Association Between Insomnia and Asthma Burden in the Severe Asthma Research Program (SARP) III

Luyster, Faith S.; Strollo, Patrick J.; Holguin, Fernando; Castro, Mario; Dunican, Eleanor M.; Fahy, John V.; Gaston, Benjamin; Israel, Elliot; Jarjour, Nizar N.; Mauger, David T.; Moore, Wendy C.; Wenzel, Sally E.

doi:10.1016/j.chest.2016.09.020

Cited by 56 publications

(65 citation statements)

References 36 publications

(55 reference statements)

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“…A significant proportion of patients with difficult asthma report symptoms of anxiety and depression, although it is unclear to which extent these symptoms are the result of the severity of their asthma, or a contributing cause of their symptoms. In the Severe Asthma Research Population (SARP), patients with insomnia, anxiety and depression had a 2.4‐fold increased risk for poor asthma control and a 1.5 higher risk for healthcare utilization, suggestion a significant impact of these conditions on asthma‐related outcomes …”

Section: Anxiety and Depressionmentioning

confidence: 99%

“…In the Severe Asthma Research Population (SARP), patients with insomnia, anxiety and depression had a 2.4-fold increased risk for poor asthma control and a 1.5 higher risk for healthcare utilization, suggestion a significant impact of these conditions on asthma-related outcomes. 59 A commonly used tool for assessing potential traits of anxiety and depression is the Hospital Anxiety and Depression Scale (HADS), a validated self-assessment questionnaire containing 14 questions in total, 7 for anxiety and 7 for depression. 60,61 The highest score is 21 for each domain.…”

Section: Anxiety and Depressionmentioning

confidence: 99%

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Co‐morbidities in severe asthma: Clinical impact and management

2017

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Patients with severe asthma represent a minority of the total asthma population, but carry a majority of the morbidity and healthcare costs. Achieving better asthma control in this group of patients is therefore of key importance. Systematic assessment of patients with possible severe asthma to identify treatment barriers and triggers of asthma symptoms, including co-morbidities, improves asthma control and reduces healthcare costs and is recommended by international guidelines on management of severe asthma. This review provides the clinician with an overview of the prevalence and clinical impact of the most common co-morbidities in severe asthma, including chronic rhinosinusitis, nasal polyposis, allergic rhinitis, dysfunctional breathing, vocal cord dysfunction, anxiety and depression, obesity, obstructive sleep apnoea syndrome (OSAS), gastroesophageal reflux disease (GERD), bronchiectasis, allergic bronchopulmonary aspergillosis (ABPA) and eosinophilic granulomatous with polyangiitis (EGPA). Furthermore, the review offers a summary of recommended diagnostic and management approaches for each co-morbidity. Finally, the review links co-morbid conditions to specific phenotypes of severe asthma, in order to guide the clinician on which co-morbidities to look for in specific patients.

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Section: Anxiety and Depressionmentioning

confidence: 99%

Section: Anxiety and Depressionmentioning

confidence: 99%

Co‐morbidities in severe asthma: Clinical impact and management

2017

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“…Anxiety and depression are prevalent conditions among patients with severe asthma, and may contribute to symptoms, but also be the result of having a severe and chronic disease [77]. Patients may be screened with questionnaires such as the Hospital depression and Anxiety Scale (HADS) [78,79], although there are as of yet no validated questionnaires for asthma specifically.…”

Section: Systematic Assessment Of Severe Asthmamentioning

confidence: 99%

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

Porsbjerg

Ulrik

Skjold

et al. 2018

European Clinical Respiratory Journal

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Although a minority of asthma patients suffer from severe asthma, they represent a major clinical challenge in terms of poor symptom control despite high-dose treatment, risk of exacerbations, and side effects. Novel biological treatments may benefit patients with severe asthma, but are expensive, and are only effective in appropriately targeted patients. In some patients, symptoms are driven by other factors than asthma, and all patients with suspected severe asthma (‘difficult asthma’) should undergo systematic assessment, in order to differentiate between true severe asthma, and ‘difficult-to-treat’ patients, in whom poor control is related to factors such as poor adherence or co-morbidities. The Nordic Consensus Statement on severe asthma was developed by the Nordic Severe Asthma Network, consisting of members from Norway, Sweden, Finland, Denmark, Iceland and Estonia, including representatives from the respective national respiratory scientific societies with the aim to provide an overview and recommendations regarding the diagnosis, systematic assessment and management of severe asthma. Furthermore, the Consensus Statement proposes recommendations for the organization of severe asthma management in primary, secondary, and tertiary care.

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“…The study showed that adult patients with asthma and comorbid GAD and/or MDD who were titrated to target doses of antidepressants had reduced risk of severe asthma exacerbations and a lower number of asthma‐related outcomes over 1‐ and 2‐year follow‐up periods compared with those who were not optimized to achieve target doses. Although the relationship between asthma and anxiety/depression is well established, to our knowledge, this study is the first to investigate whether antidepressant target dose optimization compared with not achieving antidepressant target doses will improve markers of asthma control 2–4,7–10 …”

Section: Discussionmentioning

confidence: 99%

“…3 Interestingly, many conditions exist concurrently with asthma and are associated with worsened outcomes and control. [4][5][6] Psychiatric disorders, such as anxiety and depression, were shown to be more prevalent in persons diagnosed with asthma. 7 These comorbid psychiatric conditions increase the severity of asthma-related symptoms, decrease asthma control, reduce adherence to medication therapy, and increase the use of health care services.…”

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confidence: 99%

Antidepressant Target Dose Optimization and Control of Severe Asthma Exacerbations in Uninsured and Underinsured Patients with Anxiety and/or Depression

et al. 2020

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Background Generalized anxiety disorder (GAD) and major depressive disorder (MDD) are prevalent in patients with asthma. These disorders may increase asthma severity and decrease asthma control. No studies have evaluated the impact of achieving antidepressant target dose optimization compared with not achieving antidepressant target doses on asthma control in uninsured and underinsured patients. Objective To evaluate the impact of achieving antidepressant target dose optimization in uninsured and underinsured adult asthma patients with GAD and/or MDD on the risk of severe asthma exacerbations and number of asthma‐related outcomes. Methods We conducted a retrospective cohort study of uninsured and underinsured adult asthma patients with GAD and/or MDD who have been initiated on a single antidepressant and maintained on a stable dose for 8 weeks (index date). Eligible patients were followed for 12–24 months after the index date and separated into those who achieved a target dose (target group) and those who did not (control group). Poisson regression was used to compare the risk of severe exacerbations, and analysis of covariance was used to compare the number of severe exacerbations and other asthma‐related outcomes between the target and control groups during the 1‐ and 2‐year post‐index periods. Results A total of 61 patients (24 in the target group and 37 in the control group) met inclusion criteria. The target group had a reduced risk of severe asthma exacerbations compared with the control group during the 1‐year post‐index (adjusted risk reduction [RR] 0.46, 95% confidence interval [CI] 0.26–0.82) and 2‐year post‐index (adjusted RR 0.5, 95% CI 0.3–0.82) periods. The target group also experienced a lower number of severe asthma exacerbations and other asthma‐related outcomes during the 1‐ and 2‐year post‐index periods compared with the control group after adjusting for confounders. Conclusions Among uninsured and underinsured asthma patients with GAD and/or MDD who were initiated on a single antidepressant, those who were titrated to achieve target doses had a reduced risk of severe asthma exacerbations and a lower number of asthma‐related outcomes than those who were not optimized to achieve target doses.

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Association Between Insomnia and Asthma Burden in the Severe Asthma Research Program (SARP) III

Cited by 56 publications

References 36 publications

Co‐morbidities in severe asthma: Clinical impact and management

Co‐morbidities in severe asthma: Clinical impact and management

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

Antidepressant Target Dose Optimization and Control of Severe Asthma Exacerbations in Uninsured and Underinsured Patients with Anxiety and/or Depression

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