Those with respiratory conditions such as severe asthma are considered to be at a higher risk of complications after infection with COVID-19 but could a worsening of disease control be simply due to worrying about the pandemic?
Having anxiety can result in a negative impact upon quality of life among those with chronic health conditions. Whether knowledge of the global pandemic due to COVID-19 could trigger increased anxiety and ultimately a worsening of disease control in patients with severe asthma, was the question posed by a team from the Department of Internal Medicine, Medical University of Lodz, Poland. Using data from a cohort of patients treated at their hospital with severe asthma during March to June 2020, at the height of the COVID-19 pandemic, doctors invited the patients to complete several questions. All were treated with the biologics, omalizumab, mepolizumab and benralizumab and completed the State-Trait Anxiety inventory (STAI), which is a validated tool for measuring anxiety as both a temporal and general, long-standing personal trait. In addition, the asthma control questionnaire (ACQ) and a mini asthma quality of life questionnaire (mAQLQ) were also completed (with higher scores in both representing better control and quality of life) and the scores obtained, compared to the last values recorded in the medical records.
In total, 87 patients, with a mean age of 56 years (39% male) completed all questionnaires. Overall, asthma was rated as completely controlled in 34%, partially controlled in 23% but uncontrolled in 42.5%. Nearly half of all patients (46%) had a higher ACQ score (compared to their last score in the medical records) although more than a third (37%) actually experienced a reduction in ACQ. In contrast, the majority (62%) of patients reported a reduction in mAQLQ scores. In terms of anxiety, 34% of patients were deemed to have a high state of anxiety and 8% had high trait anxiety. Moreover, among those with high state anxiety, more patients (30% vs 15.8%) had a lower mAQLQ score. The authors concluded that high levels of anxiety are associated with a worsening of disease control and that this anxiety may have arisen because of the COVID-19 pandemic.
Lacwik P et al. High levels of anxiety during COVID-19 pandemic as a risk factor of clinical worsening in patients with severe asthma. J Allergy Clin Immunol Pract 2021