Skip to main content
Top
Published in: Allergy, Asthma & Clinical Immunology 1/2023

Open Access 01-12-2023 | Bronchial Asthma | Research

Anxiety in adults with asthma during the coronavirus disease 2019 pandemic: a Canadian perspective

Authors: Sophia Linton, Kayley Xu, Lubnaa Hossenbaccus, Hannah Botting, Sarah Garvey, Adam Sunavsky, Lisa M. Steacy, Dean A. Tripp, Anne K. Ellis

Published in: Allergy, Asthma & Clinical Immunology | Issue 1/2023

Login to get access

Abstract

Background

Asthma is a chronic airway inflammatory disease that affects millions of Canadians and often contributes to higher levels of anxiety among patients. Since the coronavirus disease 2019 (COVID-19) pandemic was a time of increased anxiety and fear among the Canadian population, it was thought that those with asthma may experience heightened anxiety levels due to uncertain access to care, the potential to misinterpret asthma symptoms for symptoms of COVID-19 (or vice versa), and the concern about being treated differently by those around them when experiencing asthma symptoms. Therefore, this study sought to perform a cross-sectional analysis of the asthma-anxiety relationship in adults with and without asthma in the unique context of the COVID-19 pandemic from a Canadian perspective.

Methods

This study employed the COVID-19 Associated Anxiety in Allergic Rhinitis and Asthma patients Experiencing Symptoms (CAAARES) survey, consisting of COVID-19-specific questions, the Generalized Anxiety Disorder Assessment-7 (GAD-7) and the Asthma Control Questionnaire-6 (ACQ-6). Data collection occurred through the Qualtrics XM platform and data analyses were conducted with the IBM SPSS Statistics 28 software.

Results

A total of 741 valid responses were collected (asthma group, n = 244; control group, n = 497). 31.6% and 26.2% of respondents in the asthma and control groups, respectively, met the diagnostic criteria for GAD. There was no significant difference (p = .067) in mean GAD-7 scores between the two groups. A Hierarchal Multiple Regression (HMR) model was developed, and neither asthma status nor ACQ-6 score had a significant predictive effect on the GAD-7 score. There was a statistically significant (p < .001) weak positive correlation (r = .22) between GAD-7 and ACQ-6 scores. In a simple mediation (SMM) model, perceived COVID-19 stress of others was not identified as a significant mediator of the relationship between ACQ-6 and GAD-7 (indirect effect β = 0.014).

Conclusion

Our study of a Canadian cohort demonstrates elevated levels of anxiety overall, amongst both asthma and control groups. While AR status was significantly greater in the asthma group, it was not a significant predictive variable of GAD-7 score. Our data suggests that COVID-19-specific factors appear to have a greater contribution to anxiety than asthma status or control.
Literature
1.
go back to reference Kaplan A, Balkovec S, Carlsten C, Feldman M, McNeilly S, O’Keefe A et al. Susan Waserman, MSc, MD, FRCPC.:25. Kaplan A, Balkovec S, Carlsten C, Feldman M, McNeilly S, O’Keefe A et al. Susan Waserman, MSc, MD, FRCPC.:25.
3.
go back to reference Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63(Suppl 86):8–160.CrossRefPubMed Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63(Suppl 86):8–160.CrossRefPubMed
4.
go back to reference Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. OpenSAFELY: factors associated with COVID-19 death in 17 million patients. Nature. 2020;584(7821):430–6.CrossRefPubMedPubMedCentral Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. OpenSAFELY: factors associated with COVID-19 death in 17 million patients. Nature. 2020;584(7821):430–6.CrossRefPubMedPubMedCentral
5.
go back to reference Liu S, Cao Y, Du T, Zhi Y. Prevalence of Comorbid Asthma and related outcomes in COVID-19: a systematic review and Meta-analysis. J Allergy Clin Immunol Pract. 2021;9(2):693–701.CrossRefPubMed Liu S, Cao Y, Du T, Zhi Y. Prevalence of Comorbid Asthma and related outcomes in COVID-19: a systematic review and Meta-analysis. J Allergy Clin Immunol Pract. 2021;9(2):693–701.CrossRefPubMed
6.
go back to reference Hou H, Xu J, Li Y, Wang Y, Yang H. The Association of Asthma with COVID-19 mortality: an updated Meta-analysis based on adjusted Effect estimates. J Allergy Clin Immunol Pract. 2021;9(11):3944–3968e5.CrossRefPubMedPubMedCentral Hou H, Xu J, Li Y, Wang Y, Yang H. The Association of Asthma with COVID-19 mortality: an updated Meta-analysis based on adjusted Effect estimates. J Allergy Clin Immunol Pract. 2021;9(11):3944–3968e5.CrossRefPubMedPubMedCentral
7.
go back to reference Shi T, Pan J, Katikireddi SV, McCowan C, Kerr S, Agrawal U, et al. Risk of COVID-19 hospital admission among children aged 5–17 years with asthma in Scotland: a national incident cohort study. Lancet Respir Med. 2022;10(2):191–8.CrossRefPubMedPubMedCentral Shi T, Pan J, Katikireddi SV, McCowan C, Kerr S, Agrawal U, et al. Risk of COVID-19 hospital admission among children aged 5–17 years with asthma in Scotland: a national incident cohort study. Lancet Respir Med. 2022;10(2):191–8.CrossRefPubMedPubMedCentral
8.
go back to reference Bloom CI, Drake TM, Docherty AB, Lipworth BJ, Johnston SL, Nguyen-Van-Tam JS, et al. Risk of adverse outcomes in patients with underlying respiratory conditions admitted to hospital with COVID-19: a national, multicentre prospective cohort study using the ISARIC WHO Clinical Characterisation Protocol UK. Lancet Respir Med. 2021;9(7):699–711.CrossRefPubMedPubMedCentral Bloom CI, Drake TM, Docherty AB, Lipworth BJ, Johnston SL, Nguyen-Van-Tam JS, et al. Risk of adverse outcomes in patients with underlying respiratory conditions admitted to hospital with COVID-19: a national, multicentre prospective cohort study using the ISARIC WHO Clinical Characterisation Protocol UK. Lancet Respir Med. 2021;9(7):699–711.CrossRefPubMedPubMedCentral
9.
go back to reference Miller R, Englund K. Clinical presentation and course of COVID-19. Cleve Clin J Med. 2020;87(7):384–8.CrossRefPubMed Miller R, Englund K. Clinical presentation and course of COVID-19. Cleve Clin J Med. 2020;87(7):384–8.CrossRefPubMed
10.
go back to reference Bousquet J, Jutel M, Akdis CA, Klimek L, Pfaar O, Nadeau KC, et al. ARIA-EAACI statement on asthma and COVID-19 (June 2, 2020). Allergy. 2021;76(3):689–97.CrossRefPubMed Bousquet J, Jutel M, Akdis CA, Klimek L, Pfaar O, Nadeau KC, et al. ARIA-EAACI statement on asthma and COVID-19 (June 2, 2020). Allergy. 2021;76(3):689–97.CrossRefPubMed
11.
go back to reference Jiang M, Qin P, Yang X. Comorbidity between depression and asthma via immune-inflammatory pathways: a meta-analysis. J Affect Disord. 2014;166:22–9.CrossRefPubMed Jiang M, Qin P, Yang X. Comorbidity between depression and asthma via immune-inflammatory pathways: a meta-analysis. J Affect Disord. 2014;166:22–9.CrossRefPubMed
12.
go back to reference Rosenkranz MA, Davidson RJ. Affective neural circuitry and mind-body influences in asthma. NeuroImage. 2009;47(3):972–80.CrossRefPubMed Rosenkranz MA, Davidson RJ. Affective neural circuitry and mind-body influences in asthma. NeuroImage. 2009;47(3):972–80.CrossRefPubMed
13.
go back to reference Choi HG, Kim JH, Park JY, Hwang YI, Jang SH, Jung KS. Association between Asthma and Depression: A National Cohort Study. J Allergy Clin Immunol Pract. 2019;7(4):1239–1245e1.CrossRefPubMed Choi HG, Kim JH, Park JY, Hwang YI, Jang SH, Jung KS. Association between Asthma and Depression: A National Cohort Study. J Allergy Clin Immunol Pract. 2019;7(4):1239–1245e1.CrossRefPubMed
14.
go back to reference Li Y, Jiang Q, Ji Y, Cao C. Anxiety and depression may associate with poorer control and quality of life in adults with asthma. Allergy. 2020;75(7):1759–62.CrossRefPubMed Li Y, Jiang Q, Ji Y, Cao C. Anxiety and depression may associate with poorer control and quality of life in adults with asthma. Allergy. 2020;75(7):1759–62.CrossRefPubMed
15.
go back to reference Han YY, Forno E, Marsland AL, Miller GE, Celedón JC. Depression, Asthma, and Bronchodilator Response in a nationwide study of US adults. J Allergy Clin Immunol Pract. 2016;4(1):68–73e1.CrossRefPubMed Han YY, Forno E, Marsland AL, Miller GE, Celedón JC. Depression, Asthma, and Bronchodilator Response in a nationwide study of US adults. J Allergy Clin Immunol Pract. 2016;4(1):68–73e1.CrossRefPubMed
16.
go back to reference Nouwen A, Freeston MH, Labbé R, Boulet LP. Psychological factors associated with emergency room visits among asthmatic patients. Behav Modif. 1999;23(2):217–33.CrossRefPubMed Nouwen A, Freeston MH, Labbé R, Boulet LP. Psychological factors associated with emergency room visits among asthmatic patients. Behav Modif. 1999;23(2):217–33.CrossRefPubMed
17.
go back to reference Tibosch MM, Verhaak CM, Merkus PJFM. Psychological characteristics associated with the onset and course of asthma in children and adolescents: a systematic review of longitudinal effects. Patient Educ Couns. 2011;82(1):11–9.CrossRefPubMed Tibosch MM, Verhaak CM, Merkus PJFM. Psychological characteristics associated with the onset and course of asthma in children and adolescents: a systematic review of longitudinal effects. Patient Educ Couns. 2011;82(1):11–9.CrossRefPubMed
18.
20.
go back to reference Craig TJ, McCann JL, Gurevich F, Davies MJ. The correlation between allergic rhinitis and sleep disturbance. J Allergy Clin Immunol. 2004;114(5):139–45.CrossRef Craig TJ, McCann JL, Gurevich F, Davies MJ. The correlation between allergic rhinitis and sleep disturbance. J Allergy Clin Immunol. 2004;114(5):139–45.CrossRef
21.
go back to reference Ledford DK, Lockey RF. Asthma and comorbidities. Curr Opin Allergy Clin Immunol. 2013;13(1):78–86.CrossRefPubMed Ledford DK, Lockey RF. Asthma and comorbidities. Curr Opin Allergy Clin Immunol. 2013;13(1):78–86.CrossRefPubMed
22.
go back to reference Xiong J, Lipsitz O, Nasri F, Lui LMW, Gill H, Phan L, et al. Impact of COVID-19 pandemic on mental health in the general population: a systematic review. J Affect Disord. 2020;277:55–64.CrossRefPubMedPubMedCentral Xiong J, Lipsitz O, Nasri F, Lui LMW, Gill H, Phan L, et al. Impact of COVID-19 pandemic on mental health in the general population: a systematic review. J Affect Disord. 2020;277:55–64.CrossRefPubMedPubMedCentral
23.
go back to reference Morin CM, Bjorvatn B, Chung F, Holzinger B, Partinen M, Penzel T, et al. Insomnia, anxiety, and depression during the COVID-19 pandemic: an international collaborative study. Sleep Med. 2021;87:38–45.CrossRefPubMedPubMedCentral Morin CM, Bjorvatn B, Chung F, Holzinger B, Partinen M, Penzel T, et al. Insomnia, anxiety, and depression during the COVID-19 pandemic: an international collaborative study. Sleep Med. 2021;87:38–45.CrossRefPubMedPubMedCentral
24.
go back to reference Wei L, Islam JY, Mascareno EA, Rivera A, Vidot DC, Camacho-Rivera M. Physical and Mental Health Impacts of the COVID-19 pandemic among US adults with chronic respiratory conditions. J Clin Med. 2021;10(17):3981.CrossRefPubMedPubMedCentral Wei L, Islam JY, Mascareno EA, Rivera A, Vidot DC, Camacho-Rivera M. Physical and Mental Health Impacts of the COVID-19 pandemic among US adults with chronic respiratory conditions. J Clin Med. 2021;10(17):3981.CrossRefPubMedPubMedCentral
25.
go back to reference Eldeirawi KM, Nyenhuis SM, Huntington-Moskos L, Polivka BJ. Coronavirus disease 2019–related anxiety is associated with uncontrolled asthma in adults. Ann Allergy Asthma Immunol. 2022;129(1):109–11.CrossRefPubMedPubMedCentral Eldeirawi KM, Nyenhuis SM, Huntington-Moskos L, Polivka BJ. Coronavirus disease 2019–related anxiety is associated with uncontrolled asthma in adults. Ann Allergy Asthma Immunol. 2022;129(1):109–11.CrossRefPubMedPubMedCentral
26.
go back to reference Patella V, Pelaia C, Zunno R, Pelaia G. Biologicals decrease psychological distress, anxiety and depression in severe asthma, despite Covid-19 pandemic. Respir Med. 2022;200:106916.CrossRefPubMedPubMedCentral Patella V, Pelaia C, Zunno R, Pelaia G. Biologicals decrease psychological distress, anxiety and depression in severe asthma, despite Covid-19 pandemic. Respir Med. 2022;200:106916.CrossRefPubMedPubMedCentral
27.
go back to reference Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.CrossRefPubMed Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.CrossRefPubMed
28.
go back to reference Juniper EF, O’Byrne PM, Guyatt GH, Ferrie PJ, King DR. Development and validation of a questionnaire to measure asthma control. Eur Respir J. 1999;14(4):902–7.CrossRefPubMed Juniper EF, O’Byrne PM, Guyatt GH, Ferrie PJ, King DR. Development and validation of a questionnaire to measure asthma control. Eur Respir J. 1999;14(4):902–7.CrossRefPubMed
29.
go back to reference Juniper EF, Bousquet J, Abetz L, Bateman ED, GOAL Committee. Identifying “well-controlled” and “not well-controlled” asthma using the Asthma Control Questionnaire. Respir Med. 2006;100(4):616–21.CrossRefPubMed Juniper EF, Bousquet J, Abetz L, Bateman ED, GOAL Committee. Identifying “well-controlled” and “not well-controlled” asthma using the Asthma Control Questionnaire. Respir Med. 2006;100(4):616–21.CrossRefPubMed
30.
go back to reference Louise P, Siobhan O, Louise M, Jean G. The burden of generalized anxiety disorder in Canada. Health Promot Chronic Dis Prev Can Res Policy Pract. 2017;37(2):54–62. Louise P, Siobhan O, Louise M, Jean G. The burden of generalized anxiety disorder in Canada. Health Promot Chronic Dis Prev Can Res Policy Pract. 2017;37(2):54–62.
31.
go back to reference Yonemoto N, Kawashima Y. Help-seeking behaviors for mental health problems during the COVID-19 pandemic: a systematic review. J Affect Disord. 2023;323:85–100.CrossRefPubMed Yonemoto N, Kawashima Y. Help-seeking behaviors for mental health problems during the COVID-19 pandemic: a systematic review. J Affect Disord. 2023;323:85–100.CrossRefPubMed
32.
go back to reference Lacwik P, Szydłowska D, Kupczyk M, Pałczyński C, Kuna P. High levels of anxiety during the COVID-19 pandemic as a risk factor of clinical worsening in patients with severe asthma. J Allergy Clin Immunol Pract. 2021;9(3):1381–3.CrossRefPubMedPubMedCentral Lacwik P, Szydłowska D, Kupczyk M, Pałczyński C, Kuna P. High levels of anxiety during the COVID-19 pandemic as a risk factor of clinical worsening in patients with severe asthma. J Allergy Clin Immunol Pract. 2021;9(3):1381–3.CrossRefPubMedPubMedCentral
33.
go back to reference Muñoz-Cano R, Ribó P, Araujo G, Giralt E, Sanchez-Lopez J, Valero A. Severity of allergic rhinitis impacts sleep and anxiety: results from a large spanish cohort. Clin Transl Allergy. 2018;8(1):23.CrossRefPubMedPubMedCentral Muñoz-Cano R, Ribó P, Araujo G, Giralt E, Sanchez-Lopez J, Valero A. Severity of allergic rhinitis impacts sleep and anxiety: results from a large spanish cohort. Clin Transl Allergy. 2018;8(1):23.CrossRefPubMedPubMedCentral
34.
go back to reference Lamb CE, Ratner PH, Johnson CE, Ambegaonkar AJ, Joshi AV, Day D, et al. Economic impact of workplace productivity losses due to allergic rhinitis compared with select medical conditions in the United States from an employer perspective. Curr Med Res Opin. 2006;22(6):1203–10.CrossRefPubMed Lamb CE, Ratner PH, Johnson CE, Ambegaonkar AJ, Joshi AV, Day D, et al. Economic impact of workplace productivity losses due to allergic rhinitis compared with select medical conditions in the United States from an employer perspective. Curr Med Res Opin. 2006;22(6):1203–10.CrossRefPubMed
35.
go back to reference Xi L, Cao F, Zhang Y, Zhang L. Severity of nasal obstruction can predict the anxiety status of patients with allergic rhinitis but not patients with vasomotor rhinitis. Int Forum Allergy Rhinol. 2016;6(11):1196–203.CrossRefPubMed Xi L, Cao F, Zhang Y, Zhang L. Severity of nasal obstruction can predict the anxiety status of patients with allergic rhinitis but not patients with vasomotor rhinitis. Int Forum Allergy Rhinol. 2016;6(11):1196–203.CrossRefPubMed
36.
go back to reference Ekström S, Mogensen I, Georgelis A, Westman M, Almqvist C, Melén E, et al. General stress among young adults with Asthma during the COVID-19 pandemic. J Allergy Clin Immunol Pract. 2022;10(1):108–15.CrossRefPubMed Ekström S, Mogensen I, Georgelis A, Westman M, Almqvist C, Melén E, et al. General stress among young adults with Asthma during the COVID-19 pandemic. J Allergy Clin Immunol Pract. 2022;10(1):108–15.CrossRefPubMed
37.
go back to reference Wang Y, Shi C, Yang Y, Zhang S, Li W, Huang N, et al. Anxiety and depression in allergic rhinitis patients during COVID-19 pandemic in Wuhan, China. Asian Pac J Allergy Immunol. 2022;40(3):210–6.PubMed Wang Y, Shi C, Yang Y, Zhang S, Li W, Huang N, et al. Anxiety and depression in allergic rhinitis patients during COVID-19 pandemic in Wuhan, China. Asian Pac J Allergy Immunol. 2022;40(3):210–6.PubMed
38.
go back to reference Pedrozo-Pupo JC, Campo-Arias A. Depression, perceived stress related to COVID, post-traumatic stress, and insomnia among asthma and COPD patients during the COVID-19 pandemic. Chron Respir Dis. 2020;17:1479973120962800.CrossRefPubMedPubMedCentral Pedrozo-Pupo JC, Campo-Arias A. Depression, perceived stress related to COVID, post-traumatic stress, and insomnia among asthma and COPD patients during the COVID-19 pandemic. Chron Respir Dis. 2020;17:1479973120962800.CrossRefPubMedPubMedCentral
39.
go back to reference de Boer GM, Houweling L, Hendriks RW, Vercoulen JH, Tramper-Stranders GA, Braunstahl GJ. Asthma patients experience increased symptoms of anxiety, depression and fear during the COVID-19 pandemic. Chron Respir Dis. 2021;18:14799731211029658.PubMedPubMedCentral de Boer GM, Houweling L, Hendriks RW, Vercoulen JH, Tramper-Stranders GA, Braunstahl GJ. Asthma patients experience increased symptoms of anxiety, depression and fear during the COVID-19 pandemic. Chron Respir Dis. 2021;18:14799731211029658.PubMedPubMedCentral
Metadata
Title
Anxiety in adults with asthma during the coronavirus disease 2019 pandemic: a Canadian perspective
Authors
Sophia Linton
Kayley Xu
Lubnaa Hossenbaccus
Hannah Botting
Sarah Garvey
Adam Sunavsky
Lisa M. Steacy
Dean A. Tripp
Anne K. Ellis
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Allergy, Asthma & Clinical Immunology / Issue 1/2023
Electronic ISSN: 1710-1492
DOI
https://doi.org/10.1186/s13223-023-00833-z

Other articles of this Issue 1/2023

Allergy, Asthma & Clinical Immunology 1/2023 Go to the issue