Asthma-Specific Questionnaires May Identify Psychological Comorbidities in Chronic Disease

Asthma-specific questionnaires may reveal a more targeted method for identifying psychological comorbidities in patients with chronic asthma, according to study results published in the Journal of Asthma.

Researchers evaluated 300 patients at a tertiary asthma clinic in England who met ≥1 of the following necessary criteria: symptoms of severe asthma, an severe asthma episode within the last 10 years, frequent use of oral corticosteroids, spirometry results indicating asthma, and/or transition from pediatric services. Researchers sought to determine a correlation between asthma-specific and anxiety/depression questionnaires based on the patients’ scores. During the course of 6 months, patients were asked to complete an Asthma Control Questionnaire (ACQ), mini-Asthma Quality of Life Questionnaire (mini-AQLQ), Generalized Anxiety Disorder-7 form (GAD-7), and a Patient Health Questionnaire (PHQ-9). The patients’ answers were collected electronically and transferred to a spreadsheet.

The scores of the 300 patients were assessed and receiver operating characteristic curves and a correlation matrix were generated. Researchers noted a positive association between ACQ and PHQ-9 scores, according to the Pearson correlations (P ≤ .0001; r=0.64) and the GAD-7 score (P ≤.0001; r=0.53). Similarly, the researchers noted a significant negative association between the mini-AQLQ and both the PHQ-9 (P ≤.001; r= -0.65) and GAD-7 (P ≤.001; r= -0.59) scores.

A total of 71 individuals (47%) had a GAD-7 score of ≥10, which is consistent with moderate anxiety and indicates a need for further evaluation. Similarly, the mean PHQ-9 scores of 10.8 also indicated a need for further evaluation of depressive symptoms.

Researchers stated individuals with a “mini-AQLQ score of <3 identify the majority of individuals with GAD-7 or PHQ-9 scores above the usual threshold of 10 and may represent a useful trigger” for further psychological assessment. Furthermore, “[a]n ACQ-6 score of >5, indicating poor asthma control, was predictive of comorbid depression.” A total of 75% of participants with a mini-AQLQ score <3 also met the GAD-7 and PHQ-9 thresholds (score, 10). In addition, an ACQ >5 score was strongly predictive of a highPHQ-9 score (positive predictive value=0.84).

The investigators also noted a considerable proportion of missing or incomplete questionnaires. Of the 300 participants, only 134 (45%) completed each questionnaire with 140 to 150 individuals missing PHQ-9 and GAD-7 scores, respectively. Although each questionnaire has been proven effective and reliable for their respective fields, the administration of multiple forms may lead to patients feeling overwhelmed. However, the exact reason for the incomplete portions is uncertain. Despite the low completion rates for anxiety/depression questionnaires, the results were still within a statistical significant range for analysis. 

Based on these findings, data support the use of asthma-specific questionnaires as screening tools to effectively assess the unmet psychological needs of patients with chronic asthma. The use of a more targeted method “has the potential to reduce the ‘questionnaire burden’ on patients attending the asthma clinic.”

Reference

Robinson R, Barber K, Jones G, Blakey J, Burhan H. Exploring the relationship between generalised anxiety/depression scales and asthma-specific quality of life/control questionnaires in a specialist asthma clinic [published online April 9, 2020]. J Asthma.  doi:10.1080/02770903.2020.1744640