For those living with asthma, particularly those with severe forms of the disease, the emotional and mental health burden can be detrimental and significantly impact multiple aspects of their lives. Is clinical care currently addressing these needs?
Some would argue that asthma and mental health issues represent a clinical catch-22. It’s long been recognized that stress, anxiety, and depression can exert a negative impact on asthma and that simultaneously, these issues occur in higher rates in people with asthma than in the general population. The two therefore frequently co-exist and aggravate one another, leaving individuals trapped in a vicious cycle: improving their mental health can help improve their asthma symptoms, but to achieve the former, they must achieve the latter.1,2
For those living with severe forms of the disease, asthma can have a detrimental impact on emotions and personal relationships, which can contribute to mental health issues. Symptoms can often cause patients to feel isolated, as they carry the emotional burden of the disease alone due to fear of troubling a family member, close friend or partner.3 In contrast to milder forms of the disease, severe asthma can impose a debilitating, long-term burden on mental health; a factor which current clinical support may not be adequately addressing.4
A survey of 804 adults with asthma by the Asthma and Allergy Foundation of America (AAFA) in 2017 reported a negative impact on a number of areas of respondents’ lives including sports/exercise, travelling, hobbies, finances, work, school, self-confidence and spending time with friends. Indeed, 40% of respondents with severe asthma reported an ‘extreme limitation’ on everyday tasks due to their asthma.5 The daily recurrence of these challenges led patients to report feelings of frustration, anxiousness, depression, fear and anger. Results also indicated that patients’ relationships with their family, partners, friends and colleagues were impacted by asthma; only 17% of respondents with severe asthma reported no impact on their personal relationships. When asked about the frequency of their thoughts about their asthma, 78% of patients with severe asthma reported that they ‘always’ have thoughts about their condition. Finally, nearly half (41%) of respondents with severe asthma felt that their asthma was so severe, there were no treatments available to make them better.5 Together, these results highlight the considerable emotional, social and financial burden of asthma for patients.5
Beyond these struggles with the disease, many patients also felt concern or unhappiness about possible medication side effects. Worries included weight gain; being misunderstood by friends, family members and partners; being stigmatized and becoming uncharacteristically introverted and concerns for the future.4 How can healthcare providers alter their way of recognizing and managing the emotional needs of asthma patients, while also treating the physiological aspects of the disease?
Patients have suggested the development of ‘life planning’ support services to aid people living with severe asthma. These could offer an individual the ability to discuss their career, finances, parenting, relationships, mental health, and emotions with a counselor. Such services could also help to address non-adherence to medication through discussion and increased understanding of disease and medication use, and could help improve accessibility to medical care by addressing barriers such as child care.4 In addition, evaluation of mental health symptoms and assessing the emotional impact of asthma on the patient can help healthcare professionals adjust and incorporate management of mental health into asthma treatment plans. For example, referring to a specialist, to increase the likelihood of improving a patients’ symptoms, quality of life and wellbeing.1
Discover more about the daily challenges of those living with asthma in our ‘Asthma Stories’ series.
RESP-41995 November 2019