Mental health disease in patients with severe asthma: a problem overlooked

<bold>Introduction</bold> Inflammation is implicated in the pathophysiology of depression (Leonard. Acta Neuropsych. 2018. 30(1):1), which itself associates with poor asthma control. However, the relationship between inflammatory depression and severe asthma requires further characterisation. We aimed to assess the prevalence of depression and anxiety in a group of severe asthmatic patients, some of whom went on to receive biologic medications. <bold>Methods:</bold> Data were collected retrospectively in patients referred to a severe asthma service. Demographics, anthropometrics, smoking status, biologic treatment, the hospital anxiety and depression scale (HADS), mental health comorbidity and medications were recorded. Differences in those who went on to receive biologic treatment were assessed. <bold>Results:</bold> Included were 96 mostly female (62%), middle aged (mean 53.9) and overweight (mean BMI 31.7) patients. 53% were started on a biologic. Mental health disease prevalence was high - by HADS score, 53.9% had depression and 40.6% had anxiety. 29.3% had a diagnosed psychiatric disease, depression (19.8%) and anxiety (17.7%) being the most common. 33.7% were using a psychotropic medication. Patients who subsequently received a biologic had similar mental health characteristics compared to those that did not. HADS score (mean 16.77 vs 17.24, p=0.84), psychiatric comorbidity (48.1% vs 51.9%, p=0.52) and psychotropic medication use (30.6% vs 37.2%, p=0.5) showed no difference. <bold>Conclusions:</bold> Depression and anxiety are highly prevalent and likely under-diagnosed in severe asthma. The relationship between mental health and asthma requires further investigation, particularly to determine the extent to which it may be causative.