PSYCHOLOGICAL MORBIDITY AND COPING SKILLS IN PATIENTS WITH BRITTLE AND NON-BRITTLE ASTHMA - A CASE-CONTROL STUDY

Background An association between psychological morbidity and asthma i s well recognized and an increase in negative psychosocial factors in brittle asthma has been previously reported. Such factors, apart from affecting patient perceptions, may alter patients' selfmanagement of t heir condition. Methods We have undertaken a case-control study on 29 well characterized brittle and non-brittle asthmatics in the West Midl ands Region to assess their level of psychological morbidity, using th e General Health Questionnaire (GHQ) and the living with asthma questi onnaire, and their responses to changes in asthma symptoms, using the Asthma Symptom Checklist and a taped interview. Results Significant di fferences in GHQ (mean score brittle 19.5 vs non-brittle 7.2, P = 0.00 02) and living with asthma (mean score brittle 1.30 vs non-brittle 1.0 0, P = 0.002) reinforced the presence of psychological factors in this group of patients with severe asthma. Interviews regarding responses to hypothetical asthma attacks showed that patients with brittle asthm a delayed seeking medical attention more often than those with non-bri ttle asthma and instead preferred to self-administer beta-agonist medi cation. Sixteen (55.2%) of the 29 patients with brittle asthma would h ave delayed 7 days before seeking medical attention in a slow onset at tack compared with 6/29 (20.7%) in the non-brittle group. In a fast on set attack 14 (48.3%) patients with brittle asthma would not have summ oned help, despite finding it difficult to walk to the kitchen for a d rink whereas in the non-brittle group 24 out of 29 (82.8%) would have summoned help. Levels of family support tended to be lower in patients with brittle asthma (mean family APGAR 7.3 vs 8.65 P = 0.09). Conclus ions Brittle asthma is associated with greater psychological morbidity and altered strategies for coping with deteriorating asthma symptoms. Attention should be paid to the presence of such factors in the manag ement of patients with brittle asthma.