Co-morbid psychological dysfunction is associated with a higher risk of asthma exacerbations: a systematic review and meta-analysis

doi:10.21037/jtd.2016.04.68

. 2016 Jun;8(6):1257-68.

doi: 10.21037/jtd.2016.04.68.

Co-morbid psychological dysfunction is associated with a higher risk of asthma exacerbations: a systematic review and meta-analysis

Li Zhang¹, Xin Zhang¹, Jing Zheng¹, Lan Wang¹, Hong-Ping Zhang¹, Lei Wang¹, Gang Wang¹

Affiliations

Affiliation

¹ 1 Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu 610041, China ; 2 Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, 3 Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.

PMID: 27293845
PMCID: PMC4886028
DOI: 10.21037/jtd.2016.04.68

Co-morbid psychological dysfunction is associated with a higher risk of asthma exacerbations: a systematic review and meta-analysis

Li Zhang et al. J Thorac Dis. 2016 Jun.

. 2016 Jun;8(6):1257-68.

doi: 10.21037/jtd.2016.04.68.

Authors

Li Zhang¹, Xin Zhang¹, Jing Zheng¹, Lan Wang¹, Hong-Ping Zhang¹, Lei Wang¹, Gang Wang¹

Affiliation

¹ 1 Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu 610041, China ; 2 Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, 3 Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.

PMID: 27293845
PMCID: PMC4886028
DOI: 10.21037/jtd.2016.04.68

Abstract

Background: The longitudinal associations between psychological dysfunction (PD) and asthma exacerbations (AE) have not been adequately addressed. This study aimed to systematically assess the influence of PD on AE, and to determine whether different PD affects AE differentially.

Methods: Electronic databases (PubMed, Cochrane library, Web of Science, Embase, and Ovid) were searched for prospective cohort studies on the influence of PD on AE in individuals with asthma. Relative risk (RR) and adjusted RR (RRadj) were pooled across studies. Subgroup analyses assessed the effects of different types of PD and the time-dependent response to the duration of PD exposure.

Results: Ten articles that involved 31,432 adults with asthma with follow-up of 6.0-86.4 months were included. PD significantly increased the risk of AE [RRadj =1.06, 95% confidence interval (95%CI): 1.04-1.09, P<0.001], presenting as hospitalizations (RRadj =1.22, 95% CI: 1.12-1.34, P<0.001), unscheduled doctor visits (RR =4.26, 95% CI: 2.52-7.19), and emergency department (ED) visits (RRadj =1.06, 95% CI: 1.01-1.10, P=0.009) because of asthma. Depression significantly increased the risk of AE (RRadj =1.07, 95% CI: 1.04-1.11, P<0.001), presenting as hospitalizations (RRadj =1.26, 95% CI: 1.07-1.49, P=0.007) and ED visits (RRadj =1.06, 95% CI: 1.02-1.11, P=0.007) because of asthma. Anxiety was only associated with an increased risk of AE in pregnant women (RR =1.05, 95% CI: 1.01-1.08), possibly due to the small amount of data available on anxiety. The influence of PD on AE was only significant when the PD exposure time exceeded one year.

Conclusions: Co-morbid PD adversely affects AE, and there are differential effects of depression and anxiety. Asthmatic subjects with PD may benefit from more attention when establishing a treatment regimen in clinical practice.

Keywords: Asthma; anxiety; depression; exacerbation; psychological dysfunction (PD).

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Conflict of interest statement

Conflicts of Interest: Dr. G Wang received funding from the China AstraZeneca Lung Foundation in 2013. The other authors have no conflicts of interest to declare.

Figures

**Figure 1**
Flow of study identification, inclusion, and exclusion.

**Figure 2**
Effects of psychological dysfunction on asthma exacerbations. CI, confidence interval; RR, relative risk; RRs, relative risk estimates. ^a,b,c, this study was regarded as three independent studies, separated according to the age of the participants.

**Figure 3**
Effects of depression and anxiety on asthma outcomes. (A) Effects of depression on asthma exacerbations; (B) effects of anxiety on asthma exacerbations; (C) effects of depression on hospitalizations because of asthma; (D) effects of depression on emergency department visits because of asthma; (E) effects of anxiety on hospitalizations because of asthma; (F) effects of anxiety on emergency department visits because of asthma. CI, confidence interval; RR, relative risk; RRs, relative risk estimates. ^a,b,c, this study was regarded as three independent studies, separated according to the age of the participants.

**Figure 4**
Effects of psychological dysfunction on hospitalizations (A) and emergency department visits (B) because of asthma. CI, confidence interval; RR, relative risk; RRs, relative risk estimates. ^a,b,c, this study was regarded as three independent studies, separated according to the age of the participants.

**Figure 5**
Dose-dependent relation between psychological dysfunction and asthma exacerbations. CI, confidence interval; RR, relative risk; RRs, relative risk estimates. ^a,b,c, this study was regarded as three independent studies, separated according to the age of the participants.

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References

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[1] GINA Report. Global strategy for asthma management and prevention. Revised 2015. Available online: http://www.ginasthma.org/

[2] GINA Report. Global strategy for asthma management and prevention. Revised 2015. Available online: http://www.ginasthma.org/

[3] Lane S, Molina J, Plusa T. An international observational prospective study to determine the cost of asthma exacerbations (COAX). Respir Med 2006;100:434-50. 10.1016/j.rmed.2005.06.012 - DOI - PubMed

[4] Lane S, Molina J, Plusa T. An international observational prospective study to determine the cost of asthma exacerbations (COAX). Respir Med 2006;100:434-50. 10.1016/j.rmed.2005.06.012 - DOI - PubMed

[5] Reddel HK, Taylor DR, Bateman ED, et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med 2009;180:59-99. 10.1164/rccm.200801-060ST - DOI - PubMed

[6] Reddel HK, Taylor DR, Bateman ED, et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med 2009;180:59-99. 10.1164/rccm.200801-060ST - DOI - PubMed

[7] Lu Y, Mak KK, van Bever HP, Ng TP, et al. Prevalence of anxiety and depressive symptoms in adolescents with asthma: a meta-analysis and meta-regression. Pediatr Allergy Immunol 2012;23:707-15. 10.1111/pai.12000 - DOI - PubMed

[8] Lu Y, Mak KK, van Bever HP, Ng TP, et al. Prevalence of anxiety and depressive symptoms in adolescents with asthma: a meta-analysis and meta-regression. Pediatr Allergy Immunol 2012;23:707-15. 10.1111/pai.12000 - DOI - PubMed

[9] Goldney RD, Ruffin R, Fisher LJ, et al. Asthma symptoms associated with depression and lower quality of life: a population survey. Med J Aust 2003;178:437-41. Erratum in: Med J Aust 2003;179:17. - PubMed

[10] Goldney RD, Ruffin R, Fisher LJ, et al. Asthma symptoms associated with depression and lower quality of life: a population survey. Med J Aust 2003;178:437-41. Erratum in: Med J Aust 2003;179:17. - PubMed

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Co-morbid psychological dysfunction is associated with a higher risk of asthma exacerbations: a systematic review and meta-analysis

Affiliation

Co-morbid psychological dysfunction is associated with a higher risk of asthma exacerbations: a systematic review and meta-analysis

Authors

Affiliation

Abstract

Conflict of interest statement

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