ABSTRACT
Rationale Difficult to treat asthma (DTTA) is asthma that is uncontrolled despite medium/high ICSLABA treatment and/or maintenance oral corticosteroids (OCS);severe asthma is a subset. Previous research suggests that anxiety and depression are common among patients with severe asthma;these may impact asthma control and quality of life. Screening for anxiety and depression has been recommended, followed by appropriate psychiatrist/psychologist referral. However, little is known about whether the mental health support needs of people with DTTA are being met, and any attributable health service utilisation. The aims of this study were to explore mental health issues, and healthcare utilization, in people with DTTA within a nationally-representative population of people with a diagnosis of asthma.Methods The DTTA Survey was a cross-sectional survey in February-March 2021 of 5457 participants aged ≥18 years with current asthma, randomly selected from a large web-based survey panel of adult Australians. All survey participants answered demographic questions and questions regarding asthma symptoms, medications and health service use, with additional questions for those with DTTA. DTTA was identified based on ERS/ATS criteria.Mental status was assessed via reported comorbidities, mental health referrals and treatment, and the Hospital Anxiety and Depression Scale (HADS) which assesses feelings in the previous week. The Consultation and Relational Empathy (CARE) measure was also used to gauge participants' perceptions about the consultation process with their general practitioner.Results 1170 (21.4%) of participants had DTTA. Of these 56.8% (664/1170) were female (Table). The proportions of DTTA participants who reported being told by a doctor/nurse that they had anxiety or depression, and selected “have at present” for these diagnoses, were 35.9% and 28.9% respectively;21.8% indicated both. However, by HADS, 63.4% self-reported current anxiety symptoms and 39.9% current depression symptoms. 50% reported feeling more anxious about their asthma due to COVID19. Overall, 47.9% of those with DTTA (561/1170) reported treatment for anxiety or depression in the previous year. Treatments included medication (72.7%);Cognitive Behavioural Therapy (42.8%);and mindfulness training (23.9%). Concerning mental health support, 611 participants (52.2%) had consulted with a psychologist or counsellor in last 5 years;38.8% of those visits were within the previous 3 months. Over half these consultations (52.5%) were initiated by the participant, and 33.6% by the GP. Conclusion The findings from this representative population survey provide insights regarding prevalence and management of anxiety and depression among people with DTTA, and may assist clinicians in supporting their mental health needs. (Table Presented).
ABSTRACT
Respirable aerosols (< 5 µm in diameter) present a high risk of SARS-CoV-2 transmission. Guidelines recommend using aerosol precautions during aerosol-generating procedures, and droplet (> 5 µm) precautions at other times. However, emerging evidence indicates respiratory activities may be a more important source of aerosols than clinical procedures such as tracheal intubation. We aimed to measure the size, total number and volume of all human aerosols exhaled during respiratory activities and therapies. We used a novel chamber with an optical particle counter sampling at 100 l.min-1 to count and size-fractionate close to all exhaled particles (0.5-25 µm). We compared emissions from ten healthy subjects during six respiratory activities (quiet breathing; talking; shouting; forced expiratory manoeuvres; exercise; and coughing) with three respiratory therapies (high-flow nasal oxygen and single or dual circuit non-invasive positive pressure ventilation). Activities were repeated while wearing facemasks. When compared with quiet breathing, exertional respiratory activities increased particle counts 34.6-fold during talking and 370.8-fold during coughing (p < 0.001). High-flow nasal oxygen 60 at l.min-1 increased particle counts 2.3-fold (p = 0.031) during quiet breathing. Single and dual circuit non-invasive respiratory therapy at 25/10 cm.H2 O with quiet breathing increased counts by 2.6-fold and 7.8-fold, respectively (both p < 0.001). During exertional activities, respiratory therapies and facemasks reduced emissions compared with activities alone. Respiratory activities (including exertional breathing and coughing) which mimic respiratory patterns during illness generate substantially more aerosols than non-invasive respiratory therapies, which conversely can reduce total emissions. We argue the risk of aerosol exposure is underappreciated and warrants widespread, targeted interventions.