Effect of biological agent therapy on anxiety and depression scores in severe asthma patients

Asthma is a heterogeneous chronic disease characterized by airway inflammation and presenting with symptoms such as shortness of breath, cough, wheezing and chest tightness in the form of attacks. Severe asthma is defined as the asthma group that cannot be controlled despite the administration of the highest appropriate dose of medication, full compliance of the patient, correct inhaler technique, treatment of comorbid conditions, and elimination of environmental and occupational contact, or whose control is impaired when the dose of medication is reduced under these conditions. The best-known endotype of asthma is Type 2 asthma, which is characterized by the presence of Th2 cytokines associated with airway and peripheral blood eosinophilia. Biological agents such as omalizumab (anti IgE) and mepolizumab (anti IL5) can be applied in this patient group. Asthma is one of the most common chronic diseases and can cause psychiatric symptoms that affect the quality of life of patients and impair their compliance with treatment. The incidence of psychiatric disorders, especially depression and anxiety, has been reported to be 25-49% in patients with difficult asthma. While there are many studies on the development of psychiatric disorders in asthmatic patients, the study showing the effect of treatment on psychiatric disorders, especially in patients receiving severe asthma treatment, is very limited. The main purpose of our study is to compare the anxiety disorder and depression status of patients with severe asthma and those with severe asthma who do not use biologic agents, using anxiety and depression scores. The secondary aim of our study; The aim of this study is to compare the anxiety disorder and depression status among the subjects using omalizumab and mepolizumab among the subjects using biologic agents. Severe asthma patients who were admitted to Adnan Menderes University Chest Diseases clinic or applied to the outpatient clinic between 01.01.2020 and 19.01.2023 were included in this study. It is a cross-sectional and descriptive study. As data collection tools, a questionnaire with 22 questions prepared by the researcher, developed in line with the relevant literature, Beck Anxiety Inventory (BAI) with 21 questions, and Hospital Anxiety and Depression Scale with 14 questions were used. Research data were evaluated using xii SPSS 21.0 statistical program. A total of 69 severe asthma cases, 46 women and 23 men, were included in the study. The mean age of the cases was 53.4±13.5 years. 8.7% (n=6) of the cases were active, 11.6% (n=8) of them were passive cigarettes, 63.8% (n=44) were non-smoker, 15.9% ( n=11) were exsmokers, smokers consumed an average of 5.1±9.2 packs/year, 2.9% (n=2) had BMI <18.5 kg/m2, 17% (n=2) =12) It was determined that 18.5-24.9 kg/m2, 36.2% (n=25) 25-29.9 kg/m2, 43.5% (n=30) ≥30 kg/m2. It was observed that 63.8% (n=44) of the cases had chronic disease. When the PFT parameters of the cases before and after the treatment were compared, it was observed that the FEV1/FVC, FEV1, FVC values increased statistically. The number of attacks, eosinophil absolute value, eosinophil percentage value, total IgE, specific IgE positivity, skin prick test positivity were statistically significantly different between Group 1 (receiving biological agents) and Group 2 (non-biological agents) cases. When BAI, HAD A and HAD D scores were compared between Group 1 and Group 2 cases, it was seen that all scores were statistically significantly lower in Group 1. When BAI, HAD A and HAD D scores were compared between the subjects receiving Omalizumab and Mepolizumab, the HAD D score was found to be statistically significantly lower in those receiving Omalizumab. Looking at asthma and difficult asthma epidemiology studies; The data of our study are consistent with the literature information that severe asthma is seen as the female predominant gender at older ages, obesity is common, and the majority of the patients have never smoked. In our study; eosinophil absolute value median value 600.0(70.0-3730.0), eosinophil percent median value 6.7(.8-30.0), median total IgE 161.0(3.3-2205.0) and it was found to be statistically significantly higher in patients receiving biologic agents. In our study, the PFT parameters of the cases before and after the treatment were compared, and a statistically significant difference was found between the PFT parameters before and after the treatment. These results show us that the results of our study are largely consistent with the results of other studies in the literature. When the results of our study were evaluated, the BAI, HAD A and HAD D scores were compared between the subjects who received and did not receive biological agents, and the BAI, HAD A and HAD D scores were found to be statistically significantly lower in the subjects who received biological agents. It is seen that the results of our study are xiii largely compatible with the results of other studies in the literature. All these study results show us that biologic agent treatment provides benefits in asthma patients who are at risk for the development of depression and anxiety disorder, improves their quality of life and significantly reduces the symptoms of mental health disorders. Key Word: Anxiety, Biologic Therapies, Depression, Severe Asthma.