Psychopathology in patients with severe asthma is associated with increased health care utilization

Severe asthma accounts for the majority of health costs for this disease, w hich is mainly related to the treatment of failed control. Several psychoso cial factors have been associated with poor asthma control, but the questio n remains whether psychiatric disorder in patients with severe asthma predi sposes for increased health care utilization. In the present study we compa red outpatients with severe asthma with and without psychological dysfuncti oning with respect to health care utilization. All patients used high dose inhaled corticosteroids and long-acting bronchodilators for more than 1 yr, and had difficult-to-control asthma, requiring one or more courses of cort icosteroids during the past year or maintenance therapy with prednisone. Me dical history was taken and health care utilization questionnaires were com pleted. The General Health Questionnaire (GHQ) was used to identify psychia tric cases (GHQ-12 score of greater than or equal to 6), There were no diff erences between the psychiatric cases (n = 21) and the noncases (n = 77) wi th respect to demographic and objective disease characteristics. However, t he psychiatric cases had increased odds ratios (OR) for frequent visits to GP (OR = 5.9), frequent emergency visits (OR = 5.3), frequent exacerbations (OR = 12.4), and frequent hospitalizations (OR = 4.8) as compared with the nonpsychiatric patients. The present findings suggest that the morbidity a nd costs of asthma might be related to the level of psychological dysfuncti oning in patients with severe asthma rather than to asthma severity per se, thereby identifying an area of potential intervention.