Introduction Anxiety and depression correlate with poor asthma control. There is a cyclical relationship: poor asthma control increasing likelihood of emotional distress, which in turn reduces patient adherence and healthcare utilisation. In this study we assessed quality of life and the prevalence of depression and anxiety in patients with severe asthma.

Methods 55 patients on step 4–5 therapy attending the severe asthma clinic at North Manchester General Hospital, completed two questionnaires anonymously: Hospital Anxiety and Depression Scale (HADS) and Health Survey Short-Form (SF-36). The HADS yields scores for anxiety and depression with scores greater than or equal to 8/21 in either domain considered clinically significant. SF-36 scores were transformed into composite mental and physical component scores, with scores<40 considered poor.

Results 49% and 31% of the sample had clinically significant anxiety and depression respectively. 33% had scores falling in the moderate-severe range for anxiety and/or depression with 5 patients having co-existing moderate-severe anxiety and depression. Patients reported poor quality of life relating to their physical (50%) and mental health (33%).

Conclusion The prevalence of anxiety in patients with severe asthma is significantly higher than in patients with chronic respiratory disorders (49% cf. 29%)¹ and is linked to poorer health and quality of life outcomes.

Extrapolating from our findings, we expect a third of patients in the asthma service (≥500 patients seen per year including 125 new referrals), to benefit from individual psychological support. NICE guidance recommends each should receive initial assessment and 12 therapy sessions (cognitive behavioural therapy/psychodynamic psychotherapies).

The position paper by the Kings Fund² argued that mental health services should be delivered as part of an integrated approach to health. This study supports a clear role for an integrated physical health clinical psychology service as part of routine care for patients with severe asthma.

References

1. Naylor, Haines, Vyas, Fowler. M3 anxiety and depression in patients with breathing pattern disorders or chronic respiratory disease. Thorax2015;70:A227–A228.

2. Naylor, Das, Ross, Honeyman, Thompson, Gilburt. (2016). Bringing together physical and mental health. A New Frontier for Integrated Care. London: The Kings Fund.