Co-morbid psychological dysfunction is associated with a higher risk of asthma exacerbations: a systematic review and meta-analysis

Zhang, Li; Zhang, Xin; Zheng, Jing; Wang, Lan; Zhang, Hongping; Wang, Lei; Wang, Gang

doi:10.21037/jtd.2016.04.68

Cited by 39 publications

(38 citation statements)

References 62 publications

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“…There was a higher prevalence of psychological symptoms in patients with uncontrolled or severe asthma, which is also similar to other studies (18). The mechanisms that underlie the relationship between psychological symptoms and asthma remain unclear (19). We recently found that anxiety symptoms are associated with greater perceived dyspnea intensity in asthma during bronchoconstriction (16); and that depression and high stress were associated with reduced bronchodilator response (20,21), and altered pattern of inflammation (22), which could be involved in therapy resistance.…”

Section: Discussionsupporting

confidence: 79%

Severe and uncontrolled asthma in China: a cross-sectional survey from the Australasian Severe Asthma Network

Wang¹,

Wang²,

Gibson³

et al. 2017

J. Thorac. Dis.

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Background: Severe asthma is largely unexplored in the Chinese population. Patients with asthma underwent systematic evaluation, by investigating the characteristics of uncontrolled asthma and of asthma treated with three different controller therapies. Methods: This multi-centre, real-world study was conducted from March 2014 to September 2015. Adults with stable asthma underwent assessment of medication use, asthma control, quality of life, psychological symptoms, work productivity and activity impairment, bronchodilator response and sputum induction. Results: Participants (n=379) had a mean (SD) age of 47.4 (14.0) years, and 57.0% were female. There were 14.8% (n=56) of patients receiving treatment with Step 4/5 as severe asthma, but only 13 (3.4%) met ERS/ATS severe refractory asthma criteria. The patients with severe asthma usually used triple controller therapy: ICS/LABA, additional leukotriene modifier or theophylline, and reported better asthma control.Two fifths of patients (n=147) had uncontrolled asthma, with worse symptoms, psychological symptoms (both Conclusions: Although there is a relatively low proportion of severe refractory asthma based on ERS/ATS criteria, two of five patients with asthma in China are uncontrolled, displaying more psychological symptoms and reduced work productivity. Substantial gain in asthma control is obtained by triple controller therapy and this may be a promising therapeutic option for persistent asthma.

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Section: Discussionsupporting

confidence: 79%

Severe and uncontrolled asthma in China: a cross-sectional survey from the Australasian Severe Asthma Network

Wang¹,

Wang²,

Gibson³

et al. 2017

J. Thorac. Dis.

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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%

“…Several proposed mechanisms have explained how mismanaged anxiety and depression may lead to poor asthma outcomes. At the psychological level, stress imparted by anxiety and depression was shown to decrease patients’ sense of self‐worth, perceived self‐efficacy in disease management, and medication adherence, potentially resulting in greater asthma‐related morbidity 3,32–34 . At the physiologic level, psychologic stress may also exacerbate atopic disorders through immune dysregulation.…”

Section: Discussionmentioning

confidence: 99%

“…Exacerbations associated with uncontrolled asthma account annually for 6.2% of all outpatient physician office visits, as well as 1.7 million emergency department (ED) visits 1 . This places a large financial burden on the health care system and a significant burden on patients in regard to cost and lost productivity 1–3 . Much of the direct and indirect costs associated with asthma come from poor control of the condition, and prevention of asthma exacerbations is critical to overall control 3 …”

mentioning

confidence: 99%

“…1 This places a large financial burden on the health care system and a significant burden on patients in regard to cost and lost productivity. [1][2][3] Much of the direct and indirect costs associated with asthma come from poor control of the condition, and prevention of asthma exacerbations is critical to overall control. 3 Interestingly, many conditions exist concurrently with asthma and are associated with worsened outcomes and control.…”

mentioning

confidence: 99%

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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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Management paradigms for chronic rhinosinusitis in individuals with asthma: An evidence‐based review with recommendations

Gill

Alt

Detwiller³

et al. 2023

Int Forum Allergy Rhinol

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BackgroundDespite the significant morbidity associated with chronic rhinosinusitis (CRS) in individuals with asthma (CRSwA), there is a paucity of codified, evidence‐based management strategies for CRS in this population.MethodsUsing PubMed, Embase, and Cochrane Review Databases, a systematic review was performed covering management strategies for CRSwA. A total of 5903 articles were screened, and 70 were included for full‐text analysis. After application of exclusion criteria, 53 articles comprised the qualitative synthesis. The level of evidence was graded and benefit‐harm assessments, as well as value judgment and recommendations, were providedResultsStrong evidence confirms the benefit of oral and topical medications on sinonasal‐specific outcomes in individuals with CRSwA; there is low‐grade evidence demonstrating that these agents improve lung function and/or asthma control. Moderate to strong evidence suggests that endoscopic sinus surgery (ESS) improves both sinonasal‐ and asthma‐specific quality of life. Although there is insufficient to low evidence to indicate that ESS improves pulmonary function in this population, data indicate a positive impact of this intervention on asthma control. Biologic medications strongly improve both subjective and objective sinonasal‐ and asthma‐specific outcomes.ConclusionEvidence supports managing CRS in individuals with CRSwA in a stepwise fashion, starting with traditional nonbiologic oral and topical medication, and escalating to second‐line treatments, such as ESS and biologics. Optimal treatment of individuals who have CRSwA often requires concurrent, directed management of asthma, as not all CRS interventions impact asthma status.

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Co-morbid psychological dysfunction is associated with a higher risk of asthma exacerbations: a systematic review and meta-analysis

Cited by 39 publications

References 62 publications

Severe and uncontrolled asthma in China: a cross-sectional survey from the Australasian Severe Asthma Network

Severe and uncontrolled asthma in China: a cross-sectional survey from the Australasian Severe Asthma Network

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

Management paradigms for chronic rhinosinusitis in individuals with asthma: An evidence‐based review with recommendations

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