Psychological comorbidities in difficult asthma within the WATCH cohort

Background: Strong evidence exists for a high prevalence of depression and anxiety in severe asthmatics, which correlates with poor asthma control Aim: To analyse psychological co-morbidities within a tertiary difficult asthma clinic at University Hospital Southampton Methods: Patients with difficult asthma were enrolled into the prospective longitudinal Wessex AsThma CoHort (WATCH) study. 313 of 380 patients with a complete data set of psychological co-morbidities, healthcare utilisation, Hospital and Anxiety Depression Score (HADS), Asthma Control Questionnaire (ACQ6), Mindful Attention Awareness Scale (MAAS), Nijmegen, fractional exhaled nitric oxide (FeNO) and spirometry were analysed Results: 59.1% patients had no recorded psychological co-morbidity. Of those diagnosed with a psychological co-morbidity; 11.2% had depression, 6.4% had anxiety and 23.3% had both. While there were no statistically significant differences across groups in spirometry or FeNO, there were in ACQ, MAAS, Nijmegen scores and hospitalisations in the past 12 months. Post hoc analysis found patients with a combined diagnosis of depression and anxiety had greater ACQ6 (p Conclusion: A large burden of psychological co-morbidity exists within WATCH, with a predominant combined diagnosis of depression and anxiety. This is associated with poor symptom control, lower levels of dispositional mindfulness, symptoms of dysfunctional breathing and increased healthcare utilisation. Our findings support the importance of an integrated psychological service as part of routine care in difficult asthma clinics