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Anxiety and depression in asthma and COPD: Results of recent studies

(PSYCHIATRIC TIMES) - A number of studies have found an increased prevalence of anxiety and depression in patients with asthma and chronic obstructive pulmonary disease (COPD). Although the relationship is not completely understood, it is clear that psychological disorders can adversely affect the course of both diseases.

This Clinical Update sums up some of the findings recently reported in the literature.

Asthma and panic disorder

There is growing recognition of the relationship between anxiety, stress, and asthma.1 A number of studies have documented an association between asthma and panic disorder.2-5 For example, a longitudinal community-based study, conducted by Goodwin and Eaton,5 found that the presence of asthma increased the risk of panic in adults. The results of a recent prospective study by Hasler and associates6 are consistent with this but also demonstrate the bidirectional relationship between asthma and panic disorder.

Their study included 591 persons who were observed from age 19 to 40 years.6 The study sample was tailored to include persons at risk for psychiatric disorders.

After adjusting for potential confounders, the analysis indicated that active asthma predicted subsequent panic disorder (odds ratio, 4.5) and panic disorder predicted subsequent active asthma (odds ratio, 6.3). The associations were stronger in smokers than in nonsmokers and were stronger in women than in men. Confounders of the relationship between asthma and panic included smoking, anxiety in early childhood, and a family history of allergy.

A number of mechanisms might account for the link between asthma and panic disorder (Table). Having a potentially life-threatening disease such as asthma probably increases anxiety in many patients and may trigger panic attacks in some. In addition, asthma and panic may share certain risk factors. Smoking, for instance, increases the risk of asthma and impairs the response to asthma therapy7,8; it also increases the risk of panic.9 Stress during childhood has also been identified as a risk factor for both asthma and panic.10-12

Impact on asthma control

It is becoming increasingly clear that psychological variables can influence the onset and course of asthma. Chronic stress, for example, can trigger asthma exacerbations in children.10 Anxiety and depression have been associated with a less favorable asthma-related health status in adults.13

Lavoie and coworkers14 found evidence that the presence of a psychiatric disorder is associated with poorer asthma control and asthma-related quality of life. In their study, 406 adults with asthma underwent a structured psychiatric interview, completed the Asthma Control Questionnaire and Asthma Quality of Life Questionnaire, and underwent pulmonary function testing. The results indicated that 34% had a psychiatric diagnosis, such as major depression (15%), panic disorder (12%), or generalized anxiety disorder (5%).

The presence of a psychiatric diagnosis was not associated with a difference in pulmonary function. However, asthma control and quality of life were worse in patients who had a psychiatric diagnosis.14

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