Page 65 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Discussion
In the present study we found a higher prevalence of psychological distress (depression and anxiety) in patients with severe, prednisone-dependent asthma as compared to patients with severe, non-prednisone dependent or mild-moderate disease. Patients with prednisone-dependent asthma were 3.5 times more likely to have clinically significant depression symptoms, and about 2.5 times more likely to have significant anxiety symptoms as compared to patients with severe or mild-moderate disease. With respect to personality traits we found no differences in patients with severe, prednisone-dependent asthma and the other groups. This implies that this particular group of patients with prednisone-dependent asthma should be screened routinely for anxiety and depression symptoms and offered psychiatric care if needed.
The present study is the first, to our knowledge, to systematically investigate psychological distress and personality traits in patients with severe, prednisone-dependent asthma as compared to less severe, non-prednisone dependent asthma. Previous studies have investigated the prevalence of depression or anxiety symptoms (HADS score >11) in asthma irrespective of disease severity. They found prevalences ranging from 10-13.6 % and 9-31.6 % respectively [18;28;29].
The non-prednisone dependent asthma patients in our study had HADS-A and HADS-D scores similar to that of the general population [25;30]. However, patients with severe prednisone-dependent asthma had higher scores, similar to those of (non-psychiatric) medical outpatients [25]. This indicates that the prevalence of anxiety and depression symptoms in severe prednisone- dependent asthma is high, but not higher than in other outpatients. The prevalence of anxiety and depression in severe non-prednisone dependent asthma and mild-moderate asthma is within the normal range.
Studies that compared the prevalence of anxiety and depression between patients with severe and milder forms of asthma found conflicting results. Several studies showed no differences between patients with severe and mild-moderate asthma [11-13], while other studies found higher levels of psychopathology in patients with more severe disease [31-33]. The present study sheds new light on these conflicting findings by showing that only
Anxiety and depression in asthma
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