Children and adolescents with anxiety and depression have higher rates of asthma-related emergency department (ED) visits, researchers have warned in a study published online this week in Pediatrics.

They analyzed data from 65,342 pediatric patients with asthma who were included in the Massachusetts All-Payer Claims Database and found that nearly one quarter (24.7%) had an additional diagnosis of anxiety (11.2%), depression (5.8%), or both (7.7%).

Moreover, patients with comorbid depression and anxiety were twice as likely to visit the ED for an asthma-related emergency compared with children who had asthma but no mental health diagnosis.

“Part of the reason we focused on ED visits,” said lead author Naomi Bardach, “is because that’s a sign that somebody’s asthma is out of control…It’s a sign that we could do something better for this kid.”

The overall rate of asthma-related visits to the ED was 17.1 visits per 100 child-years. However, among children with anxiety and depression the rate rose to 18.9 and 21.7 ED visits per 100 child-years, respectively. Children with both anxiety and depression had the highest rate of ED use at 27.6, nearly two times the rate (15.5) among children with no mental health diagnosis.

Without biological data, it’s not clear how the interplay of asthma and anxiety or depression increases ED visits, said Bardach, MD, a professor of pediatrics and health policy at the University of California San Francisco. But stress and anxiety are known to exacerbate asthma symptoms, so it is possible stress may be at the root of the child’s asthma emergencies and their anxiety, she told Medscape Medical News. Alternatively, depression and anxiety might make it harder for a patient to adhere to his or her medication and manage the condition, which could increase the risk of exacerbations. 

What is clear, Bardach said, is that there’s a meaningful link between a child’s mental health and how often a family finds themselves in an ED for asthma attacks or other severe symptoms. So there’s incentive, Bardach said, for primary care physicians to screen for behavioural health conditions, as recommended by the American Academy of Pediatrics, especially in children with asthma.

Likewise, if a patient’s asthma isn’t under control or responsive to treatment, pulmonologists might consider screening for depression and anxiety, or referring the patient for screening, as a possible next step.

For children who do present with asthma and mental health issues, more intensive counselling on medication and symptom recognition may be necessary. Anxiety and depression can make it more difficult for patients to recognize and respond to symptoms, and it could be difficult to distinguish between asthma symptoms, anxiety and depression symptoms, and medication side effects, the authors write. In addition, clinicians may consider scheduling follow-up appointments more frequently in these patients, Bardach said, to ensure that patients are adhering to medication and managing both or all of their conditions.


REFERENCE: Bardach et al: Depression, Anxiety, and Emergency Department Use for Asthma;