The impact of psychological distress on allergic rhinitis and asthma control

Psychological distress is prevalent in allergic rhinitis and asthma (ARA) patients and could influence disease control. The aim of this study was to evaluate which dimensions of psychological distress are related to poor symptoms control in ARA patients. We performed a cross-sectional study of patients (≥ 18 years-old) diagnosed with ARA, without psychiatric pathology, with at least 6 months of follow up in our outpatient asthma consultation. All patients completed 2 questionnaires: Symptom Checklist-90 Revised questionnaire and Control of Allergic Rhinitis and Asthma Test (CARAT). FEV1 and FEV1/FVC were also collected. Patients were divided according to the CARAT subscores: asthma control (CARATa) and rhinitis control (CARATr). We included 115 patients, mostly female (n=78, 67.8%), with a mean age of 41.6+14.7 years. Psychological distress was more frequent in female patients and was associated with poor asthma control (p=0.027) but not with poor rhinitis control. Subscores of CARAT revealed that 74 (64.3%) patients had poorly controlled asthma (CARATa 0.001), obsessive-compulsive traits (p=0.014), depression (p=0.037), sleep difficulties (p=0.003) and guilt feelings (p=0.034). Poorly controlled rhinitis (CARATr ≤8) (n=86, 74.8%) was associated with guilt feelings (p=0.022) . No significant differences were found respecting to FEV1 and FEV1/FVC between groups. Patients with tendency to over-value their symptoms, self-centered, with obsessive traits, depressive symptoms and sleep disturbances have a higher risk of poorly controlled asthma. Psychological evaluation and management of patients presenting these traits may improve asthma control.