High anxiety during COVID-19 pandemic may be risk factor for clinical worsening of asthma

High anxiety during the COVID-19 pandemic is a potential risk factor for clinical worsening of severe asthma and decline in quality of life, researchers reported.

“Mental health can have a significant role in managing chronic diseases, particularly during the global pandemic,” Piotr Lacwik, MD, professor in the School of Medicine at the Collegium Medicum of Jan Kochanowski University in Kielce, Poland, and colleagues wrote in The Journal of Allergy and Clinical Immunology: In Practice.

Researchers surveyed 87 patients with severe asthma (mean age, 56.1 years; 39.1% men) who were receiving biological treatment with omalizumab (Xolair, Genentech), mepolizumab (Nucala, GlaxoSmithKline) and benralizumab (Fasenra, AstraZeneca) in the National Severe Asthma Treatment Program during March and June 2020 visits. At each visit, patients completed the State-Trait Anxiety Inventory (STAI) questionnaire and a COVID-19 survey to assess concerns regarding the impact of COVID-19 on patients’ anxiety, asthma and quality of life. Complete medical data were available for all patients, including changes in the Asthma Control Questionnaire (ACQ) and Mini Asthma Quality of Life Questionnaire (mAQLQ) to compare with their last visit before COVID-19.

Forty-six percent of patients had an increase in their ACQscore, 17% reported no change and 37% had a reduction in their score. The researchers observed a larger impact on asthma-related quality of life: 62% of patients had a reduced mAQLQ score, 18% reported no change and 20% had an increased score. Mean change in ACQ score was 0.214 and mean change in mAQLQ was 0.248, according to the results.

Twenty-two patients had a significant decline in asthma symptom control and 18 patients had a significant decline in quality of life.

Mean STAI scores were 44.82 for state anxiety and 42.14 for trait anxiety. Most patients reported that the COVID-19 pandemic significantly affected their responses. Thirty-four percent of patients qualified as having high state anxiety and 8% as having high trait anxiety. In those with high state anxiety, there was a higher proportion of patients with significant ACQ score increases (53.3% vs. 10.5%) and quality of life score decreases (30% vs. 15.8%) compared with those with low (n = 7) to moderate (n = 50) state anxiety.

The researchers also reported a significant association between change in ACQ and state anxiety (P < .001) and trait anxiety (P < .01). There was not a significant association between types of anxiety and quality of life score, according to the results.

High level of state anxiety in patients may be a risk factor for a significant decline in ACQ (OR = 9.71; P < .001) and quality of life scores (OR = 2.29; P = .008) compared with patients with low or moderate state anxiety, the researchers reported.

No patients experienced exacerbations in the 3 months after assessment.

According to the researchers, these results suggest that the major event of a global pandemic may significantly affect patients’ level of anxiety, which is reflected in patients’ quality of life and disease control.

“Regular screening of severe asthmatics using the STAI questionnaire could be a valuable addition in asthmatic patient care,” the researchers wrote. “Further studies are required to assess whether an intervention aimed at reducing anxiety could prove effective in improving asthma control.”

The researchers cited several limitations of the current study, including lack of anxiety measures before the pandemic and the possibility that other factors related to COVID-19, such as increased stress or depression and greater exposure to household allergens during shutdowns, may also have had an impact on the changed in asthma control and quality of life.