COVID-19 Related Stress and Uncontrolled Asthma Among Adults

RATIONALE: The COVID-19 pandemic has been associated with detrimental effects on mental as well as physical health. Studies on the impact of the psychosocial stress associated with the pandemic on adults with asthma are limited. We examined the associations of COVID-19 related stress with asthma control in adults. Methods: An online cross-sectional study was conducted with US adults with asthma. Study invitations were shared with potential participants via social media and email lists. Stress was measured using a 5-point Likert scale to capture participants' responses to 8 questions on being worried, sad vs. happy, relaxed vs. nervous, not fidgety vs. extremely fidgety, not fatigued vs. fatigued, focused vs. unfocused, not irritable vs. extremely irritable, and not lonely vs. extremely lonely. Responses were summed for a score ranging from 8-40 with higher values indicating higher stress. Stress scores were categorized into 4 levels (low: 8-16, moderate:17-24, high: 25-32, very high: 33-40). Participants also completed the asthma control test (ACT), answered questions about health care utilization during the pandemic, and reported the level of life changes they and their families experienced due to the pandemic. Results: Participants (N=909) were mostly female (82%), white (80%), from urban areas (61%), with at least a college degree (69%), and had a mean age of 44±15 years. Of participants, 13% and 15% were put into self-quarantine with and without symptoms, respectively;14% lost their job;and 21% had reduced ability to earn money. Less educated, non-white, and those who rent or live with family were more likely to experience significantly higher levels of stress in the 2 weeks before the survey. Almost 58% had an asthma exacerbation since the pandemic and 43% had uncontrolled asthma (ACT≤19). In adjusted multiple logistic regression models, we observed a significant dose-response (p trend<0.0001) direct relationship of COVID-19 related stress levels with the odds of uncontrolled asthma. Compared to participants with low stress score, the odds of having uncontrolled asthma were 1.58 (95% CI=1.04,2.41), 2.74 (95% CI=1.72,4.37), and 6.46 (95% CI=3.18,13.12) for those at moderate, high, and very high levels of stress, respectively, after adjusting for covariates. Conclusions: Adults with asthma are significantly impacted by the pandemic. Our findings show a significant and dose-response detrimental effect of COVID-19 related stress on asthma control. Health care providers should attempt to assess the psychosocial impact of COVID-19 on adults with asthma and provide the necessary mental health care and referrals.