Baseline depression, anxiety, and sleep impairment were associated with poorer asthma-related quality of life (r=-0.40 to -0.32, p<0.001) and worse asthma control (r=0.28 to 0.34, p<0.001).
RCT (n=323)
randomized
Does the DASH diet plus lung health education improve asthma outcomes in adults with uncontrolled asthma?
Baseline mental and sleep health are moderately associated with asthma control and quality of life in adults with uncontrolled asthma, highlighting the need to address psychosocial disparities.
Effect estimate: r = -0.40 to -0.32 (AQLQ); r = 0.28 to 0.34 (ACQ-6)
p-value: p=<0.001
Abstract Rationale More than half of adults with asthma meet criteria for uncontrolled symptoms, often leading to more emergency department visits, absenteeism, fragmented sleep, and reduced quality of life. Many patients experience psychiatric comorbidities such as anxiety and depression alongside their asthma symptoms. The ALOHA randomized controlled trial tests whether adherence to the Dietary Approaches to Stop Hypertension (DASH) diet can improve asthma outcomes in patients with uncontrolled disease. Here, we examined baseline associations between mental health, sleep health, and asthma outcomes in this diverse cohort. Methods Adults aged 18 years or over (N = 323) were randomized to receive DASH diet counseling plus lung health education, or lung health education alone. Baseline self-reported measures included anxiety (GAD-7), depression (PHQ-8), and sleep disturbance and impairment (PROMIS Sleep Impairment). Asthma outcomes included quality of life (AQLQ), asthma control (ACQ-6, ACT), and spirometry (FEV1/FVC ratio). Pearson correlations and one-way ANOVA assessed relationships between psychosocial measures and asthma outcomes, including subgroup differences by race/ethnicity, education, and annual income. Results Participants had a median age of 45. 7 years (IQR 33. 5 - 55. 2) ; 76. 5% were women, 54. 5% had adult-onset asthma, and 38% reported an annual income below 35, 000. Mean (±SD) scores were PHQ-8 = 5. 6 ± 5. 0, GAD-7 = 4. 1 ± 4. 4, PROMIS Sleep Disturbance = 54. 0 ± 8. 1, MiniAQLQ = 4. 5 ± 1. 2, and ACQ-6 = 1. 6 ± 1. 0. Higher depression, anxiety, and sleep impairment were moderately associated with poorer asthma-related quality of life (r = -0. 40 to -0. 32, p 0. 001) and worse asthma control (r = 0. 28 to 0. 34, p 0. 001). Associations with spirometry were not significant. AQLQ scores varied significantly by education level, income, and race/ethnicity (all p 0. 05), revealing disparities in baseline disease impact. Conclusions Baseline findings from the ALOHA trial show that poorer mental and sleep health are moderately linked to worse asthma control and quality of life. Psychosocial disparities by socioeconomic and racial factors further emphasize inequities in asthma burden. These results warrant further investigation, including whether baseline psychological distress predicts differential response to the DASH diet and identifying subgroups that may benefit from simultaneous interventions for asthma and mental health. This abstract is funded by: Supported by the National Heart, Lung, and Blood Institute (R61/R33 HL155160; ALOHA trial) and the National Institute of Diabetes and Digestive and Kidney Diseases Short-Term Research Training Program (T35DK131960).
Shah et al. (2026) conducted an RCT in Uncontrolled asthma (n=323). DASH diet counseling plus lung health education vs. Lung health education alone was evaluated on Associations between mental health, sleep health, and asthma outcomes (quality of life, asthma control, spirometry) (r = -0.40 to -0.32 (AQLQ); r = 0.28 to 0.34 (ACQ-6), p=<0.001). Baseline depression, anxiety, and sleep impairment were associated with poorer asthma-related quality of life (r=-0.40 to -0.32, p<0.001) and worse asthma control (r=0.28 to 0.34, p<0.001).