Page 59 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Introduction
Mental disorders, including anxiety and depression are more prevalent in asthma as compared to the general population [1-8]. Although there is a clear relationship between anxiety, depression and asthma, the association with asthma severity is controversial. Some studies have shown significant differences in anxiety [9] and depression [10] in patients with severe asthma as compared to those with milder disease, while other studies did not find such differences [11-13].
Although these results are inconsistent, it has been clearly demonstrated that psychiatric morbidity in asthma is associated with reduced adherence to treatment [14], loss of asthma control [10;15], increased medical consumption [16] and increased exacerbations requiring bursts of oral corticosteroids [17;18]. Moreover, it has been shown that depression in chronic diseases such as asthma, has a greater effect on general health than depression or asthma alone [7].
Patients who use chronic oral corticosteroids are at higher risk of developing psychiatric comorbidities [19;20]. In patients with severe, prednisone- dependent asthma this may be bi-directional. On the one hand, the use of oral corticosteroids in severe asthma may lead to higher levels of anxiety and depression; while on the other hand, the underlying psychopathology may lead to less asthma control and thereby more prednisone dependence. Patients with steroid-dependent asthma seem therefore to be at highest risk of developing depression and anxiety disorders, and might benefit most from psychiatric interventions that contribute to asthma control.
In addition to anxiety and depression, specific personality traits have been associated with disease severity and poor outcome. Patients with near-fatal asthma have been shown to have less adaptive personality characteristics [15], and patients with severe asthma according to ATS criteria [21] appeared to have maladaptive coping styles [13] as compared to patients with milder disease. There are no reports comparing other personality traits between patients with mild-moderate and severe asthma.
Anxiety and depression in asthma
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