Am. J. Respir. Crit. Care Med., Volume 163, Number 5, April 2001, 1093-1096

Psychopathology in Patients with Severe Asthma Is Associated with Increased Health Care Utilization

ANNEKE ten BRINKE, MARIJE E. OUWERKERK, AEILKO H. ZWINDERMAN, PHILIP SPINHOVEN, and ELISABETH H. BEL

Department of Pulmonary Diseases, Leiden University Medical Center, Division of Clinical and Health Psychology, Leiden University, Department of Medical Statistics, Leiden University, and Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands

Severe asthma accounts for the majority of health costs for this disease, which is mainly related to the treatment of failed control. Several psychosocial factors have been associated with poor asthma control, but the question remains whether psychiatric disorder in patients with severe asthma predisposes for increased health care utilization. In the present study we compared outpatients with severe asthma with and without psychological dysfunctioning with respect to health care utilization. All patients used high dose inhaled corticosteroids and long-acting bronchodilators for more than 1 yr, and had difficult-to-control asthma, requiring one or more courses of corticosteroids during the past year or maintenance therapy with prednisone. Medical history was taken and health care utilization questionnaires were completed. The General Health Questionnaire (GHQ) was used to identify psychiatric cases (GHQ-12 score of  6). There were no differences between the psychiatric cases (n = 21) and the noncases (n = 77) with respect to demographic and objective disease characteristics. However, the psychiatric cases had increased odds ratios (OR) for frequent visits to GP (OR = 5.9), frequent emergency visits (OR = 5.3), frequent exacerbations (OR = 12.4), and frequent hospitalizations (OR = 4.8) as compared with the nonpsychiatric patients. The present findings suggest that the morbidity and costs of asthma might be related to the level of psychological dysfunctioning in patients with severe asthma rather than to asthma severity per se, thereby identifying an area of potential intervention.

This article has been cited by other articles:

				A. Kullowatz, D. Rosenfield, B. Dahme, H. Magnussen, F. Kanniess, and T. Ritz Stress Effects on Lung Function in Asthma are Mediated by Changes in Airway Inflammation Psychosom Med, May 1, 2008; 70(4): 468 - 475. [Abstract] [Full Text] [PDF]

				C. A. Mancuso, S. Wenderoth, H. Westermann, T. N. Choi, W. M. Briggs, and M. E. Charlson Patient-Reported and Physician-Reported Depressive Conditions in Relation to Asthma Severity and Control Chest, May 1, 2008; 133(5): 1142 - 1148. [Abstract] [Full Text] [PDF]

				A. L. James and S. Wenzel Clinical relevance of airway remodelling in airway diseases Eur. Respir. J., July 1, 2007; 30(1): 134 - 155. [Abstract] [Full Text] [PDF]

				E. L. McQuaid, D. Koinis Mitchell, N. Walders, J. H. Nassau, S. J. Kopel, R. B. Klein, M. Z. Wamboldt, and G. K. Fritz Pediatric Asthma Morbidity: The Importance of Symptom Perception and Family Response to Symptoms J. Pediatr. Psychol., March 1, 2007; 32(2): 167 - 177. [Abstract] [Full Text] [PDF]

				E. Lobo, P. De Jonge, F. J. Huyse, J. P.J. Slaets, M.-J. Rabanaque, and A. Lobo Early Detection of Pneumology Inpatients at Risk of Extended Hospital Stay and Need for Psychosocial Treatment Psychosom Med, January 1, 2007; 69(1): 99 - 105. [Abstract] [Full Text] [PDF]

				J. M. Feldman, M. I. Siddique, E. Morales, B. Kaminski, S.-E. Lu, and P. M. Lehrer Psychiatric Disorders and Asthma Outcomes Among High-Risk Inner-City Patients Psychosom Med, November 1, 2005; 67(6): 989 - 996. [Abstract] [Full Text] [PDF]

				S. Wenzel Severe Asthma in Adults Am. J. Respir. Crit. Care Med., July 15, 2005; 172(2): 149 - 160. [Abstract] [Full Text] [PDF]

				O. Oguzturk, A. Ekici, M. Kara, M. Ekici, M. Arslan, A. Iteginli, T. Kara, and E. Kurtipek Psychological Status and Quality of Life in Elderly Patients With Asthma Psychosomatics, February 1, 2005; 46(1): 41 - 46. [Abstract] [Full Text] [PDF]

				R J Adams, D H Wilson, A W Taylor, A Daly, E Tursan d'Espaignet, E Dal Grande, and R E Ruffin Psychological factors and asthma quality of life: a population based study Thorax, November 1, 2004; 59(11): 930 - 935. [Abstract] [Full Text] [PDF]

				K. M. Kamal, L.-A. Miller, M. Castro, N. Zimmermann, and S. Crocker Psychosocial Factors and Asthma Am. J. Respir. Crit. Care Med., June 1, 2004; 169(11): 1253 - 1254. [Full Text]

				S.E. Wenzel A different disease, many diseases or mild asthma gone bad? Challenges of severe asthma Eur. Respir. J., September 1, 2003; 22(3): 397 - 398. [Full Text] [PDF]

				A. Stauder and M. Kovacs Anxiety Symptoms in Allergic Patients: Identification and Risk Factors Psychosom Med, September 1, 2003; 65(5): 816 - 823. [Abstract] [Full Text] [PDF]

				M. J. TOBIN Asthma, Airway Biology, and Nasal Disorders in AJRCCM 2001 Am. J. Respir. Crit. Care Med., March 1, 2002; 165(5): 598 - 618. [Full Text] [PDF]