Anxiety related to COVID-19 associated with uncontrolled asthma in adults

Adults with high levels of anxiety due to COVID-19 during the first few months of the pandemic were more likely to experience uncontrolled asthma, according to a study published in Annals of Allergy, Asthma & Immunology.

Health care providers should therefore assess the mental health of their patients and refer them to specialists as necessary, Kamal M. Eldeirawi, PhD, RN, FAAN, associate professor of epidemiology in the department of population health nursing science at University of Illinois Chicago College of Nursing, and colleagues wrote.

The researchers conducted an online, cross-sectional study of adults in the United States aged 18 years and older with a self-reported physician diagnosis of asthma, collecting 873 complete responses through Dec. 19, 2020.

The survey included eight questions graded on a 5-point Likert scale to measure the participants’ experiences during the previous 2 weeks. The participants also completed the asthma control test (ACT) and answered other questions about health care utilization and life changes during the pandemic.

The cohort had a mean age of 45 ± 15 years and was 83% female, 80% white and 60% urban, with 69% holding a college degree. Additionally, 14% of participants had lost their job and 21% had reduced ability to earn money.

Also, 13% self-quarantined with COVID-19 symptoms and 15% self-quarantined without symptoms, with 25% reporting confirmed or suspected COVID-19 and 2% hospitalized due to COVID-19.

The survey further found that almost 57% had a self-reported asthma episode or attack during the pandemic, with 29% contacting their health care provider due to urgent symptoms and 43% reporting uncontrolled asthma based on an ACT score of 19 or less.

According to the survey, most of the participants said they were worried about themselves, their families and their friends developing COVID-19 in addition to their own physical, mental and emotional health.

Nearly 48% of the participants scored high for anxiety, with participants who were less educated or renting or living with family or friends more likely to experience significantly higher anxiety levels (P < .01).

Also, significantly higher levels of anxiety occurred among participants who had self-quarantined, those who had confirmed or suspected COVID-19 and those who had been exposed to others with confirmed or suspected COVID-19 (P < .05).

Overall, uncontrolled asthma was twice as likely among the participants with high anxiety compared with those with low levels of anxiety (OR = 2; 95% CI, 1.45-2.74).

When researchers divided patients into quartiles based on their levels of anxiety, they found a significant dose-response direct relationship between anxiety related to COVID-19 and odds for uncontrolled asthma (P < .001). In total, 28.83% of those in the lowest quartile for anxiety reported uncontrolled asthma, followed by 36.44% in the second quartile, 40% in the third quartile and 64.26% in the quartile with the highest levels of anxiety.

Compared with patients in the lowest quartile for anxiety, researchers calculated ORs for uncontrolled asthma of 1.64 (95% CI, 1.06-2.53) for the second quartile, 1.78 (95% CI, 1.12-2.85) for the third and 3.83 (95% CI, 2.41-6.09) for the quartile with the highest anxiety.

Noting previous studies connecting increased physical and mental symptoms among those with chronic respiratory conditions during the pandemic, the researchers pointed to associations between acute stress and increased sympathetic nervous system responses, cortisol and inflammatory responses in people with asthma.

Considering the physical and psychological impacts that the COVID-19 pandemic has had on health, the researchers called on policymakers to improve access to mental health services for everyone, especially during pandemics.