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Patients with asthma who overuse albuterol more likely to have depression

Adults with asthma significantly overused albuterol as a treatment for the disease, according to study results.

The participants who overused albuterol had an increased odds of a lower quality of life, worse physical functioning and worse mental functioning, according to study results.

“Emotional affect, particularly depression, can influence disease perception and medication behaviors among those with chronic illness,” Joe K. Gerald, MD, PhD, an assistant professor in the community, environment and policy department at University of Arizona, said in a press release. “Among patients with asthma, depression has been associated with greater symptom reporting, lower quality of life, and lower adherence to controller medication.”

Gerald and colleagues conducted an analysis of data from the Trial of Asthma Patients clinical trial to assess albuterol use on symptom and symptom-free days and to identify predictors of albuterol overuse and controller medication underuse.

The analysis included 416 participants who reported symptom and symptom-free days. Participants recorded albuterol, montelukast and placebo use and asthma symptoms on daily diary cards.

The researchers identified 51% of the participants as expected users of albuterol, 27% of participants as over users and 22% as under users.

Forty-five percent of the over users used albuterol every day.

All participants used albuterol on symptom-free days 20% of the time. Eighty-eight percent of albuterol use every day occurred in participants who over used.

Over users reported greatest symptom burden from more frequent symptom days (P < .001), worse scores on the asthma control questionnaire (P < .001), the asthma symptom utility index (P < .001) and the shortness-of-breath questionnaire (P < .001).

Participants who over used albuterol reported worse mental functioning (P = .04) than those who used the expected amount and those who under used.

Thirty-two percent of over users had a heightened risk for depression — assessed by a Center for Epidemiological Studies – Depression score threshold of 16 or more — compared with 19% of under users and 17% of expected users (P < .01).

“We know that appropriate use has been previously identified with accurate knowledge of asthma medications, higher self-reported health status, prior consultation with a specialist and thoughtful budgeting of medications,” Gerald said in the release. – by Ryan McDonald

Disclosure: Gerald reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.