PSYCHIATRIC AND MEDICAL FEATURES OF NEAR-FATAL ASTHMA

Background - The associations between psychiatric caseness, denial, an d self reported measures of handicap and morbidity due to asthma in pa tients suffering a near fatal attack of asthma have not been fully exp lored. Methods - Seventy seven consecutive subjects who presented to A delaide teaching hospitals with a near fatal attack of asthma were ass essed with a validated semistructured interview following discharge fr om hospital. Results - 43% of the patients scored greater than or equa l to 5 on the GHQ-28 questionnaire. There was a positive correlation b etween GHQ-28 score and Limitation to daily activities due to asthma, and between GHQ-28 score and days lost from work, school or usual dail y activities, both of which were retained after adjusting for age and sex. Asthma severity did not show a clear association with GHQ-28 scor e. The asthmatic patients reported high levels of denial, 57% scoring more than 3 out of 5 on the denial scale of the Illness Behaviour Ques tionnaire. Presentation with a history of progressive respiratory dist ress was negatively associated with denial score. This persisted after adjustment for age and sex - that is, those with high denial scores w ere more likely to report presentation as sudden collapse than progres sive respiratory distress. Conclusions - Psychiatric caseness (GHQ sco re greater than or equal to 5) is associated with high levels of morbi dity in asthmatic patients who survive a near fatal attack of asthma. High levels of denial in asthmatic subjects may be life threatening. T he link between morbidity associated with asthma and psychiatric featu res, along with other psychosocial issues, warrants further investigat ion. A broader paradigm than the traditional medical model should be c onsidered when assessing patients with asthma.