Depression tied to poor asthma therapy adherence

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by Megan Rauscher, Reuters, 20 Oct 2006

NEW YORK (Reuters Health) - Depressive symptoms are common among inner-city adults hospitalized for asthma flare-ups, according to a new study in the medical journal Chest.

Furthermore, such symptoms identify individuals who are unlikely to stick to their asthma medication regimen when they go home.

"Typically, when someone comes into the hospital and we treat their asthma, we don't necessarily look at whether they are depressed," Dr. Susan J. Bartlett commented. "But maybe we need to, because these individuals are really at very high risk of being poorly adherent to their asthma therapy once they get out of the hospital."

Bartlett and her colleagues at Johns Hopkins School of Medicine in Baltimore studied the effect of depression on adherence to asthma therapy after discharge in 59 patients. The participants were mostly female, mostly African American inner-city adults with an average age of 43 who were hospitalized for an asthma exacerbation.

"We assessed their levels of depression while in hospital and found that a significant number of them -- 41 percent -- did have significant levels of depressive symptoms," Bartlett told Reuters Health.

For up to 2 weeks following hospital discharge, electronic monitors were used to assess the patients' use of inhaled and oral asthma therapies.

Overall adherence to asthma medication was suboptimal but it was significantly worse in people who had high levels of depressive symptoms, the investigators report. Specifically, adherence to asthma therapy was 60 percent in patients exhibiting high levels of depressive symptoms versus 74 percent in those without depressive symptoms.

When the researchers took into account factors that might influence adherence -- such as age, gender, or education -- "patients who were depressed were about 11 times more likely to be poorly adherent to asthma therapy -- meaning taking less than 50 percent of it," Bartlett explained.

It remains to be seen whether screening and treating depression and providing additional forms of psychosocial support might improve adherence to asthma medication. "Certainly that would be a reasonable thought and something we definitely need to look into," Bartlett said.

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