High COVID-19-related Anxiety a Risk Factor for Worsening of Asthma, Quality of Life

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In patients with severe asthma, increased anxiety during the coronavirus disease 2019 (COVID-19) pandemic is a potential risk factor for clinical worsening of disease and decline in quality in life (QoL), according to a new survey.

“From the beginning, it [COVID-19] was considered especially threatening to vulnerable populations such as patients with chronic respiratory conditions, which could naturally lead to increased levels of stress and anxiety,” wrote authors led by Piotr Lacwik, MD, professor, School of Medicine, Collegium Medicum of Jan Kochanowski University, Kielce, Poland, in The Journal of Allergy and Clinical Immunology: In Practice.

Researchers surveyed 87 patients with severe asthma (mean age, 56.1 years; 39.1% men) who were receiving biological treatment with omalizumab, mepolizumab, and benralizumab in the National Severe Asthma Treatment Program during March and June 2020.

At each visit, participants completed the State-Trait Anxiety Inventory (STAI) questionnaire and a 15-item COVID-19 survey that assessed concerns regarding the impact of COVID-19 on patients’ anxiety, asthma, and QoL.

Complete medical data were available for all participants, including changes in the Asthma Control Questionnaire (ACG) and Mini Asthma Quality of Life Questionnaire (mAQLQ) to compare with their last visit prior to COVID-19.

Survey results showed 46% of participants had an increase in their ACQ score, 17% reported no change, and 37% had a reduction their score. Lacwik and colleagues observed an even bigger impact on asthma-related QoL: 62% of participants had a reduced mAQLQ score, 18% reported no change, and 20% reported an increased score.

Mean changes in ACQ and mAQLQ scores were 0.214 and —0.248, respectively. Also, 22 participants had a significant decline in asthma symptom control and 18 had a significant decline in QoL, according to the survey.

Mean STAI scores were 44.82 for state anxiety and 42.14 for trait anxiety; most patients reported in the COVID-19 survey that the pandemic “considerably affected” their responses, wrote authors.

A total of 30 patients (34%) qualified as having high state anxiety and 7 patients (8%) had high trait anxiety. Among those with high state anxiety, there was a higher proportion of participants with significant ACQ score increases (53.3% vs 10.5%) and mAQLQ score decreases (30% vs 15.8%) compared with those with low-to-moderate state anxiety.

Linear regression analysis also showed that both state and trait anxiety were significantly associated with the change in ACQ (P<.001 and P<.01, respectively), but not the mAQLQ scores.

The researchers also reported that high level of state anxiety in patients with severe asthma may be a risk factor for a significant decline in ACQ (odds ratio [OR]=9.71; P<.001) and QoL scores (OR=2.29; P=.008) vs patients with low or moderate state anxiety. No participants experienced exacerbations in the 3 months after assessment.

“Our observations showed that a major event, such as the rise of a global pandemic, may significantly affect patients’ level of anxiety, which can reflect on their quality of life and disease control,” concluded survey authors. “Regular screening of severe asthmatics using the STAI questionnaire could be a valuable addition in asthmatic patient care.”

The authors added that further studies are needed to examine whether an intervention aimed at reducing anxiety could prove effective in improving asthma control.