LOS ANGELES – Adults over age 55 with asthma and depression have nearly twice as many emergency department visits for asthma as do asthma patients without depression, based on findings in 402 asthma patients, Dr. Pooja O. Patel reported at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Comorbid depression also is associated with more asthma-related sleep disturbances and worse health-related quality of life, even though spirometry findings are similar in asthma patients with and without depression, added Dr. Patel of the University of Michigan, Ann Arbor.
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Dr. Pooja O. Patel
She analyzed data on 7,256 adults over age 55 who participated in the National Health and Nutrition Examination Survey during 2007-2012. The prevalence of physician-diagnosed asthma in this nationally representative group of older adults was 5.5%. And 196 of those 402 asthma patients, or fully 49%, had comorbid depression as defined by their scores on the Patient Health Questionnaire-9 (PHQ-9), a validated brief and reliable self-administered measure of depression severity.
One or more emergency department visits for asthma within the last 12 months occurred in 18.8% of the group with asthma alone, compared with 28.1% in those with comorbid depression. In a multivariate regression analysis adjusted for the demographic differences, this translated to a twofold increased likelihood of ED visits specifically for asthma in the group with asthma and depression.
These data make a compelling case for routine screening for depression in older adults with asthma. The PHQ-9 is a good, simple tool for this purpose. Future studies will need to be done in order to learn whether early identification and treatment of comorbid depression in older asthmatic adults will result in improved asthma outcomes, but that is a reasonable hope, Dr. Patel added.
Why is asthma control worse in older adults with depression? In an interview, Dr. Patel said she thinks demographic differences may play a role. The older asthma patients with depression had less education and lower socioeconomic status than those without depression. Also, depression could adversely affect adherence to asthma controller medications, as depression is linked to worse medication adherence.
Dr. Patel reported having no financial conflicts regarding her study.