The Detrimental Clinical Associations of Anxiety and Depression with Difficult Asthma Outcomes

Research Trends and Hotspots on Asthma and Depression: A Bibliometric Analysis

Purpose

Asthma and depression are prevalent conditions with significant comorbidity, impacting patients' quality of life. This bibliometric study aims to analyze research trends and hotspots in the field from 2000 to 2023, identifying key contributions and predicting future directions.

Methods

We conducted a systematic search in the Web of Science Core Collection (WoSCC) for articles on asthma and depression, published between 2000 and 2023. Bibliometrics, which involves the application of mathematical and statistical methods to analyze scholarly literature, was employed in this study to systematically assess the research trends and hotspots in the field of asthma and depression. VOSviewer and CiteSpace software were utilized for visual analysis and data visualization, enabling us to map collaboration networks and identify research hotspots and trends within the asthma and depression literature.

Results

Our analysis retrieved 3067 papers from 937 journals, involving 14,631 authors and 4006 institutions across 106 countries. The United States, Columbia University, the Journal of Asthma, and Christer Janson were the most prolific contributors. Six primary research themes emerged: quality of life, childhood asthma, primary care, substance P, intervention, and emotion. Additionally, Burst detection analysis identified emerging topics, including severe asthma, other respiratory diseases, and oxidative stress.

Conclusion

This bibliometric analysis has revealed significant insights into the research trends and hotspots in the field of asthma and depression. The primary findings indicate a growing body of research highlighting the impact of depression on asthma control and patients' quality of life, the need for psychological interventions in treating comorbid asthma and depression, and the emerging focus on severe asthma and oxidative stress mechanisms. These findings underscore the importance of continued research in these areas to advance our understanding and improve clinical outcomes for patients with these comorbid conditions.

Medication adherence in allergic diseases and asthma: a literature review

Patients' collaboration with healthcare providers, along with their individual dedication to follow medical recommendations, is a crucial component of effective therapy in chronic diseases. If a patient fails to fill their prescription, administers the medication improperly in terms of method and/or dosage, misses follow-up visits, or discontinues the treatment for any reason, these lapses can adversely affect disease management, impairing the effectiveness of symptom relief and prevention of progression and complications. A comparable situation pertains to allergic diseases, which require long-term and consistent treatment to achieve symptom alleviation and control. Research has shown that adherence rates for long-term therapy in chronic diseases have improved marginally over the years and continue to hover at approximately the figure published in a World Health Organization (WHO) report "Adherence to long-term therapies: evidence for action." from 2003, which had stated that only 50% of patients in developed countries follow medical recommendations and that this rate would be even lower in developing countries. Over 20 years later, literature indicated that there has been only a slight improvement on the matter, leaving room for developing and implementing effective solutions to improve medication compliance. Further investigation on this matter is required. Causes for non-adherence classified by the Global Initiative for Asthma in their main report seem to correspond to those of the report by the WHO. Similar dependency might be determined by other allergic diseases as they fit chronic disease criteria, and the issue of non-adherence affects them too. This literature review seeks to compile and synthesize current insights on factors that influence adherence, as well as explore potential methods for monitoring, evaluating, and improving its outcomes in chronic diseases related to the medical field of allergology, such as asthma, allergic rhinitis, allergic conjunctivitis, rhinoconjunctivitis, atopic dermatitis, and urticaria.

Understanding the impact of breathing pattern disorders in difficult-to-treat asthma

INTRODUCTION

Difficult-to-treat asthma is defined as asthma that is uncontrolled despite high-level treatment or requires such treatment to maintain good control and reduce exacerbations. Breathing pattern disorders (BPD) have been reported as a comorbidity in ~ 24-42% % of patients with difficult-to-treat asthma. This narrative review will assess the association, impact, and management of BPD in difficult-to-treat asthma.

AREAS COVERED

We outline current understandings of the nature of difficult-to-treat asthma and BPD. We then review the impact of BPD on difficult-to-treat asthma and Multidisciplinary Team (MDT) approaches to assessing and managing BPD in this patient group. A comprehensive literature search was performed by an asthma specialist MDT including physiotherapists, psychologists, and physicians to create a holistic perspective on this subject.

EXPERT OPINION

BPD exerts significant negative impacts across multiple domains in patients with difficult-to treat asthma. There is a need for further observational, interventional, qualitative and quantitative research to develop better diagnosis, treatment, and awareness of the impacts of BPD including health economic analysis. Studies should develop multimodal approaches that better treat both BPD and associated comorbidities within the multimorbidity framework of difficult-to-treat asthma. Recognizing and addressing BPD should be key elements in future difficult-to-treat asthma management guidelines and clinical practice.

How Does Mild Asthma Differ Phenotypically from Difficult-to-Treat Asthma?

Background

Despite most of the asthma population having mild disease, the mild asthma phenotype is poorly understood. Here, we aim to address this gap in knowledge by extensively characterising the mild asthma phenotype and comparing this with difficult-to-treat asthma.

Methods

We assessed two real-world adult cohorts from the South of England using an identical methodology: the Wessex AsThma CoHort of difficult asthma (WATCH) (n=498) and a mild asthma cohort from the comparator arm of the Epigenetics Of Severe Asthma (EOSA) study (n=67). Data acquisition included detailed clinical, health and disease-related questionnaires, anthropometry, allergy and lung function testing, plus biological samples (blood and sputum) in a subset.

Results

Mild asthma is predominantly early-onset and is associated with type-2 (T2) inflammation (atopy, raised fractional exhaled nitric oxide (FeNO), blood/sputum eosinophilia) plus preserved lung function. A high prevalence of comorbidities and multimorbidity was observed in mild asthma, particularly depression (58.2%) and anxiety (56.7%). In comparison to difficult asthma, mild disease showed similar female predominance (>60%), T2-high inflammation and atopy prevalence, but lower peripheral blood/airway neutrophil counts and preserved lung function. Mild asthma was also associated with a greater prevalence of current smokers (20.9%). A multi-component T2-high inflammatory measure was comparable between the cohorts; T2-high status 88.1% in mild asthma and 93.5% in difficult asthma.

Conclusion

Phenotypic characterisation of mild asthma identified early-onset disease with high prevalence of current smokers, T2-high inflammation and significant multimorbidity burden. Early comprehensive assessment of mild asthma patients could help prevent potential later progression to more complex severe disease.

Management of asthma in primary care in the changing context of the COVID-19 pandemic: a qualitative longitudinal study with patients

BACKGROUND

The COVID-19 pandemic dramatically affected asthma monitoring in primary care, but exploration of patients' views and their experiences of managing their asthma and seeking help from primary care during the pandemic has been limited.

AIM

To investigate patients' experiences of asthma management in the community during the COVID-19 pandemic.

DESIGN AND SETTING

A qualitative longitudinal study using semi-structured interviews with patients from four GP practices across diverse regions including Thames Valley, Greater Manchester, Yorkshire, and North West Coast.

METHOD

Interviews were undertaken with patients with asthma, who were usually managed in primary care. The interviews were audiorecorded, transcribed, and analysed using inductive temporal thematic analysis and a trajectory approach.

RESULTS

Forty-six interviews were conducted with 18 patients over an 8-month period that covered contrasting stages of the COVID-19 pandemic. Patients felt less vulnerable as the pandemic subsided, but the process of making sense of risk was dynamic and influenced by multiple factors. Patients relied on self-management strategies, but felt that routine asthma reviews should still have been conducted during the pandemic and highlighted that they had limited opportunities to discuss their asthma with health professionals. Patients with well-controlled symptoms felt that remote reviews were largely satisfactory, but still thought face-to-face reviews were necessary for certain aspects, such as physical examination and patient-led discussions of sensitive or broader issues associated with asthma, including mental health.

CONCLUSION

The dynamic nature of patients' perception of risk throughout the pandemic highlighted the need for greater clarity regarding personal risk. Having an opportunity to discuss their asthma is important to patients, even when access to face-to-face consultations in primary care is more restricted than usual.

Current and Optimal Practices in Childhood Asthma Monitoring Among Multiple International Stakeholders

Importance

Childhood asthma control largely depends on rigorous and regular monitoring. Although various clinical parameters, biomarkers, and patient-reported outcomes are helpful for monitoring purposes, there is no consensus on the minimum and/or optimal set of parameters and their relative priority.

Objective

To assess actual and perceived optimal childhood asthma monitoring practices used globally.

Design, Setting, and Participants

This international, multistakeholder survey study surveyed health care professionals and clinical academics with a professional interest in and exposure to childhood asthma between April 12 and September 3, 2021, to test for differences between the frequency that different techniques are actually used in practice vs optimal practice, between-group differences, and differences across medical settings and country economies.

Main Outcomes and Measures

Outcomes were frequency of duration of asthma monitoring visits as well as actual and perceived optimal use and importance of monitoring tools and domains.

Results

A total of 1319 participants with expertise in childhood asthma from 88 countries completed the survey. Participants included 1228 health care professionals with a balanced distribution across different care settings (305 [22.7%] primary care, 401 [29.9%] secondary, and 522 [38.9%] tertiary care) and 91 researchers. Children with mild to moderate asthma attended regular monitoring visits at a median (IQR) of 5.0 (2.5-8.0) months, with visits lasting a median (IQR) of 25 (15-25) minutes, whereas severe asthma required more frequent visits (median [IQR], 2.5 [1.0-2.5] months; median [IQR] duration, 25 [25-35] minutes). Monitoring of symptoms and control, adherence, comorbidities, lung function, medication adverse effects, and allergy were considered to be very high or high priority by more than 75% of the respondents. Different patterns emerged when assessing differences between actual and perceived optimal use of monitoring tools. For some tools, current and optimal practices did not differ much (eg, spirometry), whereas in others, there was considerable space for improvement (eg, standardized control and adherence tests). The largest gap was observed for between-visit monitoring with electronic trackers, apps, and smart devices. Differences across country economies, care settings, and medical specialties were modest.

Conclusions and Relevance

These survey results suggest that pediatric asthma monitoring is performed generally homogeneously worldwide, in most cases following evidence-based standards. Wider use of standardized instruments and the intensification of continuous between-visit monitoring, supported by electronic devices, is needed for further improvement of disease outcomes. The results of this survey, in conjunction with the available evidence base, can inform recommendations toward further optimization.

Longitudinal follow-up of the asthma status in a French-Canadian cohort

Asthma affects 340 million people worldwide and varies in time. Twenty years ago, in Canada, the Saguenay–Lac-Saint-Jean asthma family cohort was created to study the genetic and environmental components of asthma. This study is a follow-up of 125 participants of this cohort to explore the appearance, persistence, and progression of asthma over 10–20 years. Participants answered a clinical standardized questionnaire. Lung function was assessed (forced expiratory volume in 1 s, forced vital capacity, bronchial reversibility, and methacholine bronchoprovocation), skin allergy testing was performed, blood samples were obtained (immunoglobulin E, white blood cell counts) and phenotypes were compared between recruitment and follow-up. From the participants without asthma at recruitment, 12% developed a phenotype of adult-onset asthma with the presence of risk factors, such as atopy, high body mass index, and exposure to smoking. A decrease of PC₂₀ values in this group was observed and a decrease in the FEV₁/FVC ratio in all groups. Also, 7% of individuals with asthma at recruitment developed chronic obstructive pulmonary disease, presenting risk factors at recruitment, such as moderate-to-severe bronchial hyperresponsiveness, exposure to smoking, and asthma. This study allowed a better interpretation of the evolution of asthma. Fine phenotypic characterization is the first step for meaningful genetic and epigenetic studies.