the risk of depression.
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Affiliation(s)
- Zhiyu Lu
- Department of Respiratory Medicine, Ningbo First Hospital, Ningbo, China; Ningbo University School of Medicine, Ningbo, China
| | - Lina Chen
- Department of Respiratory Medicine, Ningbo First Hospital, Ningbo, China
| | - Suling Xu
- Department of Dermatology, Affiliated Hospital of Medical College, Ningbo University, Ningbo, China
| | - Qingyi Bao
- Ningbo University School of Medicine, Ningbo, China
| | - Yongyan Ma
- Department of Respiratory Medicine, Ningbo First Hospital, Ningbo, China
| | - Lili Guo
- Department of Respiratory Medicine, Ningbo First Hospital, Ningbo, China
| | - Shuaishuai Zhang
- Department of Respiratory Medicine, Ningbo First Hospital, Ningbo, China
| | - Xiaoping Huang
- Department of Respiratory Medicine, Ningbo First Hospital, Ningbo, China
| | - Chao Cao
- Department of Respiratory Medicine, Ningbo First Hospital, Ningbo, China
| | - Liemin Ruan
- Department of Mental Health, Ningbo First Hospital, Ningbo, China.
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25
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Cao C, Li W, Hua W, Yan F, Zhang H, Huang H, Ying Y, Li N, Lan F, Wang S, Chen X, Li J, Liu J, Lai T, Bao Z, Cao Y, Zhao Y, Huang G, Huang L, Huang Y, Wu P, Peng C, Chen Z, Chung KF, Zhong N, Ying S, Shen H. Proteomic analysis of sputum reveals novel biomarkers for various presentations of asthma. J Transl Med 2017; 15:171. [PMID: 28778200 PMCID: PMC5544989 DOI: 10.1186/s12967-017-1264-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 07/18/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It is now recognized that asthma can present in different forms. Typically, asthma present with symptoms of wheeze, breathlessness and cough. Atypical forms of asthma such as cough variant asthma (CVA) or chest tightness variant asthma (CTVA) do not wheeze. We hypothesize that these different forms of asthma may have distinctive cellular and molecular features. METHODS 30 patients with typical or classical asthma (CA), 27 patients with CVA, 30 patients with CTVA, and 30 healthy control adults were enrolled in this prospective study. We measured serum IgE, lung function, sputum eosinophils, nitric oxide in exhaled breath (FeNO). We performed proteomic analysis of induced-sputum supernatants by mass spectrometry. RESULTS There were no significant differences in atopy and FEV1 among patients with CA, CVA, and CTVA. Serum IgE, sputum eosinophil percentages, FeNO, anxiety and depression scores were significantly increased in the three presentations of asthmatic patients as compared with healthy controls but there was no difference between the asthmatic groups. Comprehensive mass spectrometric analysis revealed more than a thousand proteins in the sputum from patients with CA, CVA, and CTVA, among which 23 secreted proteins were higher in patients than that in controls. CONCLUSIONS Patients with CA, CVA, or CTVA share common clinical characteristics of eosinophilic airway inflammation. And more importantly, their sputum samples were composed with common factors with minor distinctions. These findings support the concept that these three different presentations of asthma have similar pathogenetic mechanism in terms of an enhanced Th2 associated with eosinophilia. In addition, this study identified a pool of novel biomarkers for diagnosis of asthma and to label its subtypes. Trial registration http://www.chictr.org.cn (ChiCTR-OOC-15006221).
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Affiliation(s)
- Chao Cao
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wen Li
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wen Hua
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fugui Yan
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hao Zhang
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huaqiong Huang
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yinghua Ying
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Na Li
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fen Lan
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shaobin Wang
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Chen
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Li
- State Key Lab. for Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jinkai Liu
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tianwen Lai
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhengqiang Bao
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuan Cao
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yun Zhao
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Gang Huang
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lili Huang
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yaqing Huang
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ping Wu
- National Center for Protein Science Shanghai, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China.,Shanghai Science Research Center, Chinese Academy of Sciences, Shanghai, China
| | - Chao Peng
- National Center for Protein Science Shanghai, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China.,Shanghai Science Research Center, Chinese Academy of Sciences, Shanghai, China
| | - Zhihua Chen
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kian Fan Chung
- National Heart & Lung Institute, Imperial College, London, UK
| | - Nanshan Zhong
- State Key Lab. for Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
| | - Songmin Ying
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. .,Department of Pharmacology, Zhejiang University School of Medicine, Hangzhou, China.
| | - Huahao Shen
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. .,State Key Lab. for Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
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26
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Walker VG. Exploration of the Influence of Factors Identified in the Literature on School-aged Children's Emotional Responses to Asthma. J Pediatr Nurs 2017; 33:54-62. [PMID: 28065421 PMCID: PMC5376515 DOI: 10.1016/j.pedn.2016.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/09/2016] [Accepted: 11/28/2016] [Indexed: 01/16/2023]
Abstract
Approximately 6.3 million US children suffer from asthma. The purpose of this study was to explore factors on school-aged children's emotional responses to asthma, N=85, ages 6-12. Correlations included Asthma related child emotional functioning QOL and (a) asthma severity, r=-0.30, p<0.01, (b) child internalizing behaviors, r=-0.26, p<0.05, (c) child externalizing behaviors r=-0.43, p<0.001; Caregiver emotional functioning QOL and (a) asthma severity, r=-0.39, p<0.001, (b) child internalizing behaviors, r=-0.22, p<0.05, (c) child externalizing behaviors, r=-0.25; p<0.05. Multiple regression analysis revealed that asthma severity and child externalizing problems accounted for 26% of the variance in asthma related child emotional functioning QOL, F (4, 79)=7.051, p<0.001 (asthma severity, β=-0.31, p<0.01; child externalizing problem behaviors, β=-0.43, p<0.001). Findings imply that asthma research should consider problem behaviors of school-aged children when addressing asthma related emotional functioning QOL.
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27
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Asthma Trigger Reports Are Associated with Low Quality of Life, Exacerbations, and Emergency Treatments. Ann Am Thorac Soc 2016; 13:204-11. [PMID: 26599372 DOI: 10.1513/annalsats.201506-390oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Despite the importance of trigger perceptions for asthma diagnosis and management, associations among asthma triggers, affective disorders, and asthma outcome have received little attention. OBJECTIVES Because anxiety and depression are known to influence patients' health reports, we measured and controlled for these affective disorders in analyzing associations among patient perceptions of asthma triggers and asthma treatment outcomes. METHODS Patients from a nationally representative sample of respiratory specialist practices (N = 459) were assessed for clinically significant anxiety and depression and completed questionnaires on asthma triggers, quality of life, and asthma control. Physicians recorded exacerbation and emergency treatment frequencies in the prior year, spirometric lung function, and allergy test results. Hierarchical multiple regressions examined associations among reported trigger factors, anxiety, depression, and asthma outcomes, including quality of life, asthma control, exacerbations, emergencies, and spirometry. MEASUREMENTS AND MAIN RESULTS Patients across asthma severity levels were well represented. Anxiety and depression were associated with more frequent nonallergic, in particular psychological, triggers. Controlling for demographics, asthma severity, anxiety, and depression, nonallergic asthma triggers (including psychological triggers) explained substantial portions of variance in asthma control (total of 19.5%, odds ratios [ORs] = 2.07-1.37 for individual triggers), asthma-related quality of life (total of 27.5%, ORs = 3.21-1.49), and general quality of life (total of 11.3%, ORs = 1.93-1.55). Psychological triggers were consistently associated with exacerbations and emergency treatments (ORs = 1.96-2.04) over and above other triggers and affective disorders. Spirometric lung function was largely unrelated to perceived asthma triggers. CONCLUSIONS Patients' perceptions of asthma triggers are important determinants of asthma outcomes, which can help identify individuals at risk for suboptimal asthma management.
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28
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Logan AC, Jacka FN, Prescott SL. Immune-Microbiota Interactions: Dysbiosis as a Global Health Issue. Curr Allergy Asthma Rep 2016; 16:13. [PMID: 26768621 DOI: 10.1007/s11882-015-0590-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Throughout evolution, microbial genes and metabolites have become integral to virtually all aspects of host physiology, metabolism and even behaviour. New technologies are revealing sophisticated ways in which microbial communities interface with the immune system, and how modern environmental changes may be contributing to the rapid rise of inflammatory noncommunicable diseases (NCDs) through declining biodiversity. The implications of the microbiome extend to virtually every branch of medicine, biopsychosocial and environmental sciences. Similarly, the impact of changes at the immune-microbiota interface are directly relevant to broader discussions concerning rapid urbanization, antibiotics, agricultural practices, environmental pollutants, highly processed foods/beverages and socioeconomic disparities--all implicated in the NCD pandemic. Here, we make the argument that dysbiosis (life in distress) is ongoing at a micro- and macro-scale and that as a central conduit of health and disease, the immune system and its interface with microbiota is a critical target in overcoming the health challenges of the twenty-first century.
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Affiliation(s)
- Alan C Logan
- International Inflammation Network (in-FLAME) of the World Universities Network, Perth, Australia.,International Society for Nutritional Psychiatry Research, Melbourne, Australia
| | - Felice N Jacka
- International Inflammation Network (in-FLAME) of the World Universities Network, Perth, Australia.,School of Medicine, Deakin University, Melbourne, Australia.,International Society for Nutritional Psychiatry Research, Melbourne, Australia
| | - Susan L Prescott
- International Inflammation Network (in-FLAME) of the World Universities Network, Perth, Australia. .,School of Paediatrics and Child Health, Perth Children's Hospital, University of Western Australia, GPO Box D 184, Perth, WA, 6840, Australia.
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29
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Carlson SM, Kim J, Khan DA, King K, Lucarelli RT, McColl R, Peshock R, Brown ES. Hippocampal volume in patients with asthma: Results from the Dallas Heart Study. J Asthma 2016; 54:9-16. [PMID: 27187077 DOI: 10.1080/02770903.2016.1186174] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Asthma is associated with an increased risk of mild cognitive impairment and dementia. Depression and oral corticosteroid use are associated with atrophy of the hippocampus and are common in asthma. However, minimal neuroimaging data are available in asthma patients. METHODS We conducted a retrospective analysis of 1,287 adult participants from the Dallas Heart Study, an epidemiological sample of Dallas County residents. Study outcome variables were hippocampal volumes measured by FreeSurfer. ANOVA was used to examine a gender difference in hippocampal volumes. General Linear Models (GLM) were conducted to examine asthma diagnosis association with hippocampal volumes. RESULTS The prevalence rate of asthma among our study sample was 10.8% with 9.6% in males and 11.7% in females. After controlling for demographic characteristics, participants with asthma had significantly smaller total, right, and left hippocampal volumes than those without asthma. The association of asthma with smaller hippocampal volume was significant among males but not among females. CONCLUSION Hippocampal volume in a large and diverse sample of adults was significantly smaller in people with asthma as compared to those without asthma. These findings suggest that asthma may be associated with structural brain differences. Thus, medical illnesses without obvious direct neurodegenerative or even vascular involvement can be associated with brain changes. Because the hippocampus is a brain region involved in memory formation, these findings may have implications for treatment adherence that could have important implications for asthma treatment. Study limitations are the reliance on a self-reported asthma diagnosis and lack of additional asthma clinical information.
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Affiliation(s)
- Scott M Carlson
- a Department of Psychiatry , The University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Julie Kim
- b Division of Allergy & Immunology in the Department of Internal Medicine , The University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - David A Khan
- b Division of Allergy & Immunology in the Department of Internal Medicine , The University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Kevin King
- c Department of Radiology , The University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Richard T Lucarelli
- c Department of Radiology , The University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Roderick McColl
- c Department of Radiology , The University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Ronald Peshock
- c Department of Radiology , The University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - E Sherwood Brown
- a Department of Psychiatry , The University of Texas Southwestern Medical Center , Dallas , TX , USA
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30
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Logan AC, Jacka FN, Craig JM, Prescott SL. The Microbiome and Mental Health: Looking Back, Moving Forward with Lessons from Allergic Diseases. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2016; 14:131-47. [PMID: 27121424 PMCID: PMC4857870 DOI: 10.9758/cpn.2016.14.2.131] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/05/2015] [Indexed: 02/06/2023]
Abstract
Relationships between gastrointestinal viscera and human emotions have been documented by virtually all medical traditions known to date. The focus on this relationship has waxed and waned through the centuries, with noted surges in interest driven by cultural forces. Here we explore some of this history and the emerging trends in experimental and clinical research. In particular, we pay specific attention to how the hygiene hypothesis and emerging research on traditional dietary patterns has helped re-ignite interest in the use of microbes to support mental health. At present, the application of microbes and their structural parts as a means to positively influence mental health is an area filled with promise. However, there are many limitations within this new paradigm shift in neuropsychiatry. Impediments that could block translation of encouraging experimental studies include environmental forces that work toward dysbiosis, perhaps none more important than westernized dietary patterns. On the other hand, it is likely that specific dietary choices may amplify the value of future microbial-based therapeutics. Pre-clinical and clinical research involving microbiota and allergic disorders has predated recent work in psychiatry, an early start that provides valuable lessons. The microbiome is intimately connected to diet, nutrition, and other lifestyle variables; microbial-based psychopharmacology will need to consider this contextual application, otherwise the ceiling of clinical expectations will likely need to be lowered.
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Affiliation(s)
- Alan C Logan
- International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN), Geelong, Australia.,International Society for Nutritional Psychiatry Research (ISNPR), Geelong, Australia
| | - Felice N Jacka
- International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN), Geelong, Australia.,International Society for Nutritional Psychiatry Research (ISNPR), Geelong, Australia.,The Centre for Innovation in Mental and Physical Health and Clinical Treatment, School of Medicine, Deakin University, Geelong, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Black Dog Institute, Sydney, Australia
| | - Jeffrey M Craig
- International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN), Geelong, Australia.,Group of Early Life Epigenetics, Department of Paediatrics, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Susan L Prescott
- International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN), Geelong, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
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31
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Cortisol response to acute stress in asthma: Moderation by depressive mood. Physiol Behav 2016; 159:20-6. [PMID: 26965527 DOI: 10.1016/j.physbeh.2016.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 03/04/2016] [Accepted: 03/05/2016] [Indexed: 01/08/2023]
Abstract
Both individuals with asthma and depression show signs of a dysregulated hypothalamus-pituitary-adrenal axis. However, little is known about the cortisol response to stress in the context of co-occurring asthma and depressive mood. Thirty-nine individuals with asthma and 41 healthy controls underwent a combined speech and mental arithmetic stressor. During the course of the laboratory session, salivary cortisol was collected 5 times, with 1 sample at 0min before the stressor and 4 samples at 0, 15, 30 and 45min after the stressor. Depressive mood in the past week was assessed with the Hospital Anxiety and Depression Scale at the beginning of the session. Depressive symptoms moderated cortisol response to the acute stressor, but only among asthmatic patients. Higher depressive mood was associated with a significant increase in cortisol, whereas low depressive mood was associated with no cortisol response. In healthy participants, depressive mood had no substantial effect on cortisol response to the stressor. These findings suggest that depressive mood and chronic inflammatory diseases such as asthma can interact to augment cortisol response to stress.
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32
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Ciprandi G, Schiavetti I, Rindone E, Ricciardolo FLM. The impact of anxiety and depression on outpatients with asthma. Ann Allergy Asthma Immunol 2015; 115:408-14. [PMID: 26392047 DOI: 10.1016/j.anai.2015.08.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/03/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Anxiety and depression may frequently affect patients with asthma. However, the findings of several studies are partially conflicting and conducted in selected cohorts. OBJECTIVE To investigate the effect of anxiety and depression in a group of outpatients with asthma. METHODS This cross-sectional, real-life study included 263 patients (109 males; mean age, 39.2 years) with asthma. Clinical examination, lung function, fractional exhaled nitric oxide measurement, Asthma Control Test (ACT) score, asthma control grade, perception of symptoms by visual analog scale, and Hospital Anxiety and Depression Scale (HADS) questionnaires were evaluated. RESULTS Globally, 97 patients (36.9%) had anxiety, and 29 (11%) had depression. Of these patients, 71 had combined anxiety and depression. Anxiety and depression were associated with poor asthma control (P =.007 and .02, respectively). Patients with depression had higher body mass indexes (P =.002). Anxiety and depression were associated with lower ACT scores (P < .001 for both). The scores on the anxiety and depression subscales of HADS were moderately related (r = 0.57). CONCLUSIONS The present real-life study indicates that anxiety and depression are common and relevant comorbidities in asthmatic outpatients and are associated with uncontrolled asthma and lower ACT scores. Thus, assessment of comorbid mental disorders should be performed in common practice.
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Affiliation(s)
- Giorgio Ciprandi
- Department of Medicine, IRCCS - Azienda Ospedaliera Universitaria San Martino, Genoa, Italy.
| | | | - Elena Rindone
- Division of Respiratory Disease, Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - Fabio L M Ricciardolo
- Division of Respiratory Disease, Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
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33
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Saito N, Itoga M, Tamaki M, Yamamoto A, Kayaba H. Cough variant asthma patients are more depressed and anxious than classic asthma patients. J Psychosom Res 2015; 79:18-26. [PMID: 25837530 DOI: 10.1016/j.jpsychores.2015.03.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/12/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Many recent studies have indicated that depression and anxiety are more common in asthmatic patients than in the general population and psychological stress can lead to asthma exacerbations, but no study specifically targets cough variant asthma (CVA) patients. The purpose of this study was to evaluate depression and anxiety levels in CVA patients compared with classic asthma patients and to identify the psychological features of CVA patients. METHODS Fifty-nine outpatients with CVA and 128 outpatients with classic asthma were interviewed about psychosomatic and psychiatric symptoms, and they underwent three psychological tests: Self-rating Depression Scale (SDS), State-Trait Anxiety Inventory (STAI), and Comprehensive Asthma Inventory (CAI). They were ultimately screened for major and minor depression, dysthymia, panic disorder, generalized anxiety disorder, social anxiety disorder, and other anxiety disorders. RESULTS CVA patients showed higher SDS and STAI scores than classic asthma patients, and mood disorders and anxiety disorders were more common than in classic asthma outpatients. The psychological factors 'frustration', 'fright into illness', and 'distorted lifestyle' were more prominent in CVA patients than in classic asthma patients. CONCLUSION CVA patients are on average more depressed and anxious than classic asthma outpatients. Though CVA appears pathologically to be just an early stage of typical asthma, the psychological stress may often be more serious than in asthma controlled by medication, which may explain why CVA cannot be controlled by a bronchodilator alone and patients often require no less intense therapy than for severe asthma.
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Affiliation(s)
- Norihiro Saito
- Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan; Department of Allergy and Respiratory Medicine, Yokote Municipal Hospital, Akita, Japan.
| | - Masamichi Itoga
- Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Mami Tamaki
- Department of Allergy and Respiratory Medicine, Yokote Municipal Hospital, Akita, Japan
| | - Ayako Yamamoto
- Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Hiroyuki Kayaba
- Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
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34
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Rank MA, Shah ND. Multiple chronic conditions and asthma: implications for practice and research. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:518-24. [PMID: 25213044 DOI: 10.1016/j.jaip.2014.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 06/26/2014] [Accepted: 06/30/2014] [Indexed: 10/24/2022]
Abstract
At least half of US adults with asthma have at least 1 other chronic condition. Having asthma and other chronic conditions are associated with poorer asthma outcomes. Several studies considered the relationship between asthma and other specific chronic conditions; results of these studies indicated that having depression or anxiety and/or panic disorder is associated with an increased risk of developing a new asthma diagnosis and with poorer asthma outcomes. In addition, results of these studies indicated that having asthma is associated with an increased risk of developing a new depression or anxiety and/or panic disorder diagnosis. Theoretical models for understanding multiple chronic conditions have emerged, with models that include a balance between patient workload and capacity; classification of specific conditions as concordant and/or discordant and/or dominant; and identification of the gap between what a patient needs and what health care services are able to offer. Potential implications for clinical providers include screening for chronic conditions not yet recognized, such as mental health disorders, promoting and tracking medication adherence in those who have multiple chronic conditions, and simplifying treatment regimens to reduce patient workload.
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Affiliation(s)
- Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Ariz; The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn.
| | - Nilay D Shah
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn; Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minn
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