Pharmacological interventions for the treatment of psychological distress in patients with asthma: a systematic review and meta-analysis

Abstract

Objective: To evaluate the effectiveness and safety of pharmacological interventions for the treatment of psychological distress in people with asthma.

Data sources: Electronic searches were performed in Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed/Medline, Embase, PsycInfo, Health Technology Assessment Database and Web of Science (inception to April 2019).

Study selections: Included studies were randomized controlled trials (RCT) or controlled clinical trials investigating the effect of pharmacological interventions for psychological distress in people with asthma. Records were screened and data extracted by two independent authors into standardized pilot-tested extraction templates. Data was analyzed according to standard Cochrane methodology and entered into Review Manager Software version 5.3.

Results: From 5,689 studies, six RCTs (n = 215) met inclusion criteria and were included in the systematic review, of which four studies were included in the meta-analysis. A meta-analysis of four studies (n = 158) indicated no evidence of an effect for selective serotonin reuptake inhibitors (Citalopram or Escitalopram) on reduction of psychological distress in adult patients with asthma. Similarly, antiepileptic medication (Levetiracetam) was no better than placebo in the treatment of psychological distress in people with asthma. Adverse events were poorly reported across all studies but were slightly increased among intervention participants compared to control participants.

Conclusions: There was great heterogeneity between studies and overall poor methodological quality providing insufficient evidence to make recommendations for or against the use of pharmacotherapy in asthma patients with psychological distress. Further confirmatory trials are warranted to make recommendations for clinical practice.

Keywords:

• Asthma
• psychological stress
• depression
• anxiety
• systematic review and meta-analysis

SYSTEMATIC REVIEW REGISTRATION NUMBER:

• CRD42018118260

Acknowledgements

We would like to thank Sarah McQuillen, Librarian, University of South Australia, for her assistance in developing the search strategy. We would also like to thank the following authors for answering our data queries: Prof. Sherwood Brown and Prof. Liam Heaney. Permission was granted by Prof. Liam Heaney on 20 December 2018 to include his study in our systematic review and meta-analysis.

Declarations of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors’ contributions

LT screened, extracted and analysed the data and drafted the manuscript. KS assisted with screening and extraction. KVC assisted with protocol development, interpretation of data and manuscript drafting. KS, ZK, HS, AT, NS and AE assisted with revision of the manuscript. All authors read and approved the final manuscript.