Depression Common in Asthma, But Moderate to Severe Disease Worsens Outcomes

Findings from a real-world study presented at the 2026 American Academy of Allergy, Asthma, and Immunology Annual Meeting in Philadelphia, Pennsylvania, showed that nearly half of participants with asthma reported depression or depressive symptoms. Presenter Jessica Cruz Perez, MD, MSc, a clinical researcher located in Benito Juárez, Mexico City, Mexico, explained that recognizing depression severity may help allergists and specialists better optimize individual asthma management by integrating mental health assessment.¹

Asthma Is Associated With Depression

The field of psychoneuroimmunology has significantly advanced the understanding of the complex interaction between the immune system and mental health; however, important gaps remain, particularly in exploring how internalizing disorders (eg, anxiety and depression) intersect with chronic inflammatory conditions. Asthma has been consistently linked to an increased risk of developing these mental health conditions. Notably, those who develop asthma during childhood are up to 3 times more likely to experience anxiety or depression compared with those without asthma. These relationships are further influenced by age- and sex-related differences in disease prevalence and mental health outcomes. Additionally, environmental exposures, particularly air pollution, have been associated with increased rates of both asthma and internalizing disorders, suggesting that external factors may amplify underlying biological vulnerabilities.²

Emerging research points to chronic airway inflammation as a potential shared mechanism linking respiratory and mental health conditions, offering new insights into how sustained immune activation may influence brain function and emotional regulation. Both preclinical and clinical studies have begun to identify pathways through which asthma and air pollution–related inflammation may contribute to the development or worsening of internalizing symptoms, reinforcing the concept of a bidirectional relationship between asthma and depression. Given that both conditions pose substantial public health burdens and significantly impact quality of life, further investigation into these overlapping mechanisms is critical. Advancing this area of research may help identify therapeutic strategies that simultaneously address respiratory and mental health outcomes, ultimately improving patient care and reducing the overall burden of disease.²

“Previous studies suggest a bidirectional relationship: asthma may increase the risk of depression, and depression may worsen asthma outcomes. However, most existing evidence comes from controlled or protocol-based research settings,” Perez said. “There [are] limited data from real allergic clinics, especially here in Latin American populations. This gap motivates us to explore this relationship from their real-world clinical condition.”¹

This real-world cross-sectional study enrolled 255 adult patients with asthma who attended a tertiary care allergy service. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), and patients were classified as either nondepressed or having mild or moderate to severe depression (M-SD) based on their numerical scores. The clinical outcomes included asthma control assessed using the Asthma Control Test, treatment adherence measured by the Test of Adherence to Inhalers, inhaled corticosteroid (ICS) dose, lung function, quality of life, and allergy biomarkers. Additionally, bivariate and multivariate analyses were performed.¹

Depression Identified in Nearly Half of Patients With Asthma

According to Perez, depression was identified in approximately 49.4% of patients (mild, 30.2%; M-SD, 19.2%). Women represented approximately 70% of all groups, and 91.5% of patients were considered to be of low socioeconomic status.¹

The M-SD group showed significantly poorer asthma control (OR, 2.76; P = .004), lower adherence (OR, 4.42; P = .001), and greater ICS requirements (OR, 2.07; P = .05) compared with their nondepressed and mildly depressed counterparts. Overall, no significant differences were observed in lung function, biomarkers, or emergency department visits. Multivariate analyses also identified that female sex (OR, 3.21; 95% CI, 1.37-7.55), poor asthma control (OR, 2.71; 95% CI, 1.30-5.65), and low adherence to treatment (OR, 5.57; 95% CI, 2.57-12.11) as independent predictors of depression, particularly in the M-SD group (P < .01).¹

“[These data] indicate that depression severity itself contributes to worse outcomes, independent of lung control or other biomarkers. Female sex and poor asthma control are associated with M-SD, especially [when] birth parents are strongly linked to [M-SD],” Perez said. “When severity is considered, a very clear pattern emerges. Something important here is that the PHQ-9 [scale] appears to be a practical, visible screening [for] the allergy clinics. Importantly, we see that not all adult patients with depression have worse outcomes, only those with moderate to severe symptoms.”¹

Pharmacists Can Support Patients With Asthma Experiencing Depressive Symptoms

Because M-SD was associated with poorer asthma control, lower medication adherence, and increased ICS requirements, pharmacists can help identify at-risk patients through routine interactions, medication reviews, and, when appropriate, the use of validated screening tools such as the PHQ-9. In multiple care settings, pharmacists can reinforce proper inhaler technique, address adherence barriers, and provide empathetic counseling that acknowledges the bidirectional relationship between asthma and poor mental health. Additionally, pharmacists can serve as a bridge to care by referring patients to mental health providers, collaborating with prescribers to optimize both respiratory and psychiatric treatment plans, and educating patients on how mood symptoms may impact their ability to effectively manage their symptoms. By integrating mental health awareness into asthma care, pharmacists can help improve overall outcomes and quality of life for this vulnerable patient population.

“Depression is common in [patients with asthma], and M-SD impacts asthma control and adherence [more than] mild depression. Screening for depression separately should be considered in routine clinical practice, [especially in women], because poor asthma control and low treatment adherence are primarily observed in [women] with M-SD as assessed by PHQ-9,” Perez said. “Assessing depression severity provides clinically actionable information and might help personalize asthma management.”¹

REFERENCES

1. Perez JC. Asthma control in the real world: influences and associations – association between glucagon-like peptide-1 receptor agonists and asthma exacerbations in non-diabetic patients with obesity: cohort study. Presented at: 2026 American Academy of Allergy, Asthma, & Immunology Annual Meeting; February 27-March 2, 2026; Philadelphia, PA.

2. Caulfield JI. Anxiety, depression, and asthma: new perspectives and approaches for psychoneuroimmunology research. Brain Behav Immun Health. 2021;18:100360. doi:10.1016/j.bbih.2021.100360