Anxiety in asthma: a systematic review and meta-analysis

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).

Obstructive respiratory disease in U.S. veterans: Prevalence, characteristics, and health burden

OBJECTIVE

To examine the psychiatric and physical health burden of obstructive respiratory disease in a nationally representative sample of U.S. Veterans.

METHODS

Secondary data analyses were conducted using data from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of U.S. Veterans. Participants self-reported health professional-diagnosed obstructive respiratory disease (i.e., asthma, chronic bronchitis or chronic obstructive pulmonary disease). Veterans who reported obstructive respiratory disease (n = 502) were compared to veterans without this disease but with at least one or more other medical conditions-controls (n = 3169) on measures of sociodemographic, trauma, psychiatric, and physical health characteristics. Multivariable regression analyses examined independent associations between obstructive respiratory disease and psychiatric conditions and physical characteristics.

RESULTS

A total 12.5% of the sample reported a diagnosis of obstructive respiratory disease. Compared to controls, veterans with obstructive respiratory disease were more likely to be female, unmarried/partnered, lower income, residing in the Midwest, receiving VA healthcare, and had greater lifetime and childhood trauma burden. In adjusted analyses, veterans with respiratory disease had 47-91% greater odds of screening positive for current posttraumatic stress, major depressive, and generalized anxiety disorders, and had 48% greater odds of current suicide ideation. They were also more likely to have lifetime nicotine use disorder and had more medical comorbidities and more severe somatic symptoms.

CONCLUSIONS

Obstructive respiratory disease is prevalent among U.S. veterans and associated with significant mental and physical health burden. Results highlight the need for timely screening and treatment for psychiatric and medical conditions that are highly comorbid with obstructive respiratory disease in this population.

Internet-delivered cognitive-behaviour therapy for anxiety related to asthma: study protocol for a randomised controlled trial

INTRODUCTION

There is an established association between asthma and anxiety. The overlap between asthma symptoms and symptoms of anxiety may cause individuals to overestimate their asthma severity and restrict their daily activities leading to a low quality of life. There is currently weak evidence for treatments targeting anxiety related to asthma, but cognitive-behavioural therapy (CBT) has shown some promising but mixed results. The current randomised controlled trial will investigate if exposure-based internet-delivered CBT (Internet-CBT) is more effective than treatment as usual+medical education (TAU+ME) to relieve symptoms of anxiety and asthma control.

METHODS AND ANALYSIS

90 participants will be randomised 1:1 to 8 weeks of Internet-CBT or TAU+ME. The primary outcome, the patient-reported Catastrophising Asthma Scale, will be analysed from baseline to the primary endpoint at 16 weeks using hierarchical linear mixed model of the slope over time. Secondary outcomes, such as asthma control, quality of life and forced expiratory volume in 1 s, will be analysed correspondingly.

ETHICS AND DISSEMINATION

All participants will be informed about the study and leave their consent before study entry. All results will be analysed at group level and reported through publication in a peer-reviewed scientific journal within the field. The study received ethical approval by the Swedish Ethical Review Authority in January 2020 (ID: 2019-05985; 2022-01117-02).

TRIAL REGISTRATION NUMBER

Registered at ClinicalTrials.gov (ID: NCT04230369).

Asthma medication adherence, control, and psychological symptoms: a cross-sectional study

BACKGROUND

Nonadherence to therapies and psychological disorders are associated with poor asthma control. This study aims to assess the prevalence of anxiety and depressive symptoms, asthma control, and adherence to inhalers and to investigate whether there is an association of anxiety and depressive symptoms with adherence to inhalers and asthma control.

METHODS

We measured anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale in patients with asthma. Asthma Control Test and the 10-Item Test of Adherence to Inhalers Scale were used to assess levels of asthma control adherence to inhalers, respectively. Univariate and multivariate regression models assessed the associations of anxiety and depressive symptoms with adherence to inhalers and asthma control.

RESULTS

A total of 287 patients completed the study, of whom 72% were female. The mean ± SD age and body mass index of our study population were 44 ± 13 years and 29 ± 7.2 kg/m2, respectively. Poor adherence to inhaler use was highly prevalent (49.8%; 95% CI: 43.8 to 55.7). The prevalence of anxiety, depression and poor asthma control was 27.2% (95% CI: 22.1 to 32.7), 20.9% (95% CI: 16.3 to 26.1), and 22.7% (95% CI: 17.9 to 27.9), respectively. We found a negative relationship between asthma control and anxiety, and depressive symptoms (adjusted β: -0.25; 95% CI: -0.36 to -0.14; p < 0.001 and adjusted β: -0.29; 95% CI: -0.40 to -0.18; p < 0.001, respectively). A negative relationship was also observed between adherence to inhalers and anxiety and depressive symptoms (adjusted β: -0.34; 95% CI: -0.46 to -0.22; p < 0.001 and adjusted β: -0.36; 95% CI: - 0.48 to - 0.24; p < 0.001, respectively).

CONCLUSIONS

The high prevalence of uncontrolled asthma symptoms and poor adherence to inhalers and their impact on anxiety and depression levels among patients with asthma point to the need for early screening for psychological symptoms and recognition of nonadherence as part of asthma assessment and management plan in primary care in Saudi Arabia to avoid further worsening of asthma symptoms. Further studies are needed to explore the effectiveness of specific psychoeducational interventions and investigate the long-term impact of early psychological symptom detection on asthma outcomes.

The frequency of asthma and its related factors: results of the enrolment phase of Tabari cohort study

INTRODUCTION

A large portion of the world's population has asthma. This study aimed to ascertain asthma prevalence and related factors in the Tabari cohort study (TCS).

METHODS

The TCS included 10,255 35-70-year-olds from urban and mountainous Sari (northern Iran) between June 2015 and November 2017. Education, occupation, domicile, socioeconomic position, history of psychiatric disorders, smoking (including hookah smoking), opium usage, and daily physical activity level were determined.

RESULTS

The final analysis included 9939 individuals. The asthma rate was 7.4%. Multiple factors increased asthma risk, according to statistical analysis. These factors included being female (OR, 1.337; 95% CI, 1.142-1.565), retired (OR, 1.553; 95% CI, 1.205-2.002), living in the city (OR, 1.268; 95% CI, 1.083-1.484), using opioids (OR, 1.689; 95% CI, 1.299-2.197), having lower socioeconomic status (SES) (OR, 0.723; 95% CI, 0.579-0.903), history of psychiatric disorders (OR, 2.313; 95% CI, 1.826-2.930), and aged 60-70 (OR, 2.325; 95% CI, 1.765-3.064), and BMI above 30 kg/m2 (OR, 1.499; 95% CI, 1.220-1.841). Several factors increased asthma probability in multivariate regression analysis. These factors include being female (OR = 1.389, p = 0.015), ages between 60 and 70 (OR = 2.034, p < 0.001), using opioids (OR = 1.940, p < 0.001), lower SES (OR = 0.738, p = 0.012), history of psychiatric disorders (OR = 2.035, p < 0.001), BMI above 30 kg/m2 (OR = 1.518, p < 0.001), and being a smoker (OR = 1.337, p = 0.056).

CONCLUSION

This study has identified that the prevalence of asthma in the Tabari cohort group is high. In addition, it was demonstrated that various factors are related to asthma.

Treatable Traits in Asthma: The Importance of Extrapulmonary Traits-GERD, CRSwNP, Atopic Dermatitis, and Depression/Anxiety

Treatable traits is a personalized medicine approach to the management of airway disease. Assessing traits within the 3 domains of pulmonary, extrapulmonary, and behavioral/lifestyle/risk factor traits, and applying targeted treatments to effectively manage these traits, enables a holistic and personalized approach to care. Asthma is a heterogeneous and complex airway disease that is frequently complicated by several extrapulmonary traits that impact asthma outcomes and predict future outcomes. We propose that the identification of extrapulmonary and behavioral risk factor traits and the implementation of targeted therapy will lead to improved management of people with asthma. Furthermore, many extrapulmonary traits present as "connected comorbidities"; that is, they coexist with asthma, have an impact on asthma, and effective treatment improves both asthma and the comorbidity or the comorbidities may share a similar mechanism. In this review, we explore this concept and look at atopic dermatitis, chronic rhinosinusitis with nasal polyps, gastroesophageal reflux disease, anxiety, and depression as treatable traits of asthma and how these can be managed using this approach.

Causal relationship between irritability and asthma: a bidirectional two-sample Mendelian randomization study

INTRODUCTION

Previous studies have suggested a relationship between bad mood and asthma. Therefore, in this study, a two-sample Mendelian randomization (MR) method was used to explore the correlation between irritability and asthma.

MATERIAL AND METHODS

Relevant instrumental variables (IVs) were extracted from the aggregated data of the genome-wide association studies (GWAS) database. Inverse-variance weighting (IVW) and weighted median (WME) were used for the MR analysis to evaluate the causal relationship between irritability and asthma using odds ratios (ORs) and the corresponding 95% confidence intervals (CIs), respectively. The "leave-one-out" method was used for sensitivity analysis.

RESULTS

The results of IVW analysis using random-effects models suggested that irritability increased the risk of asthma (OR = 1.954, 95% CI = 1.188-3.214, p = 0.008). The results of WME were consistent with this observation (OR = 1.934, 95% CI = 1.100-3.400, p = 0.021). Additionally, gastroesophageal reflux disease (GERD) might account for approximately 40% of the relationship between irritability and asthma. The sensitivity analysis revealed the stability of the results.

CONCLUSION

The causal relationship between irritability and asthma was analyzed through MR analysis. Irritability increased the risk of asthma. GERD might play an important mediating role in this relationship.

Care trajectories of individuals with anxiety disorders: A retrospective cohort study

BACKGROUND

Anxiety disorders (ADs) are associated with increased healthcare use (HCU), and individuals may seek healthcare through various pathways according to clinical and individual characteristics. This study aimed to characterize care trajectories (CTs) of individuals with ADs.

METHODS

This is a retrospective cohort study using the Care Trajectories - Enriched Data cohort, a linkage between the Canadian Community Health Surveys (CCHS), and health administrative data from Quebec. The cohort included 5143 respondents reporting ADs to the CCHS between 2009 and 2016. We measured CTs over 5 years before CCHS using a state sequence analysis.

RESULTS

The cohort was categorized into five types of CTs. Type 1 (52.7 %) was the lowest care-seeking group, with fewer comorbidities. Type 2 (24.0 %) had higher levels of physical and mental health comorbidities and moderate HCU, mainly ambulatory visits to general practitioners. Type 3 (13.1 %) represented older patients with the highest level of physical illnesses and high HCU, predominantly ambulatory consultation of specialists other than psychiatrists. Types 4 and 5 combined young and middle-aged patients suffering from severe psychological distress. HCU of type 4 (6.7 %) was high, mainly consultations of ambulatory psychiatrists, and HCU of type 5 (3.5 %), was the highest and mostly in acute care.

LIMITATIONS

Administrative and survey data may have coding errors, missing data and self-report biases.

CONCLUSION

Five types of CTs showed distinct patterns of HCU often modulated by physical and mental health comorbidities, which emphasizes the importance of considering ADs when individuals seek care for other mental health conditions or physical illness.

The influence of asthma on neuroinflammation and neurodevelopment: From epidemiology to basic models

Asthma is a highly heterogeneous inflammatory disease that can have a significant effect on both the respiratory system and central nervous system. Population based studies and animal models have found asthma to be comorbid with a number of neurological conditions, including depression, anxiety, and neurodevelopmental disorders. In addition, maternal asthma during pregnancy has been associated with neurodevelopmental disorders in the offspring, such as autism spectrum disorders and attention deficit hyperactivity disorder. In this article, we review the most current epidemiological studies of asthma that identify links to neurological conditions, both as it relates to individuals that suffer from asthma and the impacts asthma during pregnancy may have on offspring neurodevelopment. We also discuss the relevant animal models investigating these links, address the gaps in knowledge, and explore the potential future directions in this field.

Does Asthma Increase the Odds of Suicidal Thoughts, Plans, and Attempts?

Background Asthma is a chronic inflammatory disease of the airways affecting more than 250 million people worldwide. In the past, a possible relationship between asthma and suicidality has been hypothesized. However, further research is required as this link has not been clearly established. Our objective was to use propensity score matching to answer the following research question: does having asthma increase one's odds of developing suicidality throughout their lifetime and, if so, how large is this increase? Methodology We utilized data from the 2018 National Survey on Drug Use and Health. We analyzed the relationship between currently having asthma and having had suicidal thoughts, suicide plans, and suicide attempts over the past 12 months. Chi-square analyses were performed both before and after completing propensity score matching. Results Before matching, it was found that, compared to individuals without asthma, asthmatic individuals had 31.2% higher odds of having suicidal thoughts (p = 0.010) and 97.4% higher odds of a suicide attempt (p = 0.012). After controlling for confounders by matching, there was no longer a relationship between having asthma and suicidal thoughts (p = 0.707), suicidal plans (p = 0.523), and suicidal attempts (p = 0.260). Conclusions These findings highlight that while asthma may appear to be associated with suicidality, this association does not persist after controlling for confounding factors. Hence, it is recommended that more research be conducted on this topic and that possible confounders be further researched. In particular, there is a need to better understand the role of social determinants and other contributors to health outcomes.

Montelukast in paediatric asthma and allergic rhinitis: a systematic review and meta-analysis

BACKGROUND

We aim to assess the impact of montelukast on paediatric patients with asthma/allergic rhinitis, measured using patient-reported outcome measures, compared with other treatments or placebo.

METHODS

Protocol registration CRD42020216098 (www.crd.york.ac.uk/PROSPERO). MEDLINE and Embase databases were used to conduct the search. Two authors independently selected studies and extracted data, and a third reviewer resolved discrepancies. Meta-analyses were constructed to estimate the standardised mean difference (SMD) using a random-effects model.

RESULTS

Out of 3937 articles identified, 49 studies met the inclusion criteria, mostly randomised clinical trials (sample sizes: 21-689 patients). The SMD of change pooled estimators for the global, mental and physical domains of health-related quality of life were not statistically significant. For daytime and night-time symptoms scores, the SMD (95% CI) was in favour of inhaled corticosteroids (-0.12, -0.20- -0.05 and -0.23, -0.41- -0.06, respectively). The pooled estimator for global asthma symptoms was better for montelukast when compared with placebo (0.90, 0.44-1.36).

CONCLUSIONS

The synthesis of the available evidence suggests that, in children and adolescents, montelukast was effective in controlling asthma symptoms when compared with placebo, but inhaled corticosteroids were superior in controlling symptoms, especially at night-time. These findings of our systematic review concur with current guidelines for asthma treatment.

Psychological distress and symptom-related burnout in asthma during the COVID-19 pandemic

People with asthma may be particularly vulnerable to pandemic-related psychological distress, and research is needed to understand the impact of the coronavirus disease 19 (COVID-19) pandemic on their health and well-being. We sought to study the well-being of people with asthma relative to non-asthmatic controls during the COVID-19 pandemic. We also investigated asthma symptoms and COVID-19-related anxiety as potential mediators of distress. Participants completed self-report measures of psychological functioning, including anxiety, depression, stress, and burnout. Controlling for potential confounds, multiple-regression analyses examined differences in psychological health between people with and without asthma. Mediator analyses investigated the role of asthma symptoms and COVID-19-related anxiety in this relationship. 234 adults (111 with asthma, 123 without) participated in an online survey from July to November 2020. During this time, people with asthma reported higher levels of anxiety, perceived stress, and burnout symptoms compared to controls. Elevations in burnout symptoms were found beyond general anxiety and depression (sr2 = .03, p < .001). Reported symptoms typical in both asthma and COVID-19 partially mediated this relationship (Pm = .42, p < .05). People with asthma reported unique psychological challenges during the COVID-19 pandemic including elevated burnout symptoms. Experience of asthma symptoms played a key role in vulnerability to emotional exhaustion. Clinical implications include increased attention to asthma symptom burden within the context of heightened environmental stress and restricted healthcare access.

The prevalence of anxiety and depression in bronchiectasis patients and their association with disease severity: a cross-sectional study

Bronchiectasis is a chronic lung disease characterized by recurrent respiratory symptoms. Several studies demonstrated that psychological comorbidities are common in patients with bronchiectasis. The aim of this study is to investigate the prevalence of anxiety and depression in bronchiectasis patients and assess their association with disease severity. In this cross-sectional study, we included patients diagnosed with bronchiectasis. The study was conducted using an interviewer-administered questionnaire via phone calls and data collected from the electronic medical records at JUH. The questionnaire included patients' demographics and disease characteristics. Anxiety and depression were assessed using GAD7 and PHQ9 respectively. Bronchiectasis disease severity was assessed using BSI and FACED score. The total number of included patients was 133. Moreover, 53.4% of the participants were females while the rest were males (46.6%). PHQ9 demonstrated that 65.4% of the patients had depression. Regarding anxiety, GAD7 scale showed that 54.1% of the patients had anxiety. Pearson correlation showed that bronchiectasis severity index was significantly associated only with PHQ9 depression scores (r = 0.212, P value = 0.014). The prevalence of depression and anxiety is high among patients with bronchiectasis. We believe that patients affected with bronchiectasis should be screened for depression to improve their quality of life.

The Interaction Between Asthma, Emotions, and Expectations in the Time of COVID-19

Introduction

The main aim was to gain insight into the experience of adult people with a diagnosis of at least 6-months of mild or moderate persistent asthma according to the Global Initiative for Asthma (GINA), and their emotions, beliefs, and expectations during the first wave of COVID-19.

Methods

Qualitative semi-structured interviews using the Interpretative Phenomenological Analysis (IPA) were carried out by phone involving 31 people (mean age=58.2; SD=16.2). Interviews were audio recording, transcribed verbatim and analysed through thematic analysis.

Results

Five superordinate themes and themes were dedicated to illness (symptoms of asthma; difficulties related to COVID-19), experienced emotions (lockdown period; medical changes; emotions COVID-19 related), beliefs (about asthma; about COVID-19), expectations (related to asthma; related to COVID-19) and behaviours (to protect; risk taken; adherence; contacts with General Practitioners; support). The prevalence of emotions such as fear, worry and anxiety emerged in the participants' narratives. All are accompanied by a preference for action and problem solving. A sense of protection, connection to self and other, and commitment to life were revealed as central concepts for enhancing well-being even at a time of deterring.

Discussion

The common threads of the presence of uncertainty and vulnerability open the outlook of a treatment that ensures greater continuity and ownership of care in the patient, preserving the sense of self-efficacy even in times of greater instability.

The Association of Asthma with Anxiety, Depression, and Mild Cognitive Impairment among Middle-Aged and Elderly Individuals in Saudi Arabia

Asthma is a common chronic inflammatory condition with increasing global prevalence. There is some evidence highlighting the effect of asthma on brain functioning. In Saudi Arabia, limited studies have examined the relationship between asthma and mental health, including cognition and mood disorders in older adults in particular. In this study, we examine the association between asthma and mental health outcomes in middle-aged and elderly individuals in Riyadh, Saudi Arabia. In a cross-sectional study, 243 subjects were recruited from outpatient clinics between 2020-2021 (non-asthmatic: n = 159, asthmatic: n = 84). The Montreal Cognitive Assessment test, the Hospital Anxiety and Depression Scale, and the Asthma Control Test were used to assess cognition, anxiety and depression, and asthma control, respectively. Logistic regression analysis while controlling for covariates revealed an association between asthma and symptoms of anxiety and depression (OR = 2.40 [95% CI: 1.07-5.35]) and mild cognitive impairment (MCI) (OR = 1.80 [95% CI: 1.00-3.24]). Poorly controlled asthma increased the odds of anxiety cases (OR = 4.88 [95% CI: 1.09-17.2]). Stratifying analysis by age intervals revealed that asthma was associated with symptoms of anxiety and depression (OR = 2.5 [95% CI: 1.00-6.08]) in middle-aged patients only, while elderly asthmatics had increased odds of having MCI (OR = 7.4 [95% CI: 2.34-23.31]). These findings highlight the possible effects of asthma and its control on mental health among middle-aged and elderly individuals in Saudi Arabia.

Brain structural and functional alterations related to anxiety in allergic asthma

Psychiatric disorders are common in patients with allergic asthma, and they can have a significant impact on their quality of life and disease control. Recent studies have suggested that there may be potential immune-brain communication mechanisms in asthma, which can activate inflammatory responses in different brain areas, leading to structural and functional alterations and behavioral changes. However, the precise mechanisms underlying these alterations remain unclear. In this paper, we comprehensively review the relevant research on asthma-induced brain structural and functional alterations that lead to the initiation and promotion of anxiety. We summarize the possible pathways for peripheral inflammation to affect the brain's structure and function. Our review highlights the importance of addressing neuropsychiatric disorders in the clinical guidelines of asthma, to improve the quality of life of these patients. We suggest that a better understanding of the mechanisms underlying psychiatric comorbidities in asthma could lead to the development of more effective treatments for these patients.

Weighing poor immunometabolic health in relatives for severity of affective symptoms: A study of patients with depressive and anxiety disorders and their siblings

BACKGROUND

Affective (i.e. depressive and anxiety) disorders often co-occur with immunometabolic diseases and related biological pathways. Although many large population-based and meta-analytic studies have confirmed this link in community and clinical samples, studies in at-risk samples of siblings of persons with affective disorders are lacking. Furthermore, this somatic-mental co-occurrence may be partially explained by familial clustering of the conditions. First, we examined whether the association between a wide range of immunometabolic diseases and related biomarker based risk-profiles with psychological symptoms replicates in at-risk siblings of probands with affective disorders. Second, leveraging on a sibling-pair design, we disentangled and quantified the effect of probands' immunometabolic health on siblings' psychological symptoms and on the association between immunometabolic health and these symptoms in siblings.

METHODS

The sample included 636 participants (Mage = 49.7; 62.4% female) from 256 families, each including a proband with lifetime depressive and/or anxiety disorders and at least one of their sibling(s) (N = 380 proband-sibling pairs). Immunometabolic health included cardiometabolic and inflammatory diseases, body mass index (BMI), and composite metabolic (based on the five metabolic syndrome components) and inflammatory (based on interleukin-6 and C-reactive protein) biomarker indices. Overall affective symptoms and specific atypical, energy-related depressive symptoms were derived from self-report questionnaires. Mixed-effects analyses were used to model familial clustering.

RESULTS

In siblings, inflammatory disease (γ = 0.25, p = 0.013), higher BMI (γ = 0.10, p = 0.033) and metabolic index (γ = 0.28, p < 0.001) were associated with higher affective symptoms, with stronger associations for atypical, energy-related depressive symptoms (additionally associated with cardiometabolic disease; γ = 0.56, p = 0.048). Immunometabolic health in probands was not independently associated with psychological symptoms in siblings nor did it moderate the association between immunometabolic health and psychological symptoms estimated in siblings.

CONCLUSIONS

Our findings demonstrate that the link between later life immunometabolic health and psychological symptoms is consistently present also in adult siblings at high risk for affective disorders. Familial clustering did not appear to have a substantial impact on this association. Instead, individual lifestyle, rather than familial factors, may have a relatively higher impact in the clustering of later life immunometabolic conditions with psychological symptoms in at-risk adult individuals. Furthermore, results highlighted the importance of focusing on specific depression profiles when investigating the overlap with immunometabolic health.

Management of comorbidities in difficult and severe asthma

Difficult-to-treat and severe asthma are challenging clinical entities. In the face of suboptimal asthma control, the temptation for clinicians is to reflexively escalate asthma-directed therapy, including increasing exposure to corticosteroids and commencement of costly but potent biologic therapies. However, asthma control is objectively and subjectively assessed based on measurable parameters (such as exacerbations or variability in pulmonary physiology), symptoms and patient histories. Crucially, these features can be confounded by common untreated comorbidities, affecting clinicians' assessment of asthma treatment efficacy.

Alexithymia and asthma: a systematic review

Growing evidence from scientific research elucidates the important role of alexithymia in chronic immune diseases. This Review aims to explore the presence of alexithymia in patients affected by asthma and clarify its associations with other involved psychological and physical factors. In January 2023, according to PRISMA guidelines, a systematic search using PubMed and Scopus was conducted. Twenty-six studies were eligible based on inclusion criteria. Alexithymia was significantly present in asthma patients, with most studies reporting a higher prevalence (from 9 to 62.8%) than in control groups (approximately 10%). The coexistence of asthma and alexithymia was associated with a worse quality of life, psychiatric comorbidity, poor symptom control, and difficulty in recognizing exacerbations of the disease. These results suggest that alexithymia can negatively impact the management of asthma. For this reason, we recommend an accuracy assessment in clinical settings and the implementation of psychological interventions to promote the emotional and physical wellbeing of asthmatic patients.

More airway smooth muscle in males versus females in a mouse model of asthma: A blessing in disguise?

NEW FINDINGS

What is the central question of this study? The lung response to inhaled methacholine is reputed to be greater in male than in female mice. The underpinnings of this sex disparity are ill defined. What is the main finding and its importance? We demonstrated that male airways exhibit a greater content of airway smooth muscle than female airways. We also found that, although a more muscular airway tree in males might contribute to their greater responsiveness to inhaled methacholine than females, it might also curb the heterogeneity in small airway narrowing.

ABSTRACT

Mouse models are helpful in unveiling the mechanisms underlying sex disparities in asthma. In comparison to their female counterparts, male mice are hyperresponsive to inhaled methacholine, a cardinal feature of asthma that contributes to its symptoms. The physiological details and the structural underpinnings of this hyperresponsiveness in males are currently unknown. Herein, BALB/c mice were exposed intranasally to either saline or house dust mite once daily for 10 consecutive days to induce experimental asthma. Twenty-four hours after the last exposure, respiratory mechanics were measured at baseline and after a single dose of inhaled methacholine that was adjusted to trigger the same degree of bronchoconstriction in both sexes (it was twice as high in females). Bronchoalveolar lavages were then collected, and the lungs were processed for histology. House dust mite increased the number of inflammatory cells in bronchoalveolar lavages to the same extent in both sexes (asthma, P = 0.0005; sex, P = 0.96). The methacholine response was also markedly increased by asthma in both sexes (e.g., P = 0.0002 for asthma on the methacholine-induced bronchoconstriction). However, for a well-matched bronchoconstriction between sexes, the increase in hysteresivity, an indicator of airway narrowing heterogeneity, was attenuated in males for both control and asthmatic mice (sex, P = 0.002). The content of airway smooth muscle was not affected by asthma but was greater in males (asthma, P = 0.31; sex, P < 0.0001). These results provide further insights regarding an important sex disparity in mouse models of asthma. The increased amount of airway smooth muscle in males might contribute functionally to their greater methacholine response and, possibly, to their decreased propensity for airway narrowing heterogeneity.

Prevalence and impact of exercise-induced laryngeal obstruction in asthma: a study protocol for a cross-sectional and longitudinal study

INTRODUCTION

Exercise-induced laryngeal obstruction (EILO) and exercise-induced asthma can cause troublesome respiratory symptoms that can be difficult to distinguish between. Further, there is now a growing appreciation that the two conditions may coexist, complicating the interpretation of symptoms. The primary aim of this study is to investigate the prevalence of EILO in patients with asthma. Secondary aims include evaluation of EILO treatment effects and investigation of comorbid conditions other than EILO in patients with asthma.

METHODS AND ANALYSIS

The study will be conducted at Haukeland University Hospital and Voss Hospital in Western Norway, and enrol 80-120 patients with asthma and a control group of 40 patients without asthma. Recruitment started in November 2020, and data sampling will continue until March 2024. Laryngeal function will be assessed at baseline and at a 1-year follow-up, using continuous laryngoscopy during high-intensity exercise (CLE). Immediately after the EILO diagnosis is verified, patients will be treated with standardised breathing advice guided by visual biofeedback from the laryngoscope video screen. The primary outcome will be the prevalence of EILO in patients with asthma and control participants. Secondary outcomes include changes in CLE scores, asthma-related quality of life, asthma control and number of the asthma exacerbations, as assessed between baseline and the 1-year follow-up.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Regional Committee for Medical and Health Research Ethics, Western Norway, (ID number 97615). All participants will provide signed informed consent before enrolment. The results will be presented in international journals and conferences.

TRIAL REGISTRATION NUMBER

NCT04593394.

Anxiety and depression in women with asthma prior to fertility treatment

Objective

We investigate symptoms of anxiety and depression among women with asthma prior to fertility treatment.

Methods

This is a cross-sectional study of women screened for eligibility to the PRO-ART study (RCT of omalizumab versus placebo in asthmatic women undergoing fertility treatment (NCT03727971)). All participants were scheduled for in vitro fertilization (IVF) treatment at four public fertility clinics in Denmark. Data on demographics and asthma control (ACQ-5) were obtained. Symptoms of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS-A and D, respectively) and defined as being present on both subscales if a score >7 was obtained. Spirometry, diagnostic asthma test, and measurement of fractional exhaled nitric oxide (FeNO) were conducted.

Results

A total of 109 women with asthma were included (mean age 31.8 ± 4.6 and BMI 25.5 ± 4.6). Most women had male factor infertility (36.4%) or unexplained infertility (35.5%). Twenty-two percent of the patients reported uncontrolled asthma (ACQ-5 score > 1.5). The mean HADS-A and HADS-D scores were 6.0 ± 3.8 (95% CI 5.3-6.7) and 2.5 ± 2.2 (95% CI 2.1-3.0), respectively. Thirty (28.0%) women reported anxiety symptoms, and four (3.7%) had concomitant depressive symptoms. Uncontrolled asthma was significantly associated with both depressive (p = 0.04) and anxiety symptoms (p = 0.03).

Conclusions

More than 25% of women with asthma prior to fertility treatment had self-reported symptoms of anxiety, and just below 5% had self-reported depressive symptoms, possibly related to uncontrolled asthma.

Biofeedback Training to Increase P co2 in Asthma With Elevated Anxiety: A One-Stop Treatment of Both Conditions?

OBJECTIVE

Anxiety is highly prevalent in individuals with asthma. Asthma symptoms and medication can exacerbate anxiety, and vice versa. Unfortunately, treatments of comorbid anxiety and asthma are largely lacking. A problematic feature common to both conditions is hyperventilation. It adversely affects lung function and symptoms in asthma and anxiety. We examined whether a treatment to reduce hyperventilation, shown to improve asthma symptoms, also improves anxiety in asthma patients with high anxiety.

METHOD

One hundred twenty English- or Spanish-speaking adult patients with asthma were randomly assigned to either Capnometry-Assisted Respiratory Training (CART) to raise P co2 or feedback to slow respiratory rate (SLOW). Although anxiety was not an inclusion criterion, 21.7% met clinically relevant anxiety levels on the Hospital Anxiety and Depression Scale (HADS). Anxiety (HADS-A) and depression (HADS-D) scales, anxiety sensitivity (Anxiety Sensitivity Index [ASI]), and negative affect (Negative Affect Scale of the Positive Affect Negative Affect Schedule) were assessed at baseline, posttreatment, 1-month follow-up, and 6-month follow-up.

RESULTS

In this secondary analysis, asthma patients with high baseline anxiety showed greater reductions in ASI and PANAS-N in CART than in SLOW ( p values ≤ .005, Cohen d values ≥ 0.58). Furthermore, at 6-month follow-up, these patients also had lower ASI, PANAS-N, and HADS-D in CART than in SLOW ( p values ≤ .012, Cohen d values ≥ 0.54). Patients with low baseline anxiety did not have differential outcomes in CART than in SLOW.

CONCLUSIONS

For asthma patients with high anxiety, our brief training designed to raise P co2 resulted in significant and sustained reductions in anxiety sensitivity and negative affect compared with slow-breathing training. The findings lend support for P co2 as a potential physiological target for anxiety reduction in asthma.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT00975273 .

Severity and phenotypes of dyspnea in asthma: Impact of comorbidities

BACKGROUND

Dyspnea is a common but non-specific symptom of asthma, which in particular may be related to anxiety and hyperventilation syndrome, two frequent comorbidities of asthma.

METHODS

We conducted a prospective multicentric cohort study in dyspneic asthmatic adults. Dyspnea was assessed using the Multidimensional Dyspnea Profile questionnaire. We described the sensory (QS) and affective (A2) domains of dyspnea and investigated the effect of poor asthma control, hyperventilation and anxiety on each dimension at baseline and after 6 months.

RESULTS

We included 142 patients (65.5% women, age: 52 years). Dyspnea was severe and predominated on its sensory domain (median QS: 27/50; A2: 15/50). Uncontrolled asthma (ACQ≥1.5), hyperventilation symptoms (Nijmegen≥23) and anxiety (HAD-A≥10) were present in 75%, 45.7% and 39% of cases, respectively. Hyperventilation symptoms were associated with higher QS and A2 scores: QS at 28.4(10.7) vs. 21.7(12.8) (p = 0.001) and A2 at 24(14) vs. 11.3(11) (p < 0.001) in patients with vs. without hyperventilation symptoms. Anxiety was only associated with increased A2 (27(12.3) vs. 10.9(11), p < 0.001). At 6 months, QS and A2 decreased of 7 and 3 points, respectively, in relation with changes in ACQ-6 and Nijmegen scores as well as the HAD-A score for A2.

CONCLUSION

In breathless asthmatics, dyspnea is severe and worsened but differentially modulated by hyperventilation symptoms and anxiety. A multidimensional phenotyping of dyspnea in asthmatics could be useful to understand its origins and personalize treatment.

Symptoms of anxiety and depression in patients with persistent asthma: a cross-sectional analysis of the INSPIRERS studies

OBJECTIVES

Anxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms.

METHODS

This is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6±16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score ≥8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen's kappa. Two multivariable logistic regressions were built.

RESULTS

According to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression.

CONCLUSION

At least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies.

Sleep Apnea and Substance Use Disorders Associated with Co-Occurrence of Anxiety Disorder and Depression among U.S. Adults: Findings from the NSDUH 2008-2014

Few studies have focused on sleep apnea and substance use disorders with co-occurrence of anxiety disorder and depression. This study included a total of 270,227 adults, 9268 with co-occurrence of anxiety disorder and depression in the past year, from the combined 2008-2014 National Survey on Drug Use and Health (NSDUH) data, which are the latest datasets with measures of anxiety disorder and sleep apnea. Weighted multinomial logistic regression analyses were used to estimate the associations between anxiety disorder and depression and their co-occurrence. Comorbidity was highly prevalent: 40.4% of those with depression also met the criteria for anxiety disorder, whereas 51.8% of those with anxiety disorder also met the criteria for depression. The prevalences of anxiety only and co-occurrence increased from 2008 to 2014. The prevalences of anxiety disorder only, depression only, and co-occurrence of anxiety disorder and depression in individuals with sleep apnea were 4.4%, 12.9%, and 12.2%, respectively, and the prevalences in substance use disorders were 6.4%, 9.4%, and 10.7%, respectively. The results showed that sleep apnea, substance use disorders, and nicotine dependence were significantly associated with increased odds of anxiety disorder, depression, and co-occurrence (all p values < 0.0001). Furthermore, several chronic diseases (asthma, bronchitis, hypertension, and heart disease) were associated with the co-occurrence of anxiety disorder and depression. These findings suggest clinicians and other healthcare providers consider screening for depression and anxiety with sleep apnea and substance use disorders for improved therapeutic outcomes.

Strength of association between comorbidities and asthma: a meta-analysis

BACKGROUND

The strength of association between comorbidities and asthma has never been ranked in relation to the prevalence of the comorbidity in the nonasthma population. We investigated the strength of association between comorbidities and asthma.

METHODS

A comprehensive literature search was performed for observational studies reporting data on comorbidities in asthma and nonasthma populations. A pairwise meta-analysis was performed and the strength of association calculated by anchoring odds ratios and 95% confidence intervals with the rate of comorbidities in nonasthma populations via Cohen's d method. Cohen's d=0.2, 0.5 and 0.8 were cut-off values for small, medium and large effect sizes, respectively; very large effect size resulted for Cohen's d >0.8. The review was registered in the PROSPERO database; identifier number CRD42022295657.

RESULTS

Data from 5 493 776 subjects were analysed. Allergic rhinitis (OR 4.24, 95% CI 3.82-4.71), allergic conjunctivitis (OR 2.63, 95% CI 2.22-3.11), bronchiectasis (OR 4.89, 95% CI 4.48-5.34), hypertensive cardiomyopathy (OR 4.24, 95% CI 2.06-8.90) and nasal congestion (OR 3.30, 95% CI 2.96-3.67) were strongly associated with asthma (Cohen's d >0.5 and ≤0.8); COPD (OR 6.23, 95% CI 4.43-8.77) and other chronic respiratory diseases (OR 12.85, 95% CI 10.14-16.29) were very strongly associated with asthma (Cohen's d >0.8). Stronger associations were detected between comorbidities and severe asthma. No bias resulted according to funnel plots and Egger's test.

CONCLUSION

This meta-analysis supports the relevance of individualised strategies for disease management that look beyond asthma. A multidimensional approach should be used to assess whether poor symptom control is related to uncontrolled asthma or to uncontrolled underlying comorbidities.

Association between asthma and generalized anxiety disorder-7 (GAD-7) in Korean adolescents

BACKGROUND

Asthma is known to be associated with a variety of psychological disorders, such as anxiety, but the association between adolescent asthma and anxiety has not been investigated in detail.

METHODS

We analyzed 2,322 physician-diagnosed adolescent asthma patients and 38,696 non-asthmatic adolescent participants from the 2020 Korean Youth Risk Behavior self-administered Survey. Anxiety status was assessed using the Generalized Anxiety Disorder-7 (GAD-7) questionnaires. Multiple logistic regression analyses with complex sampling was performed with adjustments for multiple confounding variables (socioeconomic, health behavior, and psychological factors) to explore the association between GAD-7 scores and adolescent asthma.

RESULTS

The asthma group had higher rates of anxiety (GAD-7 score ≥ 10) than the non-asthma group (5.0% and 6.7%, respectively; p < 0.001). After adjustment for multiple confounders, asthma was significantly associated with an increased risk of anxiety (GAD-7 score ≥ 10) (odds ratio [OR]: 1.09; 95% confidence interval [CI]: 1.06-1.12).

CONCLUSION

Asthma is associated with an increased prevalence of anxiety in Korean adolescents.

Brain-Airway Interactions in Asthma

Asthma and brain interactions have long been appreciated and initially centered on increased anxiety and depression. Epidemiology studies have shown that early life stressors and situational disadvantages are risk factors for asthma. Conversely, the presence of asthma is a risk for mood and anxiety disorders, thus indicating a bidirectional effect between asthma and brain-related health. To substantiate asthma-brain interactions, validated instruments indicate and elucidate that communication likely exists between asthma and the brain. For example, provocation of an asthmatic response with an allergen challenge modulates how the brain responds to emotion-laden information. As detected by imaging studies, emotion-related brain activation is associated with generating airway inflammation. However, the specific mediators and processes mediating airway communication with the brain have yet to be established.Systemic inflammation is also associated with asthma and can affect other organ systems such as the cardiovascular system and the brain. Epidemiology studies have shown that asthma is a risk factor for dementia and Alzheimer's disease. In support of the importance of asthma as a risk factor for impaired cognitive function, imaging studies have shown changes to the white matter of the brain in asthma patients that resemble neuroinflammation changes seen in Alzheimer's disease and other neurodegenerative diseases. Therefore, bidirectional links between asthma and the brain exist with an important next research step to define asthma-brain interactions linked to neurodegeneration and dementia and explore whether treatments directed toward asthma-related inflammation can prevent the deleterious effects of asthma on brain health.

The Fear of Asthma Symptoms Scale and the Asthma Behavior Checklist: preliminary validity of two novel patient reported outcome measures

Objective: The aim of this study was to investigate the preliminary validity of two novel scales, the Fear of Asthma Symptoms scale (FAS) and the Asthma Behavior Checklist (ABC). Methods: Using cross-sectional design, data was collected online from 188 adult participants (Age 18-71 years) with a diagnosis of asthma and self-reported anxiety related to asthma, recruited through social media. Confirmatory factor analysis, internal consistency and test-retest reliability were ascertained to address validity.Results: The confirmatory factor analysis demonstrated convergent validity for both the FAS (average variance extracted; AVE=.57) and the item-reduced ABC-8 (AVE=.61) as well as divergent validity for both scales. Both scales demonstrated high internal consistency (FAS: α = 0.94; ABC-8: α = 0.92). Test-retest reliability assessed after 1 week was good (FAS: r=.85; ABC-8: r=.88).Conclusions: We observed promising psychometric properties of the FAS and the ABC-8. The two novel scales could be useful to identify excessive fear and avoidance in patients with asthma and to investigate putative mechanisms in clinical research on anxiety related to asthma. Further evaluation of psychometric properties in independent samples are needed.

Multimorbidity in Difficult Asthma: The Need for Personalised and Non-Pharmacological Approaches to Address a Difficult Breathing Syndrome

Three to ten percent of people living with asthma have difficult-to-treat asthma that remains poorly controlled despite maximum levels of guideline-based pharmacotherapy. This may result from a combination of multiple adverse health issues including aggravating comorbidities, inadequate treatment, suboptimal inhaler technique and/or poor adherence that may individually or collectively contribute to poor asthma control. Many of these are potentially "treatable traits" that can be pulmonary, extrapulmonary, behavioural or environmental factors. Whilst evidence-based guidelines lead clinicians in pharmacological treatment of pulmonary and many extrapulmonary traits, multiple comorbidities increase the burden of polypharmacy for the patient with asthma. Many of the treatable traits can be addressed with non-pharmacological approaches. In the current healthcare model, these are delivered by separate and often disjointed specialist services. This leaves the patients feeling lost in a fragmented healthcare system where clinical outcomes remain suboptimal even with the best current practice applied in each discipline. Our review aims to address this challenge calling for a paradigm change to conceptualise difficult-to-treat asthma as a multimorbid condition of a "Difficult Breathing Syndrome" that consequently needs a holistic personalised care attitude by combining pharmacotherapy with the non-pharmacological approaches. Therefore, we propose a roadmap for an evidence-based multi-disciplinary stepped care model to deliver this.

Allergic Rhinitis Seasonality, Severity, and Disease Control Influence Anxiety and Depression

OBJECTIVES

Allergic rhinitis (AR) has been associated with anxiety and depression. A possible influence of frequency and intensity of the AR symptoms has remained unclear. Therefore, we evaluated the association between AR, as well as its control, seasonality and severity, and the presence of anxiety and depression.

METHODS

Participants were selected from a preexistent national database and consecutively contacted by phone. AR was classified according to Allergic Rhinitis and its Impact on Asthma. Presence of anxiety and depression was identified by Hospital Anxiety and Depression Scale (HADS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II (BDI-II). We built linear regression models assessing the association between any of the assessed anxiety or depression scores and the occurrence, degree of control, seasonality or severity of AR.

RESULTS

We analyzed 115 participants with AR and 38 participants with no respiratory symptoms. Patients with AR presented higher scores of anxiety (HADS: 3.1; 95% confidence interval [CI] = 1.9; 4.3; p < 0.001) and depression (HADS: 3.8; 95% CI = 2.5; 5.0; p < 0.001). Poorer AR control was positively associated with higher prevalence and scores of anxiety (HADS: 3.0; 95% CI = 1.5; 4.5; p < 0.001) and depression (HADS: 1.8; 95% CI = 0.2; 3.4; p = 0.031). Similar results were obtained with BAI and BDI-II scales. A moderate/severe presentation of AR were also related with higher scores of anxiety (HADS: 1.7; 95% CI = 0.1; 3.2; p = 0.040) and depression (HADS: 1.7; 95% CI = 0.1; 3.3; p = 0.037).

CONCLUSION

The presence of AR, a poorer control, and a moderate/severe presentation of the disease were significantly associated with higher scores of anxiety and depression. Thus, it is important to alert to this association to allow a quick diagnosis of AR-associated pathologies. Laryngoscope, 2022.

Pediatric asthma and non-allergic comorbidities: a review of current risk and proposed mechanisms

It is increasingly recognized that children with asthma are at a higher risk of other non‐allergic concurrent diseases than the non‐asthma population. A plethora of recent research has reported on these comorbidities and progress has been made in understanding the mechanisms for comorbidity. The goal of this review was to assess the most recent evidence (2016–2021) on the extent of common comorbidities (obesity, depression and anxiety, neurodevelopmental disorders, sleep disorders and autoimmune diseases) and the latest mechanistic research, highlighting knowledge gaps requiring further investigation. We found that the majority of recent studies from around the world demonstrate that children with asthma are at an increased risk of having at least one of the studied comorbidities. A range of potential mechanisms were identified including common early life risk factors, common genetic factors, causal relationships, asthma medication and embryologic origins. Studies varied in their selection of population, asthma definition and outcome definitions. Next, steps in future studies should include using objective measures of asthma, such as lung function and immunological data, as well as investigating asthma phenotypes and endotypes. Larger complex genetic analyses are needed, including genome‐wide association studies, gene expression–functional as well as pathway analyses or Mendelian randomization techniques; and identification of gene–environment interactions, such as epi‐genetic studies or twin analyses, including omics and early life exposure data. Importantly, research should have relevance to clinical and public health translation including clinical practice, asthma management guidelines and intervention studies aimed at reducing comorbidities.

Anxiety and Comorbidities Differences in Adults with Chronic Pulmonary Diseases: Serbian Single Center Experience

Background and objectives: The purpose of this study is to investigate the differences in the degree of the anxiety and comorbidity levels in patients with different chronic pulmonary diseases such as chronic obstructive bronchitis (COPD) without emphysema phenotype, pulmonary emphysema, bronchial asthma and lung cancer. Materials and Methods: The prospective clinical study included 272 patients that were diagnosed and treated of pulmonary pathology. COPD (without emphysema phenotype) (Group-1), pulmonary emphysema (Group-2), bronchial asthma (Group-3) and lung cancer (Group-4) were assessed. For the evaluation of the anxiety degree, we used Hamilton Anxiety Rating Scale (HAM-A). Results: The degree of cardiovascular symptoms was significantly higher in Group-1 versus Group-2 (p < 0.001), Group-3 (p = 0.001) and Group-4 (p = 0.013), and significantly higher in Group-4 versus Group-2 (p = 0.046). The degree of respiratory symptoms was significantly higher in Group-1 versus Group-2 (p < 0.001), Group-3 (p < 0.001) and Group-4 (p = 0.002), and significantly higher in Group-4 versus Group-2 (p = 0.013) and versus Group-3 (p = 0.023). For gastrointestinal symptoms, the degree of one was significantly higher in Group-1 versus Group-2 (p < 0.001), Group-3 (p < 0.001) and Group-4 (p = 0.017). Somatic subscale values were significantly higher in Group-1 versus Group-2 (p < 0.001), Group-3 (p < 0.001) and Group-4 (p = 0.015), and significantly higher in Group-4 versus Group-2 (p = 0.024). Total HAM-A score was significantly higher in Group-1 versus Group-2 (p = 0.002) and Group-3 (p = 0.007). Conclusions: Patients with COPD (without emphysema phenotype) followed by the lung cancer are at elevated risk of being more mentally challenged in terms of increased anxiety. Furthermore, patients with exacerbation of evaluated pulmonary pathologies have various levels of comorbidities degrees.

Relationship between allergic diseases and mental disorders in women: A systematic review and meta-analysis

BACKGROUND

The relationship between allergic diseases (AD) and mental disorders (MD) in women has not been fully systematically evaluated. We aimed at validating this correlation.

METHODS

The relevant cohort and case-control studies from the establishment of the database to February 18, 2022 in PubMed, Embase, and Cochrane library were searched by computer. The researchers conducted the quality evaluation of the included articles by reviewing and discussing with reference to relevant standards, and conducted the analysis of the correlation between female patients with AD and MD by using Review Manager 5.4.

RESULTS

Six observational studies from 2631 studies (n = 1160858 women) were assessed as medium and high-quality studies. The meta-analysis demonstrated that AD was correlated with MD in female patients (OR = 1.21, 95%CI: 1.14-1.29), including asthma (OR = 1.16, 95%CI: 1.11-1.22), allergic rhinitis (OR = 1.31, 95%CI: 1.06-1.63), and atopic dermatitis in women (OR = 1.37, 95%CI: 1.24-1.50) were associated with MD. At the same time, subgroup analysis was performed according to region, study design, criteria of AD and MD, and the results demonstrated that both AD and MD were correlated in these different conditions.

CONCLUSION

Allergic diseases in female patients do have an association with mental disorders.

SYSTEMATIC REVIEW REGISTRATION

[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022311146].

Psychological distress after subarachnoid haemorrhage: A systematic review and meta-analysis

OBJECTIVE

Psychological distress is a common complication in patients after Subarachnoid haemorrhage (SAH) which often has significant impact on the prognosis. The objective of this study was to determine the pooled prevalence of anxiety symptoms and depressive symptoms in patients after SAH and identify relevant risk factors.

METHODS

The study adopted a systematic review and meta-analysis protocol. Multiple databases including EMBASE, Medline, PsychInfo, and Web of Science were searched for publications before 1st January 2020. Screening, data extraction, and quality assessment were undertaken following the PRISMA guidelines for preferred reporting of systematic reviews and meta-analysis. The random-effects model was used to calculate pooled prevalence rates. Meta-analysis was conducted using Comprehensive Meta-analysis software. The review protocol was registered on PROSPERO (CRD42020182594).

RESULTS

42 studies reporting anxiety symptoms and 64 studies reporting depressive symptoms were included. The pooled short term(<3 years) and long term(≥3 years) prevalence rates of anxiety symptoms were 31.4%(95% CI: 23.6%, 40.4%) and 40.4%(95% CI: 31.6%, 49.8%), respectively, whereas the pooled short term and long term prevalence rates of depressive symptoms were 25.2%(95%CI: 17.8%, 34.5%) and 35.8%(95%CI: 28.6%, 43.6%), respectively. Gender and pre-existing psychiatric conditions were identified as potential risk factors.

CONCLUSIONS

The high prevalence of anxiety symptoms and depressive symptoms after SAH highlights the need for appropriate assessment and management of psychological stress in patients after SAH. Further research is warranted to explore potential underlying mechanisms and to develop holistic interventions that incorporate understanding of both the biological and psychological impact of SAH.