Anxiety Contributes to Poorer Asthma Outcomes in Inner-City Black Adolescents
Anxiety Contributes to Poorer Asthma Outcomes in Inner-City Black Adolescents
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DOI：
10.1016/j.jaip.2017.06.034
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发表时间：
2018-01-01
影响因子：
9.4
通讯作者：
Fitzpatrick, Anne M.
中科院分区：
文献类型：
--
作者：
Shams, Marissa R.;Bruce, Alice C.;Fitzpatrick, Anne M.
背景：与黑人青少年哮喘控制不良、恶化和医疗保健利用相关的因素是复杂的，尚未得到很好的了解。尽管焦虑等心理合并症在哮喘患者中很常见，但尚未在该人群中进行过研究。目的：本研究在一组患有持续性哮喘的城市黑人青少年中描述了焦虑和相关哮喘特征，并确定了焦虑症状、持续不受控制的哮喘和1年内预期医疗保健利用之间的关系。方法：86名黑人青少年入组，用医院焦虑和抑郁量表焦虑亚量表（HADS-A）进行表型分析和焦虑症状筛查。每2个月给参与者打电话，第二次研究访问在1年后完成。主要结局包括1年研究期间持续不受控制的哮喘、需要全身性皮质类固醇的哮喘恶化和计划外的医疗保健利用。结果：在基线访问时，共有31% （n = 27）的青少年可能存在焦虑（即HADS-A评分为bb70）， 27% （n = 23）的青少年可能存在焦虑（即HADS-A评分为5-7）。焦虑症状与较差的哮喘控制、更严重的生活质量受损和更多的失眠症状相关。可能患有焦虑症的青少年患持续不受控制的哮喘和急诊科的几率也增加，但在看医生或接受全身皮质类固醇方面没有差异。结论：患有持续性哮喘的市中心黑人青少年焦虑症状的患病率较高，与哮喘控制较差、生活质量受损、失眠和哮喘急诊使用率增加相关。焦虑障碍的常规筛查可能有助于青少年哮喘的临床管理。(C) 2017年美国过敏、哮喘与免疫学学会
BACKGROUND: The factors associated with poor asthma control, exacerbations, and health care utilization in black adolescents are complex and not well understood. Although psychological comorbidities such as anxiety are common in patients with asthma, these have not been studied in this population.OBJECTIVE: This study characterized anxiety and associated asthma features in a cohort of black inner-city adolescents with persistent asthma and determined the association between anxiety symptoms, persistent uncontrolled asthma, and prospective health care utilization over 1 year.METHODS: Eighty-six black adolescents were enrolled, phenotyped, and screened for anxiety symptoms with the Hospital Anxiety and Depression Scale anxiety subscale (HADS-A). Participants were telephoned every 2 months and a second study visit was completed at 1 year. Primary outcomes included persistent uncontrolled asthma, asthma exacerbations requiring systemic corticosteroids, and unscheduled health care utilization during the 1-year study period.RESULTS: A total of 31% (n = 27) of adolescents had probable anxiety (ie, HADS-A score > 7) and 27% (n = 23) had possible anxiety (ie, HADS-A score 5-7) at the baseline visit. Anxiety symptoms were associated with poorer asthma control, more impaired quality of life, and more insomnia symptoms. Adolescents with probable anxiety disorders also had increased odds of persistent uncontrolled asthma and emergency department utilization, with no differences in physician visits or systemic corticosteroid receipt.CONCLUSIONS: Inner-city black adolescents with persistent asthma have a high prevalence of anxiety symptoms associated with poorer asthma control, impaired quality of life, insomnia, and increased prospective emergency department utilization for asthma. Routine screening for anxiety disorders may be useful in the clinical management of adolescents with asthma. (C) 2017 American Academy of Allergy, Asthma & Immunology