Medication Side Effects
According to the authors, side effects of anti-asthma medications may cause a number of psychiatric disorders in youth with asthma. Oral steroids (eg, prednisone, prelone, and prednisolone), often used to treat acute asthma exacerbation, can increase anxiety, depression, and behavioral issues. The impact may be dose-dependent, and the behavior usually abates when the medication is discontinued.9,10 Oral steroids may also be linked with mania and psychosis.11 Short-term “bursts” of corticosteroids are more likely associated with mania, while long-term therapy is more likely associated with depression.12,13 There is a high degree of nonadherence with oral and even inhaled corticosteroid therapy, which may be attributable to side effects, including mood changes.14
The authors express concern about the overuse of “quick-relief medication,” notably albuterol, which can lead to a vicious cycle of asthma and anxiety. If anxiety is mistaken for asthma, the use of albuterol can can lead to increased heart rate and catastrophizing. In turn, the increased heart rate and panic may be mistaken for asthma, thus perpetuating the cycle. Those who overuse their inhalers have greater levels of psychiatric distress, fearlessness, impulsivity, substance abuse, and suicidality than those who use inhalers appropriately.15 Even when used as prescribed, inhaled albuterol can lead to tachycardia, migraine, dizziness, nervousness, tremor, and anxiety.16
In evaluating an asthmatic child or adolescent presenting with psychiatric symptoms, it is important to assess the potential impact of anti-asthma medication on mood. Change of medication or dose adjustment may be indicated. The mood-related risks of the medication must be weighed against the risks posed by asthma itself. If necessary, lithium or another mood stabilizer may be helpful in attenuating the negative impact on mood.11
The authors note that despite the the “consistent, cross-sectional association” between asthma and psychiatric disorders, there is a scarcity of longitudinal research, and the etiology of this association remains to be elucidated. In the meantime, it is advisable for clinicians to remain cognizant of the role that asthma may play in psychiatric symptomatology in asthmatic youth.