PURPOSE: Depression may exacerbate symptoms of chronic general medical conditions and is associated with poor outcome in patients with Diabetes, Hypertension and coronary artery disease. Asthma is a similar condition which has a psychosomatic component and plays a role in exacerbation of symptoms. Thus we were interested in examining (1) Prevalence of depression in asthma patients (2) Explore attitude and expectations of the patients from their disease.
METHODS: We got 50 consecutive patients with moderate to severe asthma to fill up the Becks depression inventory (BDI). We also got them to react to the following statements: (1) My disease is asthma (2) I feel I have got too many restrictions (3) I shall be happy to have no symptoms whether I am on medicines or not. (4) I shall be happy only if I can be off all medicines (5) If untreated or inadequately treated asthma can be fatal. (6) You get dependant on inhalers if you take them regularly. (7) You get dependant on inhaled steroids. These statements were scored on a scale of ‘1 to 5’ where ‘1’ was when you strongly disagree and ‘5’ is when you strongly agree.
RESULTS: 31% of patients with had mild mood disturbance (BDI score 11-16). 34% of patients had clinical depression. Out of these 54.6% patients had borderline clinical depression and 45.4% had moderate depression. More than 70% patients agreed that they had asthma. The patients’ perception of their quality of life was poor given that 68.75% patients thought they had too many symptoms. 87.5% patients thought that they would be happy if they were asymptomatic irrespective of whether they had to take medicines. 65.7% patients understood that asthma could be fatal. About 20% of our patient population still thought they could become dependent on inhalers.
CONCLUSIONS: The relationship between asthma and depression has never really been looked at in any great detail. Since antidepressant medications are associated with improvement in both mood and physical symptoms we need trials with both asthma symptoms and depression symptoms as clinical end points.
CLINICAL IMPLICATIONS: Depression as a psychosomatic factor for exacerbations of asthma or as a cause for poor control has never been appropriately explored. However they do coexist and needs to be treated for perfect control. The 'myths' in the management of asthma have to busted if we are to attain control in asthma.
DISCLOSURE: The following authors have nothing to disclose: Raja Dhar, Aloke Ghoshal
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