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Correspondence |

Association Between Attention-Deficit/Hyperactivity Disorder and Asthma Among Adults: A Case-Control Study FREE TO VIEW

Jurjen van der Schans, MSc; Brech Aikman, MSc; Tjalling W. de Vries, MD, PhD; Pieter J. Hoekstra, MD, PhD; Eelko Hak, PhD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

aPharmacoTherapy, -Epidemiology, and -Economics Research Group, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands

bMedical Center Leeuwarden, Leeuwarden, the Netherlands

cDepartment of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

CORRESPONDENCE TO: Jurjen van der Schans, MSc, PharmacoTherapy, -Epidemiology, and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, Groningen 9713 AV, the Netherlands


Copyright 2017, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(6):1406-1407. doi:10.1016/j.chest.2017.03.052
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Recently, we showed in a meta-analysis that in children there is an association between attention-deficit/hyperactivity disorder (ADHD) and atopic diseases, especially asthma. The nature of this relationship is still unknown, although findings suggest links with environmental and/or genetic risk factors contributing to inflammatory mechanisms. Not much is known about this association among adults. The aim of the present study was to investigate associations between the presence of ADHD and the presence and severity of asthma in adults. As a secondary aim we investigated the association between ADHD and the presence of eczema and allergic rhinitis.

We conducted a case-control study using the University of Groningen pharmacy prescription database, which is representative of the Netherlands. Case subjects were defined as adults aged between 18 and 50 years with at least two prescriptions for ADHD medication within the past 12 months. Control subjects were defined as adults without any history of ADHD medication prescriptions and were matched (4:1) on age and sex for each case. The presence of asthma, eczema, and allergic rhinitis, and asthma severity, were based on the type and frequency of the prescription of drugs used to treat the specific atopic allergy (e-Appendix 1). Multivariable logistic regression analyses were applied to control for urbanization and the presence of two of the other atopic diseases (asthma, eczema, and rhinitis). Urbanization of the living area was measured to correct for the association between high urbanization levels and a higher prevalence of asthma.,

We identified a total of 3,987 individuals being treated with ADHD medication and matched them with 15,948 control subjects. Table 1 shows the characteristics of the study population. The multivariable analysis revealed that asthma, rhinitis, and eczema were significantly more common in case subjects than in control subjects, with asthma showing the strongest preponderance (Fig 1). No significant association was seen between asthma severity and the presence of ADHD.

Table Graphic Jump Location
Table 1 Cohort Characteristics of Patients With ADHD and the Matched Comparator Group
a Student t test.
b 1 = 2,500 or more addresses per km2; 2 = 1,500-2,500 addresses per km2; 3 = 1,000-1,500 addresses per km2; 4 = 500-1,000 addresses per km2; and 5 = fewer than 500 addresses per km2.
c Pearson χ2 test.
d Asthma severity was estimated on the basis of various medication proxies (e-Appendix 1).

Data are presented as No. (%) unless otherwise indicated. ADHD = attention-deficit/hyperactivity disorder.

Figure Jump LinkFigure 1 Multivariable conditional logistic regression model, with 95% confidence intervals, of the association between attention-deficit/hyperactivity disorder in adults and atopy defined according to condition and level of severity. The odds ratio is adjusted for age, sex, urbanization level, and other atopic diseases (asthma, eczema, and rhinitis). Asthma severity was estimated on the basis of various medication proxies (see e-Appendix 1).Grahic Jump Location

Similar studies also found a higher co-occurrence of both diseases than would be expected by chance. However, in our study we determined an association of a history of asthma before the first prescription of ADHD medication.

This study supports the hypothesis that in adults asthma is more common among patients with ADHD than in the general population. ADHD and asthma both have an early onset, and it is therefore difficult to determine the effect of asthma on ADHD in adults. Future studies should determine the underlying mechanism and the possible clinical implications of the association between ADHD and asthma.

van der Schans J. .Cicek R. .de Vries T.W. .Hak E. .Hoekstra P.J. . Association of atopic diseases and attention-deficit/hyperactivity disorder: a systematic review and meta-analyses. Neurosci Biobehav Rev. 2017;74:139-148 [PubMed]journal. [CrossRef] [PubMed]
 
Fasmer O.B. .Riise T. .Eagan T.M. .et al Comorbidity of asthma with ADHD. J Atten Disord. 2011;15:564-571 [PubMed]journal. [CrossRef] [PubMed]
 
Elholm G. .Linneberg A. .Husemoen L.L. .et al The Danish urban-rural gradient of allergic sensitization and disease in adults. Clin Exp Allergy. 2016;46:103-111 [PubMed]journal. [CrossRef] [PubMed]
 
Pitts M. .Mangle L. .Asherson P. . Impairments, diagnosis and treatments associated with attention-deficit/hyperactivity disorder (ADHD) in UK adults: results from the lifetime impairment survey. Arch Psychiatr Nurs. 2015;29:56-63 [PubMed]journal. [CrossRef] [PubMed]
 
Instanes JT, Klungsøyr K, Halmøy A, Fasmer OB, Haavik J. Adult ADHD and comorbid somatic disease: a systematic literature review [published online ahead of print September 22, 2016].J Atten Disord.http://dx.doi.org/10.1177/1087054716669589.
 

Figures

Figure Jump LinkFigure 1 Multivariable conditional logistic regression model, with 95% confidence intervals, of the association between attention-deficit/hyperactivity disorder in adults and atopy defined according to condition and level of severity. The odds ratio is adjusted for age, sex, urbanization level, and other atopic diseases (asthma, eczema, and rhinitis). Asthma severity was estimated on the basis of various medication proxies (see e-Appendix 1).Grahic Jump Location

Tables

Table Graphic Jump Location
Table 1 Cohort Characteristics of Patients With ADHD and the Matched Comparator Group
a Student t test.
b 1 = 2,500 or more addresses per km2; 2 = 1,500-2,500 addresses per km2; 3 = 1,000-1,500 addresses per km2; 4 = 500-1,000 addresses per km2; and 5 = fewer than 500 addresses per km2.
c Pearson χ2 test.
d Asthma severity was estimated on the basis of various medication proxies (e-Appendix 1).

Data are presented as No. (%) unless otherwise indicated. ADHD = attention-deficit/hyperactivity disorder.

References

van der Schans J. .Cicek R. .de Vries T.W. .Hak E. .Hoekstra P.J. . Association of atopic diseases and attention-deficit/hyperactivity disorder: a systematic review and meta-analyses. Neurosci Biobehav Rev. 2017;74:139-148 [PubMed]journal. [CrossRef] [PubMed]
 
Fasmer O.B. .Riise T. .Eagan T.M. .et al Comorbidity of asthma with ADHD. J Atten Disord. 2011;15:564-571 [PubMed]journal. [CrossRef] [PubMed]
 
Elholm G. .Linneberg A. .Husemoen L.L. .et al The Danish urban-rural gradient of allergic sensitization and disease in adults. Clin Exp Allergy. 2016;46:103-111 [PubMed]journal. [CrossRef] [PubMed]
 
Pitts M. .Mangle L. .Asherson P. . Impairments, diagnosis and treatments associated with attention-deficit/hyperactivity disorder (ADHD) in UK adults: results from the lifetime impairment survey. Arch Psychiatr Nurs. 2015;29:56-63 [PubMed]journal. [CrossRef] [PubMed]
 
Instanes JT, Klungsøyr K, Halmøy A, Fasmer OB, Haavik J. Adult ADHD and comorbid somatic disease: a systematic literature review [published online ahead of print September 22, 2016].J Atten Disord.http://dx.doi.org/10.1177/1087054716669589.
 
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e-Appendix 1

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