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Increased anxiety among asthmatics a risk factor in disease worsening during COVID-19

Patients with respiratory conditions such as severe asthma have a greater risk of complications after infection with COVID-19 but could a worsening of disease control be due to anxiety induced by the pandemic?

The presence of anxiety can have a negative impact upon quality of life among those with chronic health conditions. Whether knowledge of the global pandemic due to COVID-19 could trigger increased anxiety and ultimately a worsening of disease control in patients with severe asthma, was the question posed by a team from the Department of Internal Medicine, Medical University of Lodz, Poland. For the study, doctors turned to a group of patients with severe disease treated at their hospital during March to June 2020, at the height of the COVID-19 pandemic. All patients who were treated with the biologics, omalizumab, mepolizumab and benralizumab, were invited to complete the State-Trait Anxiety inventory (STAI), which is a validated tool for measuring anxiety as both a temporal and general, long-standing personal trait. The asthma control questionnaire (ACQ) and a mini asthma quality of life questionnaire (mAQLQ) were also completed (with higher scores in both representing better control and quality of life) and scores compared to the last values recorded in the medical records.

A total of 87 patients provided data and completed all questionnaires. The mean age of patients was 56 years and included 34 (39%) males. Overall control of asthma was rated as completely controlled in 34%, partially controlled in 23% but uncontrolled in 42.5%. Nearly half of all patients (46%) had a higher ACQ score (compared to the last documented score in the medical records) although more than a third (37%) actually experienced a reduction in ACQ. In contrast, 62% of patients reported a reduction in mAQLQ scores. In terms of anxiety, 34% of patients were deemed to have a high state of anxiety and 8% had high trait anxiety. Moreover, among those with high state anxiety, more patients (30% vs 15.8%) had a lower mAQLQ score.

The authors concluded that high levels of anxiety are associated with a worsening of disease control and that this anxiety may have arisen because of the COVID-19 pandemic.

Lacwik P et al. High levels of anxiety during COVID-19 pandemic as a risk factor of clinical worsening in patients with severe asthma. J Allergy Clin Immunol Pract 2021