Page 66 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma
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                                Chapter 3
prednisone-dependent severe asthma patients have more anxiety and depression, which suggests that these psychological conditions are associated with prednisone treatment rather than with disease severity per se.
With respect to personality traits, relatively few studies have been performed in severe asthma. Several studies found that patients with severe asthma [13] and near-fatal asthma [15] show less adaptive personality characteristics as compared to those with milder disease, although this relationship was not always found [12]. In these studies different methods were used to measure personality traits, and therefore the results are difficult to interpret. One study investigated the “Big 5” personality profile in a Portuguese asthma population [34]. Neuroticism scores were positively associated with asthma severity, which is consistent with the trend we found in our study. They also found extraversion and openness scores to be lower with increasing asthma severity, which we did not find. Interestingly, all patients with asthma in our study had relatively low scores on conscientiousness and very low scores on agreeableness as compared to the general population [35], for which we have no explanation. Obviously, more studies are needed to further investigate the relationship between personality traits and asthma severity.
The causality of the association between prednisone dependent asthma and anxiety and depression, might be bidirectional. The most likely explanation is that depression and possibly anxiety are a direct effect of corticosteroid treatment. One study found an association between the use of inhaled corticosteroids and depressive symptoms [36] and it has been shown that patients taking (long term) prednisone therapy tend to show higher scores on psychiatric symptoms [19;37;38]. This result is consistent with the observation of an increased prevalence of psychopathology in patients with long-term cured Cushing’s disease, suggesting irreversible effects of previous glucocorticoid excess on the central nervous system [39].
Alternatively, psychological stress might be the cause of prednisone- dependency in patients with asthma. Psychological distress has been shown to be associated with more severe asthma symptoms [40], increased health care utilization [16], and frequent exacerbations [17] requiring oral corticosteroid bursts. It could be speculated that psychological stress leads to increased
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