Prospective impact of panic disorder and panic-anxiety on asthma control, health service use, and quality of life in adult patients with asthma over a 4-year follow-up.
Background Panic disorder (PD) is a common anxiety disorder among asthmatic patients with overlapping symptoms (e.g., hyperventilation). However, the longitudinal impact of PD on asthma control remains poorly understood. This study assessed the impact of PD and panic-anxiety on asthma control over a 4.3-year follow-up in 643 adult asthmatic patients. Methods Consecutive patients presenting to a tertiary asthma clinic underwent a sociodemographic, medical history, and psychiatric (Primary Care Evaluation of Mental Disorders) interview and completed questionnaires including the Anxiety Sensitivity Index (ASI) to assess panic-anxiety. At follow-up, patients completed the Asthma Control (ACQ) and Asthma Quality of Life (AQLQ) questionnaires and reported emergency department visits and hospitalizations during the follow-up. Results Baseline frequency of PD was 10% (n = 65). In fully adjusted models, analyses revealed that PD and ASI scores predicted worse follow-up ACQ total scores (β = 0.292, p = .037; β = 0.012, p = .003) but not AQLQ total scores. ASI scores also predicted greater nocturnal and waking symptoms, activity limitations, and bronchodilator use on the ACQ (β = 0.012-0.018, p < .05) as well as lower symptom (β = -0.012, p = .006) and emotional distress (β = -0.014, p = .002) subscale scores on the AQLQ. Neither PD nor ASI scores were associated with hospitalizations, although ASI scores (but not PD) were associated with an increased risk of emergency department visits (relative risk = 1.023, 95% confidence interval = 1.001-1.044). Conclusions PD and anxiety sensitivity are prospectively associated with poorer asthma control and may be important targets for treatment.
Department of Psychology, University of Quebec at Montreal, PO Box 8888, Succursale Center-Ville, Montreal, Quebec, Canada H3C 3P8. k-lavoie@crhsc.rtss.qc.ca.
Helene
H
Favreau
Simon L
SL
Bacon
Manon
M
Labrecque
Kim L
KL
Lavoie
D000328:Adult; D000553:Ambulatory Care; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology; D001249:Asthma / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D001993:Bronchodilator Agents / Q000008:administration & dosage; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005239:Fear; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000453:epidemiology* / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011788:Quality of Life; D012044:Regression Analysis; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires
D001993:Bronchodilator Agents
anxiety sensitivity; asthma control; asthma quality of life; health service use