Department of Allergy, Fundación Jimenez Diaz, Madrid, Spain; Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; CIBERES, Instituto Carlos III, Madrid, Spain.
CIBERES, Instituto Carlos III, Madrid, Spain; Unit of Allergy and Asthma, Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
J Allergy Clin Immunol Pract. 2018 Nov-Dec;6(6):1953-1959. doi: 10.1016/j.jaip.2018.02.002. Epub 2018 Feb 15.
It has been documented that anxiety and depression are prevalent in patients with asthma and are associated with greater frequency of exacerbations, increased use of health care resources, and poor asthma control.
To examine the association of asthma diagnosis with symptoms of depression/anxiety and asthma control not only at baseline but also over a 6-month period of specialist supervision.
We enrolled 3182 patients with moderate to severe asthma. All were evaluated with spirometry, the Asthma Control Test, and the Hospital Anxiety and Depression Scale at baseline and at 6 months. Treatments were decided by specialists according to published guidelines.
At baseline, 24.2% and 12% of the patients were diagnosed with anxiety and depression, respectively, according to the Hospital Anxiety and Depression Scale. After 6 months, anxiety and depression improved, affecting 15.3% and 8.1% of patients, respectively (P < .001); mean FEV and asthma control also improved (FEV from 81.6% ± 20.9% to 86% ± 20.8%; Asthma Control Test score from 15.8 ± 4.7 to 19.4 ± 4.4; both P < .001). Patients with anxiety and depression used significantly more health care resources and had more exacerbations. A multivariate analysis showed that patients with anxiety, depression, and lower FEV (odds ratio, 0.20, 0.34, 0.62, respectively; P < .001) were independently associated with poor asthma control. A multiple linear regression analysis showed that anxiety had a nearly 4-fold greater influence over asthma control than depression (0.326/0.85 = 4.075).
Under standardized asthma care and after a specific visit with the specialist, patients present significant improvement in these psychological disorders and exhibit better asthma control and functional parameters.
有文献记录哮喘患者普遍存在焦虑和抑郁症状，且这些症状与哮喘加重频率增加、更多地使用医疗保健资源和较差的哮喘控制相关。
不仅在基线时，而且在专科医生监督的 6 个月期间，检查哮喘诊断与抑郁/焦虑症状和哮喘控制之间的关联。
我们纳入了 3182 例中重度哮喘患者。所有患者均在基线时和 6 个月时进行了肺功能检查、哮喘控制测试和医院焦虑抑郁量表评估。治疗方案由专家根据已发表的指南决定。
根据医院焦虑抑郁量表，基线时分别有 24.2%和 12%的患者被诊断为焦虑和抑郁。6 个月后，焦虑和抑郁得到改善，分别影响 15.3%和 8.1%的患者（P<.001）；平均 FEV 和哮喘控制也得到改善（FEV 从 81.6%±20.9%增加至 86%±20.8%；哮喘控制测试评分从 15.8±4.7增加至 19.4±4.4；均 P<.001）。患有焦虑和抑郁的患者使用了更多的医疗保健资源，且发生了更多的加重事件。多变量分析显示，患有焦虑、抑郁和较低 FEV 的患者（比值比分别为 0.20、0.34 和 0.62；P<.001）与较差的哮喘控制独立相关。多元线性回归分析显示，焦虑对哮喘控制的影响几乎是抑郁的 4 倍（0.326/0.85=4.075）。
在标准化的哮喘护理下，并在与专家进行专门的就诊后，患者的这些心理障碍显著改善，并且哮喘控制和功能参数得到改善。
