PSYCHIATRIC AND SOCIAL ASPECTS OF BRITTLE ASTHMA

Background-Many studies have shown that emotional factors play a part in asthma, but few have compared patients with differing severities of asthma. It was our impression that patients with ''brittle'' asthma (BA; more than 40% diurnal variation in peak flow on 15 or more days a month over a period of at least six months, and persistent symptoms despite multiple drug treatment) had greater psychosocial morbidity than asthmatic patients with less variable asthma. Methods-Twenty patients with BA and a control group of less severe asthmatic subjects matched for age, sex, and duration of illness were asked to complete the General Health Questionnaire (GHQ), a screening test for psychiatric disorders, the Eysenck Personality Inventory which measures extraversion and neuroticism, and to participate in a life events interview and a structured clinical interview (SCID) to diagnose psychiatric disorder. Results-The mean (SD) age was 45.6 (12.3) years for the BA group, and 45.7 (13.1) years for the control group. All patients were receiving inhaled steroids and regular beta2 agonists; nine patients with BA but no control patients were taking oral steroids, and 12 of the patients with BA but no controls were receiving beta2 agonists by subcutaneous infusion or injection. Eight of the patients with BA scored more than 11 on the GHQ compared with five of the control group (NS). Significantly more subjects with BA (12/20) than controls (5/20) had intercurrent or past psychiatric disorder, and 7/20 subjects with BA had a lifetime history of anxiety disorder compared with 3/20 controls. Life events analysis showed no overall difference in the total number, but the patients with BA had significantly more life events related to asthma. There was no difference in personality profiles between the two groups. Conclusions-The results suggest that patients with ''brittle'' asthma have greater psychiatric morbidity than those with less severe asthma, but that their personality profiles and overall life event experiences are similar.