Depression and pulmonary function in outpatients with asthma

The prevalence of anxiety in respiratory and sleep diseases: A systematic review and meta-analysis

BACKGROUND

Anxiety is common in those with chronic physical health conditions and can have significant impacts on both quality of life and physical health outcomes. Despite this, there are limited studies comprehensively investigating the prevalence of anxiety in respiratory and sleep medicine settings. This systematic review and meta-analysis aims to provide insight into the global prevalence of anxiety symptoms/disorders in respiratory and sleep medicine outpatients.

METHODS

PubMed, Embase, Cochrane, PsycINFO and Google Scholar databases were searched from database inception to January 23, 2023 for studies assessing the prevalence of anxiety in adult (≥16 years) respiratory and sleep medicine outpatients. Data was screened and extracted independently by two investigators. Anxiety was measured using various self-report questionnaires, structured interviews, and/or patient records. Using CMA software for the meta-analysis, a random-effects model was used for pooled estimates, and subgroup analysis was conducted on relevant models using a mixed-effects model.

RESULTS

116 studies were included, featuring 36,340 participants across 40 countries. The pooled prevalence of anxiety was 30.3 % (95%CI 27.9-32.9 %, 10,679/36,340). Subgroup analysis found a significant difference across type of condition, with pulmonary tuberculosis the highest at 43.1 % and COVID-19 outpatients the lowest at 23.4 %. No significant difference was found across anxiety types, country or age. Female sex and the use of self-report measures was associated with significantly higher anxiety estimates.

CONCLUSIONS

Anxiety is a common experience amongst patients in respiratory and sleep medicine outpatient settings. Thus, it is crucial that anxiety identification and management is considered by physicians in the field.

REGISTRATION

The protocol is registered in PROSPERO (CRD42021282416).

Interactions between Cognitive, Affective, and Respiratory Profiles in Chronic Respiratory Disorders: A Cluster Analysis Approach

This study conducted at Leamna Pulmonology Hospital investigated the interrelations among cognitive, affective, and respiratory variables within a cohort of 100 patients diagnosed with chronic respiratory conditions, utilizing sophisticated machine learning-based clustering techniques. Spanning from October 2022 to February 2023, hospitalized individuals confirmed to have asthma or COPD underwent extensive evaluations using standardized instruments such as the mMRC scale, the CAT test, and spirometry. Complementary cognitive and affective assessments were performed employing the MMSE, MoCA, and the Hamilton Anxiety and Depression Scale, furnishing a holistic view of patient health statuses. The analysis delineated three distinct clusters: Moderate Cognitive Respiratory, Severe Cognitive Respiratory, and Stable Cognitive Respiratory, each characterized by unique profiles that underscore the necessity for tailored therapeutic strategies. These clusters exhibited significant correlations between the severity of respiratory symptoms and their effects on cognitive and affective conditions. The results highlight the benefits of an integrated treatment approach for COPD and asthma, which is personalized based on the intricate patterns identified through clustering. Such a strategy promises to enhance the management of these diseases, potentially elevating the quality of life and everyday functionality of the patients. These findings advocate for treatment customization according to the specific interplays among cognitive, affective, and respiratory dimensions, presenting substantial prospects for clinical advancement and pioneering new avenues for research in the domain of chronic respiratory disease management.

Comparative analysis of pulmonary function in school-going adolescents: Examining the impact of depression and anxiety

Objectives

Given the rising concern over depression and anxiety among adolescents, this study aims to investigate their potential impact on respiratory health by comparing pulmonary function test (PFT) parameters between healthy adolescents and those with either depression or anxiety or those exhibiting symptoms of both depression and anxiety.

Materials and Methods

In this cross-sectional study, a random sample of school-going adolescents aged 13-18 years from various schools in Sikkim, both males and females, were selected. Depression and anxiety were assessed using the Revised Children's Anxiety and Depression Scale-25, and pulmonary function was measured using a computerised spirometer-Spirolab III. The recorded variables included forced vital capacity (FVC), forced expiratory volume in 1st second (FEV1), FEV1/FVC ratio, peak expiratory flow rate (PEFR) and forced expiratory flow at 25-75% (FEF 25-75%).

Results

Significant differences emerged in FVC (P = 0.034), PEFR (P = 0.013) and FEF 25-75% (P = 0.023) between healthy and depressed adolescents aged 13-18 years. Similarly, a significant difference was observed in PEFR (P = 0.022) and FEF 25-75% (P = 0.002) between healthy adolescents and those with symptoms of both depression and anxiety. These differences were more pronounced among students in higher grades. Furthermore, significant differences in PEFR (P = 0.015) and FEF 25-75% (P ≤ 0.001) were found while comparing healthy males and males with symptoms of both depression and anxiety. However, no such disparities were seen in girls. There was no significant difference in any of the parameters when compared between the healthy group and those with anxiety.

Conclusion

Depressed adolescents exhibited significantly reduced FVC, PEFR and FEF 25-75% compared to their healthy counterparts, despite being otherwise healthy. This negative association was more pronounced in the higher age group. However, anxious adolescents did not show any significant difference in PFT compared to healthy peers.

The Relationship Between Depressive Symptoms, eHealth Literacy, and Asthma Outcomes in the Context of a Mobile Health Intervention

OBJECTIVE

The ASTHMAXcel PRO mobile app provides asthma education and collects asthma outcome data. The objective of this study was to evaluate the associations between health/electronic health literacy (eHealth literacy) and depressive symptoms with app usage and clinical outcomes.

METHODS

Adults with persistent asthma were recruited to use the app. Participants completed the Patient Health Questionnaire-9 to assess for depressive symptoms, Asthma Control Test, Mini Asthma Quality of Life (QOL) Questionnaire, and the Newest Vital Sign tool to measure health literacy. Data on a subset of participants were available on eHealth literacy ( n = 24) and average number of app logins across 2 months ( n = 40).

RESULTS

The total study sample included 96 participants (46% non-Hispanic Black, 44.4% Hispanic). The average participant age was 44.0 (standard deviation = 14.9) years, with 74% identifying as female. Increased depressive symptoms were associated with worse asthma control ( β = -0.46, p < .001) and asthma QOL ( β = -0.38, p < .001), but not eHealth literacy. Higher eHealth literacy was associated with worse asthma QOL ( β = -0.48, p = .02) and more app logins ( β = 0.59, p = .04). Newest Vital Sign scores were not associated with any of the other measures.

CONCLUSIONS

Depressive symptoms were associated with worse asthma outcomes. eHealth literacy was associated with increased patient engagement with the app and worse asthma QOL, which may reflect patients with worse QOL seeking out health information on the Internet (although directionality could not be assessed). Digital health literacy may be key to increasing patient engagement with mobile health interventions.Trial Registration: National Clinical Trial No. 03847142, https://clinicaltrials.gov/ct2/show/NCT03847142 .

The Management of Extrapulmonary Comorbidities and Treatable Traits; Obesity, Physical Inactivity, Anxiety, and Depression, in Adults With Asthma

Asthma is a complex and heterogenous disease characterized by variability in disease expression and severity. Multiple extrapulmonary comorbidities and treatable traits are common in people with asthma, and there is an increasing appreciation of how these may complicate asthma management. This review will discuss the prevalence and impact of extrapulmonary comorbidities/risk factors or "traits," which have been found to co-exist in asthma (obesity, symptoms of depression and/or anxiety and physical inactivity), the impact these traits have on future outcomes (including exacerbation risk and quality of life) and asthma management, and how we should target treatment in asthma when these extrapulmonary traits are present.

Depressive Symptoms and Overperception of Airflow Obstruction in Older Adults With Asthma

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.

Association Between Depression, Lung Function, and Inflammatory Markers in Patients with Asthma and Occupational Asthma

OBJECTIVE

Depression is associated with autonomic and immune dysregulation, yet this remains poorly explored in asthma. We assessed associations between depressive disorder, lung function, and inflammatory markers in patients under investigation for occupational asthma (OA).

METHODS

One hundred twelve patients under investigation for OA (60% men) underwent a psychiatric interview to assess depressive disorder, and spirometry, a methacholine test, sputum induction, and specific inhalation challenge (SIC) to assess OA. Blood and sputum inflammatory markers were assessed.

RESULTS

There was a statistically significant association between depressive disorder (P = 0.0195) and forced expiratory volume in 1 second (FEV1) responses, with the drop in FEV1 post-SIC smaller in patients with OA and depression, versus OA with no depression (P < 0.001).

CONCLUSION

The presence of depressive disorder may influence FEV1 in patients with OA, which may be via autonomic pathways. However, further studies are warranted in order to determine the mechanisms that underlie these effects.

Association Between Asthma and Depression: A National Cohort Study

BACKGROUND

Patients with asthma often suffer from depression and vice versa. However, the temporal relationship between the 2 diseases has remained elusive.

OBJECTIVE

The aim of this study was to determine the bidirectional relationship between asthma and depression in adults, using national cohort samples in Korea.

METHODS

Using the national cohort from the study by the Korean Health Insurance Review and Assessment Service, patients with asthma and control participants were selected and matched by age group, sex, income group, region of residence, and medical histories. A stratified Cox proportional hazards model was used to analyze the hazard ratio (HR) of asthma with depression (study 1) and depression with asthma (study 2).

RESULTS

In study 1, the HR of depressive disorders was significantly higher in patients with asthma than in patients without asthma (HR, 1.35; 95% CI, 1.31-1.40). In study 2, the HR of asthma in patients with depression was significantly higher than that in patients without depression (HR, 1.25; 95% CI, 1.21-1.29).

CONCLUSION

A bidirectional association between asthma and depression was observed in this study.

Fluoxetine protects against OVA induced bronchial asthma and depression in rats

Depression is very common in asthmatic patients and may increases risk for morbidity and mortality. The present work aimed to investigate the protective effect of fluoxetine, on behavioral and biochemical changes, associated with ovalbumin (OVA) - induced bronchial asthma and depression in rats. Rats were sensitized with intraperitoneal administration of OVA plus aluminum hydroxide for 3 consecutive days then at day 11 followed by OVA intranasal challenge at days 19, 20, 21. Rats were either pretreated with dexamethasone, fluoxetine10mg/kg or fluoxetine 20 mg/kg. At the end of the experiment, various tests were performed, including open field, forced swimming and respiratory function tests. Blood was drawn for serum IgE detection. Finally, rats were euthanized, brain-derived neurotrophic factor (BDNF) was estimated in bronchoalveolar lavage (BAL) fluid and lung content of reduced glutathione (GSH), superoxide dismutase (SOD), tumor necrosis factor-alpha (TNF-α) and interleukin 4 (IL-4) were determined. Histopathological study was also performed. The results showed that fluoxetine significantly ameliorated OVA- induced biochemical and behavioral changes. Fluoxetine may protect against OVA-induced asthma and depression in rats. This effect may be mediated at least in part by its antioxidant, anti-inflammatory and immunosuppressant effect.

Co-morbid psychological dysfunction is associated with a higher risk of asthma exacerbations: a systematic review and meta-analysis

BACKGROUND

The longitudinal associations between psychological dysfunction (PD) and asthma exacerbations (AE) have not been adequately addressed. This study aimed to systematically assess the influence of PD on AE, and to determine whether different PD affects AE differentially.

METHODS

Electronic databases (PubMed, Cochrane library, Web of Science, Embase, and Ovid) were searched for prospective cohort studies on the influence of PD on AE in individuals with asthma. Relative risk (RR) and adjusted RR (RRadj) were pooled across studies. Subgroup analyses assessed the effects of different types of PD and the time-dependent response to the duration of PD exposure.

RESULTS

Ten articles that involved 31,432 adults with asthma with follow-up of 6.0-86.4 months were included. PD significantly increased the risk of AE [RRadj =1.06, 95% confidence interval (95%CI): 1.04-1.09, P<0.001], presenting as hospitalizations (RRadj =1.22, 95% CI: 1.12-1.34, P<0.001), unscheduled doctor visits (RR =4.26, 95% CI: 2.52-7.19), and emergency department (ED) visits (RRadj =1.06, 95% CI: 1.01-1.10, P=0.009) because of asthma. Depression significantly increased the risk of AE (RRadj =1.07, 95% CI: 1.04-1.11, P<0.001), presenting as hospitalizations (RRadj =1.26, 95% CI: 1.07-1.49, P=0.007) and ED visits (RRadj =1.06, 95% CI: 1.02-1.11, P=0.007) because of asthma. Anxiety was only associated with an increased risk of AE in pregnant women (RR =1.05, 95% CI: 1.01-1.08), possibly due to the small amount of data available on anxiety. The influence of PD on AE was only significant when the PD exposure time exceeded one year.

CONCLUSIONS

Co-morbid PD adversely affects AE, and there are differential effects of depression and anxiety. Asthmatic subjects with PD may benefit from more attention when establishing a treatment regimen in clinical practice.

Depression, Asthma, and Bronchodilator Response in a Nationwide Study of US Adults

BACKGROUND

Little is known about the relation between 2 common comorbidities (depression and anxiety) and asthma or bronchodilator response (BDR).

OBJECTIVE

To examine the association between depressive symptoms and asthma or BDR in US adults.

METHODS

Cross-sectional study of 20,272 adults aged 20 to 79 years from the 2007-2012 National Health and Nutrition Examination Survey. Depressive symptoms were measured using the 9-item Patient Health Questionnaire, and classified as none to minimal, mild, moderate, moderately severe, and severe. Major depression (comprising moderately severe to severe symptoms) was defined as a 9-item Patient Health Questionnaire score of 15 or more. Anxiety was defined as 5 or more days feeling anxious in the previous month. Current asthma was defined as having been diagnosed with asthma by a doctor or health professional and 1 or more asthma attack in the previous year. BDR (as percentage of baseline FEV1) was measured in 1356 participants with FEV1/forced vital capacity of less than 0.70 and/or FEV1 less than 70% of predicted. Logistic or linear regression was used for the multivariable analysis.

RESULTS

Depressive symptoms were significantly and linearly associated with asthma, independently of anxiety symptoms. Subjects with major depression had 3.4 times higher odds of asthma than did those with minimal or no depressive symptoms (95% CI, 2.6-4.5; P < .01). Among adults with asthma, major depression was associated with a 4.2% reduction in BDR (95% CI, -7.5% to -0.8%; P = .02). Major depression was not associated with BDR among adults without asthma. Anxiety was not associated with asthma or BDR.

CONCLUSIONS

Depressive symptoms are associated with asthma in adults, independently of anxiety symptoms. Major depression is associated with reduced BDR in adults with asthma.

Prevalence of depressive symptoms among patients with a chronic nonspecific lung disease in five ethnic minority groups

OBJECTIVE

Earlier studies found chronic nonspecific lung disease (CNSLD) to be associated with depressive symptoms. We aimed to assess whether the association between CNSLD and depressive symptoms varies between ethnic groups.

METHODS

We used questionnaire data from 10916 participants of the HELIUS study in Amsterdam from six different ethnic groups. We applied logistic regression analysis to determine the association between CNSLD and depressive symptoms and interaction terms to test whether this association varied between ethnic groups.

RESULTS

CNSLD prevalence was higher among South-Asian Surinamese, Turkish and Moroccans (10.1% to 12.5%) than African Surinamese, Dutch and Ghanaians (4.8% to 6.3%). The prevalence of depressive symptoms was higher among participants with CNSLD (28.4% vs. 13.7%). This association was not significantly different between ethnic groups. The absolute prevalence of depressive symptoms was higher among the CNSLD patients from ethnic minority groups (19.2 % to 35.6%) as compared with the Dutch-origin majority group (11.2%).

CONCLUSIONS

CNSLD is associated with a high risk of depressive symptoms, especially among the five ethnic minority groups. These results imply a need to monitor the mental health of CNSLD patients in particular when a patient is from an ethnic minority group.

Investigation of Anxiety and Depression in Patients with Chronic Diseases

The health of an individual depends on both his/her physical and psychological condition. In recent years it has been observed that chronic patients have frequently an affected psycho-emotional state. The purpose of this study is to investigate anxiety and depression in patients with chronic diseases and the correlation of the results with daily physical activity levels and individual health levels, as well comorbidity. This study included patients with chronic diseases that were treated in a local general hospital or were visiting often outpatient clinics of the same hospital due to their condition. The sample in this particular study included 204 patients; 118 of them were women and 86 men. From the total sample that participated in our research, 118 (57.8%) were females and the majority of the participants were secondary/basic education graduates (67%), married (71%), living in urban areas (53%). Hypertension was the most frequent chronic disease in our sample, followed by hypercholesterolemia and diabetes mellitus. Comparing the occurrence of depression and anxiety symptoms in both questionnaires in relation to the expected frequency in the general population, significant levels of depression and anxiety symptoms were recorded. Taking into consideration the findings of this research, anxiety and depression symptoms can have profound effects regarding the control of chronic diseases, the patients' quality of life and their general health.

Individual differences in cognitive ability at age 20 predict pulmonary function 35 years later

BACKGROUND

Poor pulmonary function is associated with mortality and age-related diseases, and can affect cognitive performance. However, extant longitudinal studies indicate that early cognitive ability also affects later pulmonary function. Despite the multifaceted nature of pulmonary function, most longitudinal studies were limited to a single index of pulmonary function: forced expiratory volume in 1 s (FEV1). In this study, we examined whether early adult cognitive ability predicted five different indices of pulmonary function in mid-life.

METHODS

Mixed modelling tested the association between young adult general cognitive ability (mean age=20), measured by the Armed Forces Qualification Test (AFQT), and mid-life pulmonary function (mean age=55), in 1019 men from the Vietnam Era Twin Study of Aging. Pulmonary function was indexed by per cent predicted values for forced vital capacity (FVC%p), FEV1%p, maximum forced expiratory flow (FEFmax%p), and maximal voluntary ventilation (MVV%p), and by the ratio of FEV1 to FVC (FEV1/FVC), an index of lung obstruction.

RESULTS

After adjusting for smoking, pulmonary disease, occupation, income and education, age 20 AFQT was significantly (p<0.05) associated with mid-life FVC%p (β=0.10), FEV1%p (β=0.13), FEFmax%p (β=0.13), and MVV%p (β=0.13), but was not significantly associated with FEV1/FVC (β=0.03, p=0.34).

CONCLUSIONS

Early adult cognitive ability is a predictor of multiple indices of aging-related pulmonary function 35 years later, including lung volume, airflow and ventilator capacity. Cognitive deficits associated with impaired aging-related lung function may, thus, be partly pre-existing. However, results also highlight that early life risk factors may be differentially related to different metrics of later-life pulmonary health.

The relationship between asthma and self-reported anxiety in a predominantly healthy adult population

BACKGROUND

Numerous studies involving patients with severe asthma have cited a relation between asthma and anxiety; this relation is responsible for decreased quality of life, increased morbidity, and higher health care usage. However, whether a link between milder asthma and anxiety exists remains unclear.

OBJECTIVE

To determine whether asthma and anxiety share an association in a group of predominantly healthy adults.

METHODS

Adults seen at the Cooper Clinic in Dallas, Texas from March 2000 through January 2013 for preventive medical examinations that included an extensive medical history, including a questionnaire regarding anxiety history, a physician-based physical examination, and laboratory and spirometric testing were used in the analysis. Multiple logistic regressions were used to determine the relation between asthma and anxiety.

RESULTS

The sample consisted of 15,675 patients, of whom 1,403 (9%) had an asthma diagnosis. A sizeable majority of patients with asthma rated their health good or excellent, did not use an inhaler, and had a ratio of forced expiration volume in the first second to forced vital capacity greater than 70%. When controlling for covariates, milder asthma was significantly associated with anxiety (odds ratio 1.435, 95% confidence interval 1.238-1.663, P < .001). Smoking, a variable associated with asthma severity, was significantly associated with anxiety (odds ratio 1.432, 95% confidence interval 1.261-1.626, P < .001), although other variables, such as the ratio of forced expiration volume in the first second to forced vital capacity or use of an inhaled corticosteroid or combined inhaled corticosteroid and a long-acting β agonist, were not significantly associated with anxiety.

CONCLUSION

In this cohort of patients with predominantly mild asthma, there was a 43.5% increased risk of anxiety. All patients with asthma should be considered at a higher risk of anxiety and a target population for anxiety screening.

Academic exam stress and depressive mood are associated with reductions in exhaled nitric oxide in healthy individuals

Nitric oxide (NO) has beneficial effects on cardiovascular and immune health. Stress and depression have been linked to a reduction in serum NO. In this study, we examined the effect of academic exam stress on the fraction of NO in exhaled air (FeNO) and spirometric lung function in 41 healthy college students. Participants completed assessments at mid-semester as well as in the early and late phase of an academic exam period. Negative affect, depressive mood, and salivary cortisol were elevated during exams, whereas FeNO and lung function decreased. Higher depressive mood was associated with lower FeNO, whereas higher negative affect was associated higher FeNO across time. These findings provide initial evidence that depression and prolonged stress can alter FeNO and lung function in healthy individuals, which could have adverse consequences for cardiovascular, airway, and immune health.

Analysis of the relation between level of asthma control and depression and anxiety

BACKGROUND

Frequent co-existence of bronchial asthma and depression or anxiety is an unquestioned phenomenon. In contrast, little is known about the relationship between the degree of asthma control and the prevalence of depression and anxiety. The aim of this study was to determine the potential relationship between the degree of asthma control and the prevalence of depression and anxiety.

MATERIAL/METHODS

This study included a group of 128 randomly selected asthmatic individuals with various degree of asthma control. The study was based on a questionnaire survey, using the following tools: the Asthma Control Test, Beck Depression Inventory, and State-Trait Anxiety Inventory (STAI) - X-1 and X-2 questionnaires. All the questionnaires were completed during a single follow-up visit at the clinic.

RESULTS

The occurrence of depression and its severity significantly correlated with the degree of asthma control. Individuals with depression were characterized by a significantly lower degree of asthma control compared to depression-free individuals (p<0.001). The degree of asthma control decreased significantly with increasing severity of depression (R=-0.367; p<0.001). No significant correlation was observed between the degree of asthma control and the levels of trait anxiety (R=-0.095; p=0.295) and state anxiety (R=-0.093; p=0.308).

CONCLUSIONS

The prevalence of depression and its severity significantly correlate with the degree of asthma control. Large, standardized multicenter studies of the relationship between the degree of asthma control and the prevalence of depression and other psychopathological symptoms are needed. Furthermore, it seems reasonable to introduce the screening of asthmatics for mental disorders.

Psychological status in uncontrolled asthma is not related to airway hyperresponsiveness

BACKGROUND

Airway hyperresponsiveness (AHR) is the characteristic functional abnormality of asthma, and previous studies have shown the potential for AHR to be influenced by psychological factors, yet the relationship between anxiety and/or depression and AHR remains unclear in patients with asthma.

OBJECTIVE

To explore the relationship between psychological status and AHR in asthma patients.

METHODS

In a cross-sectional study, 168 adult subjects were recruited with physician-diagnosed uncontrolled asthma and a positive result for AHR in methacholine (Mch) challenge test. Psychological status, asthma control, and asthma quality of life were assessed using Zung self-rating anxiety/depression scale, asthma control test (ACT), and asthma quality of life questionnaire (AQLQ), respectively. AHR severity was evaluated and quantified by the provocative concentration of Mch, which evoked a given decrease of 20% in FEV(1).

RESULTS

A total of 70.23% of recruited patients (n = 118) met the diagnostic criteria for anxiety and/or depression. There was a trend between negative psychological status and AHR in asthma patients that did not reach statistical significance, but no independent effects of negative mood states (anxiety, depression, or both) on AHR were established. Further, analyses revealed that only anxiety is associated with worse asthma control (p = 0.029), and a significant interaction effect of depression and anxiety accounted for lower asthma-related quality-of-life scores (p < 0.001).

CONCLUSIONS

AHR and psychological status are loosely related to each other even if in uncontrolled asthma.

Low respiratory function increases the risk of depressive symptoms in later life in men

OBJECTIVE

To assess the risk of depressive symptoms with respect to respiratory function in middle-aged men. Chronic lung diseases are associated with a high prevalence of depression, but the association of poor respiratory function with depressive symptoms has not been established in prospective population-based cohort studies.

METHODS

In a prospective, population-based cohort study with up to 30 years of follow-up, we included 1205 men aged 50 to 69 years from Finland (n = 663) and Italy (n = 542). Forced vital capacity (FVC) and forced expiratory flow in 0.75 sec (FEV(0.75)) in 1970 were analyzed in relationship to depressive symptoms (by Zung self-rating depression scale [SDS]) in 1985, 1990, 1995, and 2000, using multilevel regression models. Subsequent analyses were done separately in the strata with (n = 501) and without (n = 704) chronic diseases in 1970 (i.e., chronic lung diseases, cardiovascular diseases, or diabetes mellitus).

RESULTS

Poor respiratory function was associated independently with steeper increases in depressive symptoms over time, both for FVC (p < .001) and FEV(0.75) (p = .004). In participants without chronic diseases, a standard deviation (SD) increase in FVC was associated with a 1.1-point decrease (standard error [SE] = 0.4) in Zung SDS (p = .01) and a 1.5-point decrease (SE = 0.4) (p < .001) in participants with chronic diseases (p = .27 for interaction). Low FEV(0.75) was associated with more depressive symptoms in participants with chronic diseases (1.7 SE 0.4 decrease per SD; p < .001), but not in participants without chronic diseases (0.6 SE 0.4 decrease per SD; p = .16; p = .008 for interaction).

CONCLUSIONS

Small lung volumes were associated with an increased risk of subsequent depressive symptoms at old age, especially in persons with chronic lung diseases, cardiovascular diseases, or diabetes mellitus at baseline.

Anxiety and the management of asthma in an adult outpatient population

BACKGROUND

Review of the literature suggests that anxiety is more common among patients with asthma than among the general population, yet it does not appear to be given the attention it deserves as part of the overall management of asthma. The aim of this study was to investigate the relationship between anxiety and asthma management, in terms of Global Initiative for Asthma steps, lung function and medication.

METHODS

A total of 201 consecutive patients with respiratory physician-diagnosed asthma were recruited from an adult outpatient asthma clinic. Participants underwent a sociodemographic review, and a medical interview which included a detailed drug history. Forced expiratory volume in 1 second (FEV(1)) and peak expiratory flow (PEF) values were recorded using a Micro Medical((R)) portable spirometer. The level of anxiety was assessed using the Beck Anxiety Inventory (BAI).

RESULTS

A total of 51.5% of participants registered clinically significant levels of anxiety. Of these only 21% had already been diagnosed and were receiving treatment. Females reported significantly higher BAI scores than males (p < 0.01). More females (66.3%) registered clinically significant levels of anxiety as compared with males (33.7%) (p < 0.05). There was a positive correlation between the BAI score and the prescribed dose of inhaled glucocorticoids (r(s) = 0.150, p < 0.05) and between anxiety and GINA treatment step (r(s) = 0.139, p < 0.05). There was also a positive correlation between anxiety and the number of medicines taken by patients (r(s) = 0.259, p < 0.001).

CONCLUSIONS

Physicians treating patients with asthma should be sensitised to the association between asthma and anxiety, and should also consider assessing patients for the possibility of anxiety disorders as part of asthma management plans.

The role of physical activity and body mass index in the health care use of adults with asthma

BACKGROUND

Health care use in patients with asthma is affected by many factors, including sex and ethnicity. The role of physical activity (PA) and body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) in this relationship is unknown.

OBJECTIVE

To determine the role of PA and BMI in the health care use of patients with asthma.

METHODS

A sample of adults with asthma (n=6,835) and without asthma (n=78,051) from cycle 3.1 of the Canadian Community Health Survey was identified. Health care use was self-reported as overnight hospital stays (yes or no), length of overnight hospital stay (<4 or > or =4 nights), and physician consultations (<3 or > or =3). Self-reported physical activities were used to derive total energy expenditure and to classify participants as active (>3.0 kcal/kg of body weight per day), moderately active (1.5-3.0 kcal/kg of body weight per day), and inactive (<1.5 kcal/kg of body weight per day). The BMI was categorized as normal weight (18.5-24.9), overweight (25.0-29.9), and obese (30.0-59.9).

RESULTS

Adjusted logistic regression models revealed that patients with asthma were more likely to have an overnight hospital stay (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.95-2.60), 4 or more overnight hospital stays (OR, 1.48; 95% CI, 1.12-1.96), and 3 or more physician consultations (OR, 2.43; 95% CI, 2.18-2.71) compared with patients without asthma (OR, 1.00). Inactive patients with asthma were more likely to have an overnight hospital stay (OR, 1.68; 95% CI, 1.31-2.16) and 3 or more physician consultations (OR, 1.23; 95% CI, 1.04-1.46) than active patients with asthma (OR, 1.00). Inactive/obese patients with asthma were 2.35 (95% CI, 1.69-3.27) times more likely to have an overnight hospital stay and 2.76 (95% CI, 2.11-3.60) times more likely to have 3 or more physician consultations than active/normal weight patients with asthma (OR, 1.00).

CONCLUSIONS

Higher PA levels are associated with lower health care use in individuals with and without asthma. In those with asthma, PA was a more important factor in overnight hospital stays than BMI, whereas both BMI and PA were important determinants of physician consultations.

Psychological distress and occupational asthma

PURPOSE OF REVIEW

To summarize recent findings on the psychological impact of occupational asthma, on the basis of a review of medical and psychological literature published between 1998 and 2008. For the purposes of this review, 'psychological impacts' are defined as the experience of psychological stress or distress, which refers to the experience of negative emotions (e.g., anxiety and sadness/depression). When severe and chronic, psychological distress may reach clinical levels and is referred to as a 'psychiatric disorder', which is a clinical diagnosis based on established diagnostic criteria.

RECENT FINDINGS

Only one original article assessing psychological impacts has been published in the past 10 years (in 2007). Levels of psychological distress (i.e., depression, anxiety, and cognitive dysfunction) were all in the clinical range, and rates of anxiety disorders and dysthymia (a chronic form of depression) affected approximately 35 and 23% of patients, respectively.

SUMMARY

The paucity of available literature indicates that the study of psychological factors associated with occupational asthma is still in its infancy. Though preliminary and in need of replication, the only published study to date suggests that patients with occupational asthma may be highly anxious and many are chronically depressed, a finding that is consistent with previous studies with nonoccupational asthmatics. The established link between psychological factors (e.g., depression and anxiety) and nonoccupational asthma suggests that future studies are desperately needed to more comprehensively assess the scope and severity of the psychological burden of this disease.

Psychological and somatic symptoms in screening for depression in asthma patients

Correctly identifying asthma patients who need treatment for depression is part of comprehensive care. The objective of this study was to compare the prevalence of depressive symptoms measured by the short-form Center for Epidemiologic Studies Depression Scale (CESD-SF), which measures somatic and psychological symptoms, with the original and short-form Geriatric Depression Scale (GDS and GDS-SF), which measure only psychological symptoms. In total, 257 asthma patients (mean age 42 years, 75% women) completed the GDS (score range 0-30, positive screen > or = 11) and the CESD-SF (score range 0-30, positive screen > or = 10). The performance of each scale was compared to clinical diagnoses of depressive disorders reported by physicians using a skill score analysis. Twenty percent of patients had GDS scores > or = 11 and 32% had CESD-SF scores > or = 10. The somatic symptom of restless sleep was the most common CESD-SF symptom and the symptom that contributed most to the total score. The GDS had a skill score of +.16 (+1 = maximum possible, 0 = best guess) and the CESD-SF had a skill score of -.02 compared to physician-reported depressive disorders. Similar results were found for the GDS-SF. Thus, more patients had a positive CESD-SF screen, which was attributable mostly to a somatic sleep symptom that overlaps with asthma symptoms, and the GDS was more consistent with physicians' reports of depressive disorders.

Depressive symptoms in aged Chinese patients with silicosis

OBJECTIVES

To investigate the prevalence of depressive symptoms in patients with silicosis and its determinants.

METHODS

A cross-sectional cohort study was performed. About 121 patients with silicosis randomly selected from a case registry of a non-ferrous metal company and 110 controls completed the questionnaires of sociodemographic variables, Beck depression inventory (BDI) and lung function test. chi(2) test was performed to compare the prevalence of depressive symptoms between two groups. The relationship between the variables and depressive symptoms in patients with silicosis was assessed by performing the logistic regression analysis.

RESULTS

Prevalence of depressive symptoms in patients with silicosis was 27.3%, which was higher than the figure 7.3% in controls (chi(2)=15.8, p<001). Severe respiratory symptoms, severe impaired physical function, FEV(1) <50% predicted and (FVC)% predicted less than mean were significantly associated with the depressive symptoms (Odds ratio [OR]=4.6, 5.9, 3.0 and 5.2, respectively).

CONCLUSION

High prevalence of depressive symptoms was found in patients with silicosis. Respiratory symptoms, physical function and pulmonary functions were associated with depressive symptoms. Our findings provide evidence for physicians to screen for depressive symptoms in patients with silicosis.

Patient-reported and physician-reported depressive conditions in relation to asthma severity and control

BACKGROUND

Depressive conditions in asthma patients have been described mostly from patient reports and less often from physician reports. While patient reports can encompass multiple symptoms, physician assessments can attribute symptoms to a mental health etiology. Our objectives were to identify associations between patient- and physician-reported depressive conditions and asthma severity and control.

METHODS

Patient-reported depressive symptoms were obtained using the Geriatric Depression Scale (GDS) [possible score 0 to 30; higher score indicates more depressive symptoms]. Patients were categorized as having a physician-reported depressive disorder if they had the following: a diagnosis of depression, depressive symptoms described in medical charts, or were prescribed antidepressants at doses used to treat depression. Patients also completed the Severity of Asthma Scale (SOA) [possible score 0 to 28; higher score indicates more severe] and the Asthma Control Questionnaire (ACQ) [possible score 0 to 6; higher score indicates worse control].

RESULTS

Two hundred fifty-seven patients were included in this analysis (mean age, 42 years; 75% women). Mean SOA and ACQ (+/- SD) scores were 5.9 +/- 4.2 and 1.4 +/- 1.2, respectively; and mean GDS score was 6.3 +/- 6.4. After adjusting for age, sex, race, Latino ethnicity, education, medication adherence, body mass index, and smoking status, patient-reported depressive symptoms were associated with asthma severity (p = 0.007) and with asthma control (p = 0.0007). In contrast, physician-reported depressive disorders were associated with asthma severity (p = 0.04) but not with asthma control (p = 0.22) after adjusting for covariates.

CONCLUSIONS

Physician- and patient-reported depressive conditions were associated with asthma severity. In contrast, patient-reported depressive symptoms were more closely associated with asthma control than were physician-reported depressive disorders. Identifying associations between depressive conditions and asthma severity and control is necessary to concurrently treat these conditions in this population.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT00195117.

Specific psychiatric morbidity among a sample of asthmatics in south western Nigeria

OBJECTIVE

This study was to identify specific psychiatric morbidity among asthma patients and to compare their rates to controls.

METHOD

Hundred consecutive asthmatics were screened using the General Health Questionnaire (GHQ-30), and the Present State Examination (PSE). The same instruments were also administered to 75 healthy individuals, and 75 orthopaedic patients.

RESULTS

Patients with asthma had a higher occurrence of psychopathology. The specific psychiatric diagnoses among asthmatics were generalized anxiety disorder (23%), depressive disorder (11%), while 2% had panic disorder.

CONCLUSION

Psychiatric morbidity is more common among asthmatics, than the general population and other patient group.

Depression and panic disorder as predictors of health outcomes for patients with asthma in primary care

INTRODUCTION

Depression and panic disorder are widely acknowledged as complicating factors in asthma patients. However, their impact on health outcomes in primary care patients is less well examined. This study prospectively evaluated the impact of depression and panic disorder on outcomes of primary care patients with asthma over 1 year.

METHODS

At baseline, 256 asthma patients from 43 primary care practices completed self-report questionnaires including the Patient Health Questionnaire (PHQ), the Asthma Quality of Life Questionnaire (AQLQ), and a structured questionnaire evaluating asthma severity, hospitalisation and emergency visits. One year later, 185 (72.3%) patients completed the same questionnaire.

RESULTS

At baseline, 3.9% of patients suffered from major depressive disorder, 22.7% from minor depressive disorder, and 7.8% from panic disorder. In the year under evaluation, 17 patients (9.2%) received emergency home visits and 10 patients (5.4%) were admitted to a hospital. Depression at baseline predicted hospitalisation within the subsequent year (OR 6.1; 95% CI 1.5-24.6) and panic disorder predicted unscheduled emergency home visits (OR 4.8; 95% CI 1.3-17.7). Depression but not panic disorder predicted the AQLQ scales activity (p=0.001), symptoms (p=0.001), emotions (p=0.001) and environment (p=0.001) at follow-up.

CONCLUSIONS

Although rates of hospitalisation and emergency visits in primary care are low, the impact of psychiatric comorbidity on health outcomes for patients with asthma is substantial. It might be helpful to identify patients with psychiatric comorbidity by analysing reasons for hospitalisation and emergency visits. For these patients, intensifying care with psychiatric interventions might help to reduce inappropriate healthcare utilisation and avoid adverse outcomes.

Reported respiratory symptoms and adverse home conditions after 9/11 among residents living near the World Trade Center

This study investigated whether self-reported damage, dust, and odors in homes near the World Trade Center (WTC) after September 11, 2001, were related to increased rates of respiratory symptoms among residents and if multiple sources of exposure were associated with greater health risk. We mailed questionnaires to homes within 1.5 km of the WTC site (affected area) and in upper Manhattan (control area). Surveys asked about respiratory symptoms, unplanned medical visits, physician diagnoses, medication use, and conditions in the home after 9/11. Adverse home conditions were associated with new-onset (i.e., began after 9/11) and persistent (i.e., remained 1 year after 9/11) upper and lower respiratory symptoms in the affected area (Cumulative Incidence Ratios [CIRs] 1.20-1.71). Residents reporting longer duration of dust/odors or multiple sources of exposure had greater risk for symptoms compared to those reporting shorter duration and fewer sources. These data suggest that WTC-related contamination in the home after 9/11 was associated with new and persistent respiratory symptoms among residents living near the site. While we cannot eliminate potential biases related to self-reported data, we took strategies to minimize their impact, and the observed effects are biologically plausible.

Psychiatric symptomatology and disorders in caregivers of children with asthma

OBJECTIVE

The prevalence of asthma and asthma-related mortality has increased in recent years. Data suggest an association between psychiatric symptoms in the caregiver and asthma-related hospitalizations in the child. We examined the prevalence of psychiatric symptoms and disorders and their relationship to asthma-related service utilization in caregivers of children hospitalized for asthma.

PATIENTS AND METHODS

Caregivers (n = 175) were assessed during the child's hospitalization. The number of asthma-related hospitalizations, emergency department visits, and unscheduled clinic visits in the past 12 months was obtained. The Brief Symptom Inventory, an assessment of psychiatric symptoms including somatic, anxiety, and depression subscales, and the Mini International Neuropsychiatric Interview, a structured clinical interview for psychiatric disorders, were administered.

RESULTS

Mean age of the caregivers was 34.2 +/- 7.3 years; 96.0% were women; 15.4% were white, 57.7% were black, and 26.3% were Hispanic. A total of 47.9% had incomes less than 25,000 dollars/year. Caregivers with clinically significant elevations in 2 or more Brief Symptom Inventory subscales reported more asthma-related child hospitalizations in the past 12 months than did caregivers with lower Brief Symptom Inventory scores. Asthma-related hospitalizations correlated with Brief Symptom Inventory total, somatic, anxiety, and depression subscale scores. Caregiver diagnosis of an anxiety disorder (n = 36) was associated with more asthma-related hospitalizations in the child. Children of caregivers with current depression (n = 44) had more unscheduled clinic visits than children of caregivers without depression.

CONCLUSION

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-defined psychiatric disorders, particularly depressive disorders, were common in caregivers and associated with a greater frequency of asthma-related hospitalizations in the child.

Asthma and depression: a pragmatic review of the literature and recommendations for future research

BACKGROUND

Although the association between asthma and psychosocial factors has long been recognised, it is only in the last decade that the impact of coexisting asthma and depression has become the focus of considerable research interest. However, the findings so far have been confusing and often contradictory. This paper sets out a methodical review and appraisal of the literature to date, including suggestions for future research.

METHOD

PubMed and PsycINFO databases were used to search for English-language articles relating to asthma and depression research. The resulting articles were then reviewed and summarised, creating a report that was used to develop research recommendations.

RESULTS

The main findings from this review included: (a) results are mixed as to whether persons with asthma are more likely to be depressed than those without asthma; (b) asthma and depression may have an 'additive' adverse effect on the normal asthma-related quality of life reductions; (c) subjective measures of asthma severity may be more strongly related to depression than objective measures; (d) specific asthma symptoms appear to be linked to depression; (e) sadness and depression can produce respiratory effects consistent with asthma exacerbations; (f) depression appears to be negatively related to asthma treatment compliance; (g) corticosteroid use in asthma treatment has been associated with depression, though it is unclear how common this problem is in real life; (h) interventions that address the physical, psychological, and social consequences of asthma are likely to lead to the most successful treatment outcomes; (i) treating the depression of individuals with asthma is likely to minimise the negative effects of the coexistence; and (j) a number of common methodological problems were observed in the literature.

RECOMMENDATIONS

There is a large amount of research yet to be undertaken to clarify issues around asthma and depression, with the overdue next step being to design integrated treatment approaches, and carry out large-scale prospective studies to determine the impact of using such approaches to treat individuals with depression and asthma. Such studies will be the only way in which some fundamental questions about the development and coexistence of these two conditions will be answered.

Therapeutic value of antidepressants in asthma

Laboratory and clinical data provide evidence that a biological linkage exists between asthma and depression. Cytokines are key molecules in both diseases. They promote allergic reaction as well as depressive symptomatology. Antidepressants may have a therapeutic role in asthma by suppressing production of proinflammatory cytokines, inducing production of anti-inflammatory ones and preventing their brain effects. Most antidepressants also induce adaptive changes in central monoaminergic neurotransmission, which itself might modulate immune reactivity and central actions of cytokines. Antidepressants may also have direct effects on the immune cells. Their impact on hypothalamus-pituitary-adrenal axis is discussed. Antidepressants are expected to terminate the cascade of inflammatory events in other inflammatory diseases as well. The use of antidepressants in experimental clinical trials in patients with asthma is suggested.