{
  "abstract": "Background The prevalence of anxiety and depression in severe and difficult asthma is poorly understood as validated assessment tools assessing psychological symptoms are infrequently used in this population. It is recognised that anxiety and depression are associated with increased respiratory symptoms and there is therefore a risk of increased asthma medication, healthcare utilisation and worse outcomes for asthma patients with co-morbid anxiety and depression.Methods The Hospital Anxiety and Depression Scale (HADS) questionnaire was collected from patients with severe and difficult asthma referred to a specialist asthma clinic in the UK. Key demographic and clinical characteristics including ACQ-6 score and FeNO level were recorded and compared between patients reporting levels of anxiety and/or depression above the validated HADS threshold of 8.Results 300 patients (63% female, median age 52) completed the HADS. The median (IQR) ACQ-6 score was 1.83 (0.83–2.83) and FeNO was 29.5ppb (17–53). A HADS of ≥8 was reported by 50% patients for anxiety, 37% for depression and 31% for both. Compared to individuals reporting no psychological symptoms, patients with anxiety were younger (45 [32–67] vs 58 [38–69], p<0.001), were more likely to be female (61% vs 39%, p=0.001) and had a higher ACQ6 2.33 [1.17–3.50] vs 1.17 [0.33–2.17] despite equivalent FeNO level (median 29ppb in both groups). In a multi-linear regression analysis anxiety increased the ACQ6 by 0.84 points.Conclusion Co-morbid psychological symptoms are very common in severe and difficult asthma and significantly contribute to poor symptom control. A multi-disciplinary approach including psychological interventions has the potential to improve asthma symptom control, morbidity and to reduce asthma-related healthcare costs.",
  "authors": [
    {
      "affiliations": [
        "Guy’s Severe Asthma Centre, Guy’s and St Thomas’ NHS Trust, London, UK"
      ],
      "name": "K Stewart-Knight"
    },
    {
      "affiliations": [
        "School of Immunology and Microbial Sciences, King’s College London, London, UK"
      ],
      "name": "A Siddika"
    },
    {
      "affiliations": [
        "School of Immunology and Microbial Sciences, King’s College London, London, UK"
      ],
      "name": "K Walas"
    },
    {
      "affiliations": [
        "Guy’s Severe Asthma Centre, Guy’s and St Thomas’ NHS Trust, London, UK",
        "School of Immunology and Microbial Sciences, King’s College London, London, UK"
      ],
      "name": "J Gates"
    },
    {
      "affiliations": [
        "Guy’s Severe Asthma Centre, Guy’s and St Thomas’ NHS Trust, London, UK"
      ],
      "name": "L Osman"
    },
    {
      "affiliations": [
        "Guy’s Severe Asthma Centre, Guy’s and St Thomas’ NHS Trust, London, UK",
        "School of Immunology and Microbial Sciences, King’s College London, London, UK"
      ],
      "name": "F Haris"
    },
    {
      "affiliations": [
        "Guy’s Severe Asthma Centre, Guy’s and St Thomas’ NHS Trust, London, UK"
      ],
      "name": "L Green"
    },
    {
      "affiliations": [
        "Guy’s Severe Asthma Centre, Guy’s and St Thomas’ NHS Trust, London, UK"
      ],
      "name": "M Fernandes"
    },
    {
      "affiliations": [
        "Guy’s Severe Asthma Centre, Guy’s and St Thomas’ NHS Trust, London, UK"
      ],
      "name": "L Thomson"
    },
    {
      "affiliations": [
        "Guy’s Severe Asthma Centre, Guy’s and St Thomas’ NHS Trust, London, UK"
      ],
      "name": "C Roxas"
    },
    {
      "affiliations": [
        "Guy’s Severe Asthma Centre, Guy’s and St Thomas’ NHS Trust, London, UK"
      ],
      "name": "J Lam"
    },
    {
      "affiliations": [
        "Guy’s Severe Asthma Centre, Guy’s and St Thomas’ NHS Trust, London, UK"
      ],
      "name": "A De Looper"
    },
    {
      "affiliations": [
        "Guy’s Severe Asthma Centre, Guy’s and St Thomas’ NHS Trust, London, UK"
      ],
      "name": "G d’Ancona"
    },
    {
      "affiliations": [
        "Guy’s Severe Asthma Centre, Guy’s and St Thomas’ NHS Trust, London, UK",
        "School of Immunology and Microbial Sciences, King’s College London, London, UK"
      ],
      "name": "AM Nanzer"
    },
    {
      "affiliations": [
        "Guy’s Severe Asthma Centre, Guy’s and St Thomas’ NHS Trust, London, UK"
      ],
      "name": "J Dhariwal"
    },
    {
      "affiliations": [
        "Guy’s Severe Asthma Centre, Guy’s and St Thomas’ NHS Trust, London, UK",
        "School of Immunology and Microbial Sciences, King’s College London, London, UK"
      ],
      "name": "DJ Jackson"
    }
  ],
  "title": "M24 The prevalence of psychological symptoms in severe and difficult asthma",
  "uid": "bfb8df53-0b89-5da8-b3c6-14abc49ee8c1"
}