Search

Background: Minimal data are available on the relationship between asthma and cognitive performance. In this report, we examine the relationship between asthma and cognitive performance in older adults, a subpopulation with elevated risk of cognitive impairment., Methods: We conducted a cross-sectional, retrospective analysis of 1380 participants age ≥55 who completed preventive health examinations at the Cooper Clinic in Dallas, TX. Cognition was assessed using the Montreal Cognitive Assessment (MoCA), a brief test for mild cognitive impairment. Data were analyzed in a multiple logistic regression using MoCA scores suggestive of cognitive impairment as the dependent variable., Results: When controlling for demographic characteristics, self-rated health status, inhaled corticosteroid use, and FEV1 /FVC, asthma were associated with 78% increased risk of cognitive impairment (P = 0.02) as defined by MoCA score., Conclusions: In the largest sample examined to date, we have identified a significant relationship between asthma and cognitive impairment in older people., (© 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.)

Background: Depressive symptoms are associated with noncompliance and even sudden death in asthma patients. Some studies suggest that low-income, minority, inner-city asthma patients may be at high risk for asthma-related morbidity and mortality in which depression may be a risk factor. Minimal data are available on the prevalence of depression and other mood disorders in asthma patients., Objective: In this pilot study, we examined the prevalence of depression and the association between depression and measures of asthma severity in patients at an inner-city asthma clinic., Methods: Mood disorders were diagnosed using a diagnostic interview given to patients (N = 44) at asthma clinic visits. Inhaled steroid dose, FEV1 percentage, and asthma severity were also obtained., Results: Eighteen patients (41%) had a lifetime mood disorder but only seven of these patients received pharmacotherapy. Patients with a past mood disorder had significantly higher FEV1 percentage predicted values (P = 0.03) than those without a mood disorder. Trends toward less severe asthma (P = 0.13) and lower inhaled steroid dose (P = 0.13) in patients with a mood disorder history were also found., Conclusions: The data suggest that mood disorders are common, but often unrecognized and untreated in asthma patients. The data also suggest that mood disorders are not necessarily associated with more severe asthma, at least in the population studied.

Despite a plethora of clinical guidelines and evidence outlining the efficacy of inhaled corticosteroids, these medications continue to be underused in the treatment of asthma. This article reviews the justification for prescribing inhaled steroids as first-line therapy, discusses indications for their use, and compares potencies of the various products now available. In addition, the authors address the adverse effects commonly associated with these agents and provide evidence supporting early intervention with inhaled steroids in the treatment of persistent asthma.

Mood symptoms are reported frequently in asthma patients, particularly during corticosteroid therapy. This investigation compared the Internal State Scale (ISS), a self-report measure of symptoms of mania and depression, to the Hamilton Rating Scale for Depression (HRSD), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS) in a group of asthma patients (n=60 at baseline) before, during, and after a 1-2 week burst of prednisone. The depression and well being subscales of the ISS correlated well with HDRS scores. The perceived conflict subscale correlated with the BPRS scores. However, none of the ISS subscales correlated consistently and specifically with the YMRS in this population. Possible explanations for differences observed in bipolar versus asthma patients given the ISS are discussed. These data suggest the ISS may be a useful tool for depression symptoms and overall psychopathology in asthma patients and in patients receiving corticosteroid therapy. However, its ability may be attenuated outside of the population for which it was designed.

Objective: Psychiatric symptoms may be associated with increased asthma morbidity and mortality. However, no investigations have identified syndromal psychiatric diagnoses in asthma patients using current diagnostic criteria or examined treatment received for mental illness., Method: We conducted structured clinical interviews on 32 patients with moderate to severe asthma to identify current and past psychiatric illness., Results: Twenty-five percent of subjects had current major depressive disorder, but only 25 percent of these received antidepressants. Anxiety disorders, including panic disorder (16 percent), and social (13 percent) and specific phobias (28 percent) were also common. All subjects with panic disorder were receiving appropriate therapy., Conclusions: Asthma patients with moderate to severe asthma treated at community health facilities may have high rates of often untreated mood and anxiety disorders. Interventions aimed at identifying and treating psychiatric disorders in this population are needed.