Psychosocial issues can interplay with several aspects of severe asthma:
Anxiety has a complex relationship with asthma. It may act as a trigger for an asthma exacerbation, mimic symptoms of an asthma exacerbation or worsen an exacerbation. Children and adolescents with asthma are three times more likely to suffer from an anxiety disorder than those who do not have asthma and when present, anxiety is associated with an increase in asthma symptoms.
Depression is associated with higher morbidity and mortality in children with asthma. It may also contribute to poor self-management including reduced medication compliance, poor symptom awareness and a reduced ability to identify worsening symptoms. On the other hand, an improvement in depressive symptoms can lead to an improvement in asthma control. The role of asthma medications in depression should also be considered.
It is imperative that children are screened for anxiety or depression as part of their routine assessment. Possible screening tools are:
Treatments that target children’s knowledge, beliefs and behaviours are likely to improve compliance, management and long-term prognosis for children with asthma and psychological comorbidity. Cognitive behavioural therapy (CBT), which may involve education, relaxation training, targeting unhelpful thinking styles, exposure to fears and increasing approach behaviours is an efficacious treatment for children with asthma and anxiety (Papneja et al. 2006, Marriage et al. 2012, Sicouri et al. 2017), however further research is needed.
Severe asthma can have a range of psychosocial effects on children, including: