Fran Lowry

November 21, 2011

November 21, 2011 (Boston, Massachusetts) — Depression, self-reported and that found on a validated screening tool, is associated with poorer quality of life and worse asthma control in seniors, according to a study presented here at the American College of Allergy, Asthma & Immunology 2011 Annual Scientific Meeting.

"The number of asthmatics in the senior population is growing, and we really need to take into account their special needs," said lead author Jacqueline Ross, MD, a second-year fellow at the University of Michigan, Ann Arbor.

Other studies have found an association between quality of life and asthma control using objective measures such as forced expiratory volume in 1 second and the number of medications used; in this study, it was the comorbid depression that affected quality of life, she explained.

"It might be that older adults have more subjective complaints when they have comorbid depression," she said.

Dr. Jacqueline Ross

In the study, Dr. Ross and her team assessed the quality of life of 70 participants older than 65 years (mean age, 73.2 years) who had been diagnosed with asthma. Most (77.1%) were female, and the mean duration of asthma was 29 years.

Quality-of-life measures included the number of asthma attacks and the number of unscheduled physician visits in the previous 12 months, self-reported depression, body mass index, and patients' confidence in managing their asthma.

They found that lower quality-of-life scores were significantly associated with a greater severity of depression on the Center for Epidemiologic Studies Depression scale (CESD8; P < .001), more attacks (P = .001), and more unscheduled visits to the doctor in the previous 12 months (P = .031).

Other factors associated with lower quality-of-life scores included being male (P = .021), less confidence in being able to self-manage asthma (P = .007), and a higher body mass index (P = .049).

The study also found that lower scores on the asthma control questionnaire (ACO7) were associated with increasing severity of depression on the CESD8 scale (P = .011), more asthma attacks in the previous 12 months (P = .017), more unscheduled visits to the doctor in the previous 12 months (P =.001), self-reported depression (P =.048), and repeated hospitalizations in the previous 12 months (P = .010).

There was no correlation between spirometric/fractional exhaled nitric oxide objective data and quality of life or asthma control, Dr. Ross reported.

"A more integrated approach appears to be needed in older adults with asthma. We should not only treat the physical aspects, we should also treat the psychological and social aspects. If we treat all of these together, we may find greater success in asthma control and improved quality of life in this growing population," she said.

Chitra Dinakar, MD, from the University of Missouri-Kansas City, Missouri, agrees.

"Depression has been reported in adolescents and young adults with asthma, and there is some evidence that it can be associated with nonadherence to medications and poor treatment options," Dr. Dinakar told Medscape Medical News.

The relation between depression and asthma might involve more than 1 causal pathway. It could be that a sense of hopelessness erodes adherence and other health-promoting behavior, or that depression affects asthma directly by altering the immune system, she suggested.

"This well-designed and thought-provoking study very nicely showcases that even older adults with asthma are vulnerable to comorbid depression and lower self-confidence, which impact adversely on their asthma control. Approaching the elderly patient as a whole, rather than merely looking at the numbers or test results alone, may translate into better asthma care," she said.

Dr. Ross has disclosed no relevant financial relationships. Dr. Dinakar reports financial relationships with AstraZeneca and GlaxoSmithKline.

American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Scientific Meeting: Abstract 9. Presented November 18, 2011.

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