Impact of psychological impairment on quality of life and work impairment in severe asthma

Abstract

Background

Psychological impairment, such as anxiety and depression, is common in severe asthma. However, the impact of psychological impairment on asthma-specific quality of life (ASQOL) and work impairment has not been assessed within Southeast-Asia. Furthermore, previous ASQOL questionnaires contained items overlapping with asthma control, making it challenging to isolate the relationship between psychological impairment with ASQOL and asthma control, respectively.

Objective

To evaluate the relationship between psychological impairment with ASQOL and work impairment in severe asthma.

Methods

This is a cross-sectional study of severe asthma at Singapore General Hospital. We assessed ASQOL, psychological impairment, work impairment and asthma control using validated questionnaires. An ASQOL questionnaire not containing items evaluating asthma symptoms was selected to reduce overlap with asthma control. Medical records were used to obtain other asthma characteristics and healthcare utilization patterns.

Results

Amongst 111 patients, 37% had psychological impairment based on Hospital Anxiety and Depression Scale. Poorer ASQOL was associated with anxiety (p = .013) after controlling for demographic characteristics, asthma control and comorbidities. Anxiety symptoms were associated with greater health concerns while depression symptoms were associated with sleep difficulty and physical limitations. Having depressive symptoms was associated with an additional 16% impairment of total work hours (p = .038). Psychological impairment was not associated with spirometry results or healthcare utilization. Ethnicity significantly predicted both ASQOL and work impairment.

Conclusions

In severe asthma, patients with psychological impairment have poorer ASQOL and greater work impairment than those without psychological impairment. There is an urgent need to mitigate this problem.

Keywords:

• Anxiety
• asthma
• depression
• presenteeism
• quality of life

Acknowledgements

We would like to thank the asthma nurses Ms. Karen Tan, Ms. Lim Shu Gim, Ms. Noor Syifa, Ms. Yvonne Tiang and Ms. Yang Shi Shin, research associate Dr. Fan Qianqian, research coordinators Ms. Debby Siow and Mr. Mervyn Ong for their help with patient recruitment and administrative matters. This work was supported by AM-ETHOS Duke-NUS Medical Student Fellowship Award.

Declaration of interest

The authors declare that they have no competing interest related to this manuscript, financial or otherwise. Other conflict of interests include the following: MSK has received speaker fees and fees for serving on the advisory boards of GlaxoSmithKline, AstraZeneca and Sanofi, all paid to her hospital, Singapore General Hospital. AKWC has received speaker fees from GlaxoSmithKline, AstraZeneca and Mundipharma.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available because participants of this study did not agree for their data to be shared publicly but are available from the corresponding author on reasonable request.