Depression torpedoes asthma therapy

Frustrated with your adult asthma patients’ poor adherence to their treatment regimens? They may suffer clinical depression, and if you treat it, their asthma might improve.

This conclusion comes from two related but separate studies. In the first, investigators at The Johns Hopkins School of Medicine in Baltimore studied 59 middle-aged, inner-city adults hospitalized for an asthma exacerbation. Most participants were female (64%) and African American (80%); 41% had high levels of depressive symptoms. In the two weeks following discharge, investigators tracked the patients’ medication use with electronic monitors and found that depression was associated with an 11.4-fold increase in the odds of poor adherence to therapy.

The researchers say their findings suggest that it might be useful to screen for depression in patients with multiple hospitalizations for asthma. Those testing positive could benefit from counseling and antidepressant medication, as well as more intensive follow-up after discharge (Chest. 2006;130:1034-1038).

In the other study, Canadian researchers found that of 504 adult asthma patients, 31% met the diagnostic criteria for depressive and/or anxiety disorders — at least double the rate in the general population. Depression and anxiety were both linked with a diminished quality of life, but only depression diminished asthma control.

The researchers speculate it’s hard for depressed patients to follow treatment regimens that require sustained effort, monitoring, and self-administration. The Canadian doctors conclude that clinicians need to improve both the detection and treatment of depression and anxiety in asthma patients (Chest. 2006; 130:1039-1047).

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