Depression, Anxiety, and Healthcare Utilization in Adults with Uncontrolled Asthma

Uncontrolled asthma is often associated with recurrent acute exacerbations, progressive and chronic systemic inflammation and decreased lung function, impaired quality of life, and healthcare utilization. A considerable proportion of adult patients with uncontrolled asthma exhibit comorbid elevated symptoms of depression and anxiety. These symptoms are often underrecognized and undertreated in adults with asthma. We examined and synthesized the available literature on the efficacy of pulmonary rehabilitation, cognitive behavioral therapy, and antidepressant drug therapy, and healthcare utilization in adults with uncontrolled asthma with comorbid depression and anxiety. The prevalence of anxiety in adults with uncontrolled asthma ranges from 25 to 54%, and depression ranges from 14 to 50%. To date, the available literature on the efficacy of pulmonary rehabilitation, cognitive behavioral therapy, and antidepressant drug therapy in the treatment of anxiety and depression is limited. Untreated depression and anxiety are associated with recurrent episodes of acute exacerbations, hospitalizations, poorer quality of life, longer hospital stays, and emergency healthcare utilization. Therefore, well-controlled randomized controlled trials are needed to improve the evidence base for optimal care of adults with uncontrolled asthma and ideally to reduce healthcare utilization.