Key result
High ICS doses and asthma severity strongly correlate with psychiatric morbidity and lower mental QOL.
Why the study?
Psychiatric phenomena in asthma and their relationship with inhaled corticosteroid dose, asthma severity, and quality of life have been debated but not well quantified.
Does inhaled corticosteroid dose correlate with psychiatric morbidity and quality of life in asthmatic patients?
Cross-Sectional (n=50)
No
Does inhaled corticosteroid dose correlate with psychiatric morbidity and quality of life in asthmatic patients?
Effect estimate: Pearson's r 0.781
p-value: p=<0.01
High-dose inhaled corticosteroids in asthma patients may improve pulmonary function but are associated with increased psychiatric morbidity and reduced mental quality of life.
May link psychiatric morbidity to asthma severity or ICS; leaves open whether associations affect QOL or warrant practice changes.
OBJECTIVES: Psychiatric phenomena in asthma has been debated for some time. Inhaled corticosteroids (ICS) are a significant part of treatment. We attempted to quantify the prevalence of psychiatric morbidity relative to asthma severity, quality of life (QOL), and ICS dose. DATA SOURCES: Fifty asthmatic patients (18 > or = X < or =75 years) on ICS, attending an urban clinic had asthma and ICS dose stratified by symptom severity and preparation potency. Peak flow and forced expiratory volume in 1 second (FEV1) were measured. Patients completed general QOL and disease-specific QOL questionnaires, along with psychiatric rating scales. RESULTS: Patients (n = 50) clustered in the 40-59 year range (n = 27, 54%) and were predominantly female (n = 44, 88%) Hispanics (n = 30, 60%), with mild-moderate asthma (n = 18, 36%) and on low-dose ICS (n = 22, 44%). FEV1 ranged from 32 to 123 (mean 76.98, SE 3.01). Peak flow ranged from 210 to 590 (mean 407.83, SE 13.24). Prevalence of anxiety and depressive symptoms were higher than expected (Kendall's tau-c, n = 50, P < .01). Independently, high ICS dose and asthma severity correlated directly with all measures of psychiatric morbidity (Pearson's r0.781, P < .01). High ICS dose correlated inversely with SF-36 Mental Component Scale (Pearson's r0.681, P < .01) and directly with FEV1 and peak flow when age/sex adjusted (Spearman's rho: 0.660, P < .001). CONCLUSIONS: Psychiatric morbidity is more prevalent in this population and impacts negatively on QOL. Use of high-dose ICS benefited pulmonary function and "physical" QOL, yet may have negatively affected patients' mental well-being. Longitudinal follow-up, extension of sample size, and better study control would allow closer approximation of possible negative associations with ICS.
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Bonala et al. (2003) conducted a cross-sectional in Asthma (n=50). Inhaled corticosteroid dose was evaluated on Psychiatric morbidity (Pearson's r 0.781, p=<0.01). High inhaled corticosteroid dose and asthma severity correlated directly with all measures of psychiatric morbidity (Pearson's r=0.781, P<0.01) and inversely with mental quality of life.
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