ARLINGTON HEIGHTS, Ill. -- Depression and other mood disorders are found to be common in inner-city asthma patients, and are often unrecognized and untreated according to a pilot study published in this month's Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI). Investigators also found that mood disorders are not necessarily associated with more severe asthma.

"Our pilot study examined the prevalence of depression and the association between depression and measures of asthma severity in patients," said allergist-immunologist David A. Khan, M.D., Department of Internal Medicine, The University of Texas Southwestern Medical Center at Dallas. "We found 41 percent lifetime prevalence of mood disorders in our study population of low-income, minority, inner-city asthma clinic patients.

"This is higher than what was previously reported in the general population and in primary care populations. One possible reason is that our study population of minority patients may be at higher risk for depression and life stresses than other cultural groups," Dr. Khan said.

Forty-four adult asthma patients of mixed ethnicity participated in the 10-week study. Mood disorders were diagnosed using diagnostic interviews following routine clinic appointments. Participants had baseline spirometry performed as part of their routine visit. Inhaled steroid dose and asthma severity also were obtained.

"Our study found that less than half of the patients with a mood disorder had ever received medication for their disorder, or had a psychiatric evaluation," said E. Sherwood Brown, Ph.D., M.D., Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas. "These findings are consistent with other data."

"A surprising preliminary finding is that patients with a past mood disorder seemed to have less severe asthma symptoms than people with no mood disorder. Data also suggest the possibility that asthma symptoms may improve if the mood disorder is treated," Dr. Brown said.

Minimal data are available on the prevalence of clinically significant depression and other mood disorders in asthma patients.

"Given that our data suggest that depression is frequently untreated in minority asthma patients, studies examining the efficacy, feasibility and tolerability of antidepressant therapy in this inner-city population seem warranted," said lead-author Vicki Nejtek, Ph.D., Department of Psychiatry, The University of Texas Southwestern Medical Center. "The good news is that depressive symptoms, if recognized, can effectively be treated in most people, so that adverse outcomes for depressed asthma patients may be lessened."

Studies suggest depression may be a risk factor for asthma-related morbidity and mortality in low-income, minority, inner-city asthma patients.

"Physicians should be made aware of the significant, often untreated psychiatric illness among low-income patients, and make referrals for further evaluation when indicated. And that asthma is more difficult to diagnose and treat in patients with mood disorders," Dr. Khan said.

The ACAAI is a professional medical organization comprised of 4,100 qualified allergists-immunologists and related health care professionals. The College is dedicated to the clinical practice of allergy, asthma and immunology through education and research to promote the highest quality of patient care.

Citation:
Nejtek, VA, Brown, ES, Khan, DA, et al. Prevalence of mood disorders and relationship to asthma severity in patients at an inner-city asthma clinic. Ann Allergy Asthma Immunol 2001; 87:129-133.

---American College of Allergy, Asthma and Immunology

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