Li Hong Lin, He Xiao Li, Liang Bing Miao, Zhang Hong Ping, Wang Yan, Wang Gang
Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, P.R. China.
Allergy Asthma Proc. 2015 Nov-Dec;36(6):447-57. doi: 10.2500/aap.2015.36.3897.
To determine whether anxiety and depression are associated with greater respiratory discomfort in asthma.
Adults with asthma (n = 230) underwent methacholine (Mch) challenge. Anxiety and depression, asthma control, and quality of life were evaluated at study entry by using the Hospital Anxiety and Depression Scale, Asthma Control Test, and Asthma Quality of Life Questionnaire, respectively. Qualitative descriptors of breathlessness, dyspnea intensity (modified Borg scale and visual analog scale [VAS]), and other respiratory symptoms were evaluated before and after Mch challenge.
Patients were classified as neither anxiety nor depression (NAD), anxiety only, depression only (D), or both anxiety and depression (AD) according to the Hospital Anxiety and Depression Scale score. Asthma Control Test and Asthma Control Test, and Asthma Quality of Life Questionnaire scores were lowest in the AD group (both p < 0.001). VAS scores for dyspnea and wheezing before Mch challenge were highest in the AD group (both p < 0.05). The increase in the modified Borg scale score after Mch challenge was higher in the AD group (mean [standard deviation] 2.5 ± 2.0) than in the NAD (1.5 ± 1.5) and D (0.8 ± 0.9) groups (p = 0.006 and p = 0.003, respectively). Most descriptors of breathlessness were more prevalent in the anxiety only, D, and AD groups than in the NAD group. Multivariable logistic regression models indicated that anxiety increased the risk of dyspnea (odds ratio 1.10, p < 0.001 for the Borg score; odds ratio 3.84, p = 0.032 for the VAS score) but not for other respiratory symptoms.
Anxiety but not depression was associated with greater perceived dyspnea intensity but not other measures of respiratory discomfort in individuals with asthma. Anxiety may shape the quality and intensity of dyspnea at a given respiratory load.
确定焦虑和抑郁是否与哮喘患者更严重的呼吸不适相关。
230名成年哮喘患者接受了乙酰甲胆碱（Mch）激发试验。分别在研究开始时使用医院焦虑抑郁量表、哮喘控制测试和哮喘生活质量问卷对焦虑和抑郁、哮喘控制情况及生活质量进行评估。在Mch激发试验前后评估呼吸急促的定性描述、呼吸困难强度（改良Borg量表和视觉模拟量表[VAS]）及其他呼吸道症状。
根据医院焦虑抑郁量表评分，患者被分为既无焦虑也无抑郁（NAD）、仅焦虑、仅抑郁（D）或既焦虑又抑郁（AD）。哮喘控制测试和哮喘生活质量问卷评分在AD组中最低（均p<0.001）。Mch激发试验前，AD组的呼吸困难和喘息的VAS评分最高（均p<0.05）。Mch激发试验后，AD组改良Borg量表评分的增加（均值[标准差]2.5±2.0）高于NAD组（1.5±1.5）和D组（0.8±0.9）（分别为p = 0.006和p = 0.003）。大多数呼吸急促的描述在仅焦虑、D组和AD组中比在NAD组中更常见。多变量逻辑回归模型表明，焦虑增加了呼吸困难的风险（优势比1.10，Borg评分p<0.001；优势比3.84，VAS评分p = 0.032），但对其他呼吸道症状无影响。
焦虑而非抑郁与哮喘患者更高的呼吸困难强度相关，但与其他呼吸不适指标无关。焦虑可能会影响在给定呼吸负荷下呼吸困难的性质和强度。
