Fong Wei Chern Gavin, Rafiq Ishmail, Harvey Matthew, Stanescu Sabina, Ainsworth Ben, Varkonyi-Sepp Judit, Mistry Heena, Kyyaly Mohammed Aref, Barber Clair, Freeman Anna, Wilkinson Tom, Djukanovic Ratko, Dennison Paddy, Haitchi Hans Michael, Kurukulaaratchy Ramesh J
School of Clinical and Experimental Sciences, University of Southampton, Southampton SO16 6YD, UK.
David Hide Asthma and Allergy Research Centre, Isle of Wight NHS Trust, Isle of Wight PO30 5TG, UK.
J Pers Med. 2022 Apr 26;12(5):686. doi: 10.3390/jpm12050686.
Difficult asthma describes asthma in which comorbidities, inadequate treatment, suboptimal inhaler technique and/or poor adherence impede good asthma control. The association of anxiety and depression with difficult asthma outcomes (exacerbations, hospital admissions, asthma control, etc.) is unclear. This study assessed the clinical associations of anxiety and depression with difficult asthma outcomes in patients with a specialist diagnosis of difficult asthma. Using real-world data, we retrospectively phenotyped patients from the Wessex Asthma Cohort of Difficult Asthma ( = 441) using clinical diagnoses of anxiety and depression against those without anxiety or depression (controls). Additionally, we stratified patients by severity of psychological distress using the Hospital Anxiety and Depression Scale (HADS). We found that depression and/or anxiety were reported in 43.1% of subjects and were associated with worse disease-related questionnaire scores. Each psychological comorbidity group showed differential associations with difficult asthma outcomes. Anxiety alone (7.9%) was associated with dysfunctional breathing and more hospitalisations [anxiety, median (IQR): 0 (2) vs. controls: 0 (0)], while depression alone (11.6%) was associated with obesity and obstructive sleep apnoea. The dual anxiety and depression group (23.6%) displayed multimorbidity, worse asthma outcomes, female predominance and earlier asthma onset. Worse HADS-A scores in patients with anxiety were associated with worse subjective outcomes (questionnaire scores), while worse HADS-D scores in patients with depression were associated with worse objective (ICU admissions and maintenance oral corticosteroid requirements) and subjective outcomes. In conclusion, anxiety and depression are common in difficult asthma but exert differential detrimental effects. Difficult asthma patients with dual anxiety and depression experience worse asthma outcomes alongside worse measures of psychological distress. There is a severity-gradient association of HADS scores with worse difficult asthma outcomes. Collectively, our findings highlight the need for holistic, multidisciplinary approaches that promote early identification and management of anxiety and depression in difficult asthma patients.
难治性哮喘是指因合并症、治疗不充分、吸入器技术欠佳和/或依从性差而妨碍实现良好哮喘控制的哮喘。焦虑和抑郁与难治性哮喘结局（如急性加重、住院、哮喘控制等）之间的关联尚不清楚。本研究评估了在专科诊断为难治性哮喘的患者中，焦虑和抑郁与难治性哮喘结局的临床关联。利用真实世界数据，我们对来自韦塞克斯难治性哮喘队列（n = 441）的患者进行回顾性表型分析，依据焦虑和抑郁的临床诊断将患者分为有焦虑或抑郁组以及无焦虑或抑郁组（对照组）。此外，我们使用医院焦虑抑郁量表（HADS）按心理困扰严重程度对患者进行分层。我们发现，43.1%的受试者报告有抑郁和/或焦虑，且与更差的疾病相关问卷评分相关。每个心理合并症组与难治性哮喘结局的关联各不相同。单纯焦虑组（7.9%）与呼吸功能障碍和更多住院相关[焦虑组，中位数（IQR）：0（2） vs. 对照组：0（0）]，而单纯抑郁组（11.6%）与肥胖和阻塞性睡眠呼吸暂停相关。焦虑和抑郁双重存在组（23.6%）表现出多种合并症、更差的哮喘结局、女性居多以及哮喘发病更早。焦虑患者中更差的HADS - A评分与更差的主观结局（问卷评分）相关，而抑郁患者中更差的HADS - D评分与更差的客观结局（ICU入院和维持口服糖皮质激素需求）及主观结局相关。总之，焦虑和抑郁在难治性哮喘中很常见，但产生不同的有害影响。伴有焦虑和抑郁双重存在的难治性哮喘患者经历更差的哮喘结局以及更差的心理困扰指标。HADS评分与更差的难治性哮喘结局存在严重程度梯度关联。总体而言，我们的研究结果凸显了采用整体、多学科方法促进难治性哮喘患者焦虑和抑郁的早期识别与管理的必要性。
