Original articleAsthma, lower airway diseasesThe relationship between asthma and self-reported anxiety in a predominantly healthy adult population
Introduction
Asthma, a chronic inflammatory lung disease characterized by reversible airflow obstruction and airway hyper-responsiveness, is increasing in prevalence worldwide. Global estimates suggest that there are approximately 300 million people with asthma,1 with an additional 100 million expected by 2025.2 From 2002 through 2007, the cost of asthma was higher than $3,000 annually per person.3 A significant portion of total expenditures has been attributed to emergency room use, hospitalization, and death.4 Appropriate control of asthma remains the highest goal,2 because good management of this disease can result in increased quality of life, decreased morbidity, and lower health care costs.5
Anxiety disorders are characterized by feelings of stress or worry about everyday events and activities. Global estimates of the current prevalence of anxiety disorders range from 5.3% to 10.4%.6 The total annual cost of anxiety disorders in 2 studies from the late 1990s was estimated to be more than $40 billion.[7], [8] Anxiety disorders have been associated with several chronic medical conditions, including coronary heart disease,9 diabetes,10 chronic obstructive pulmonary disease,11 and asthma.12 The role of anxiety disorders in these conditions, particularly asthma, remains to be fully elucidated.
Several studies involving patients with severe asthma have reported a relation between asthma and anxiety.[12], [13], [14], [15], [16] The literature on associations with asthma and anxiety in patients with milder asthma is not as robust. Two smaller studies found no significant differences in the psychological characteristics or prevalence of anxiety disorders in patients with mild asthma vs severe asthma.[17], [18] Goodwin et al12 noted lifetime nonsevere asthma to be associated with an increased odds of any anxiety disorder (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.0–2.32, P < .05).12
The Cooper Clinic is a preventive medical center in Dallas, Texas, which presents an opportunity to investigate a population of predominantly healthy individuals who extensively report their medical history and undergo screening pulmonary function testing. Using this cohort, the authors sought to evaluate the relation between less severe asthma and anxiety.
Section snippets
Methods
From March 2000 through January 2013, 15,675 generally healthy adult patients were seen at the Cooper Clinic for preventive medical examinations that included an extensive medical history, physician-based physical examination, laboratory testing, and spirometry. Participants gave informed consent for the use of their data in the Cooper Center Longitudinal Study database maintained by the Cooper Institute and approved by the institute's institutional review board.
Results
Of 15,675 patients, 1,403 (9%) had an asthma diagnosis. Participant characteristics are listed in Table 1 for those with and without asthma. In general, patients at the Cooper Clinic composed a predominantly male, white, well-educated, nonsmoking patient population. Patients with asthma were slightly younger (P = .002), reported lower self-reported health ratings (P < .001), and had higher body mass indices (P = .036). They more often listed ICS or ICS/LABA use (P < .001) and had evidence of
Discussion
This study shows a significant association between asthma and anxiety in adults, most of whom appeared to have relatively mild asthma. In the present sample, 9% of patients screened had asthma, which approaches the rates of asthma in adults in the United States.1 However, owing to the preventive nature of the present sample, disease prevalence is likely underestimated. This study had several strengths, including a large sample and use of a control group. It measured a wide range of asthma
Acknowledgments
The authors thank the Cooper Clinic for data collection and the Cooper Institute for data management.
References (39)
The global burden of asthma
Chest
(2006)- et al.
Costs of asthma in the United States: 2002–2007
J Allergy Clin Immunol
(2011) - et al.
Does generalized anxiety disorder predict coronary heart disease risk factors independently of major depressive disorder?
J Affect Disord
(2005) - et al.
Association of diabetes with anxiety: a systematic review and meta-analysis
J Psychosom Res
(2013) - et al.
Association of anxiety with asthma: subjective and objective outcome measures
Psychosomatics
(2010) - et al.
Clinical characteristics and possible phenotypes of an adult severe asthma population
Respir Med
(2012) - et al.
Similar psychological characteristics in mild and severe asthma
J Psychosom Res
(2001) - et al.
Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the global burden of disease study 2010
Lancet
(2012) - et al.
Asthma and panic attacks
Biol Psychiatry
(1997) - et al.
Panic–fear in asthma: requests for as-needed medications in relation to pulmonary function measurements
J Allergy Clin Immunol
(1977)
Close correlation between anxiety, depression, and asthma control
Respir Med
Cognitive behavioural intervention for adults with anxiety complications of asthma: prospective randomised trial
Respir Med
The effectiveness of physiotherapy in patients with asthma: a systematic review of the literature
Respir Med
Depression and pulmonary function in outpatients with asthma
Respir Med
The global burden of asthma: executive summary of the GINA dissemination committee report
Allergy
An economic evaluation of asthma in the United States
N Engl J Med
The association between asthma control, health care costs, and quality of life in France and Spain
BMC Pulm Med
Global prevalence of anxiety disorders: a systematic review and meta-regression
Psychol Med
Economic costs of anxiety disorders
Anxiety
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Disclosures: Dr Khan has served as speaker for Merck, Genentech, Baxter, and ViroPharma and received research funds from the Vanberg Family Fund. Dr. Brown has received research funds from Sunovion and Forest.