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Association Between Depression, Lung Function, and Inflammatory Markers in Patients with Asthma and Occupational Asthma

Paine, Nicola J., PhD; Joseph, Maryann F., PhD; Bacon, Simon L., PhD; Julien, Cassandre A., BSc; Cartier, André, MD; Ditto, Blaine, PhD; Favreau, Hélène, PhD; Lavoie, Kim L., PhD

Journal of Occupational and Environmental Medicine: June 2019 - Volume 61 - Issue 6 - p 453–460
doi: 10.1097/JOM.0000000000001562
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Objective: Depression is associated with autonomic and immune dysregulation, yet this remains poorly explored in asthma. We assessed associations between depressive disorder, lung function, and inflammatory markers in patients under investigation for occupational asthma (OA).

Methods: One hundred twelve patients under investigation for OA (60% men) underwent a psychiatric interview to assess depressive disorder, and spirometry, a methacholine test, sputum induction, and specific inhalation challenge (SIC) to assess OA. Blood and sputum inflammatory markers were assessed.

Results: There was a statistically significant association between depressive disorder (P = 0.0195) and forced expiratory volume in 1 second (FEV1) responses, with the drop in FEV1 post-SIC smaller in patients with OA and depression, versus OA with no depression (P < 0.001).

Conclusion: The presence of depressive disorder may influence FEV1 in patients with OA, which may be via autonomic pathways. However, further studies are warranted in order to determine the mechanisms that underlie these effects.

School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK (Dr Paine), Montreal Behavioural Medicine Centre, Research Centre, Centre intégrée universitaire de services de santé et de services sociaux du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Quebec, Canada (Dr Paine, Dr Joseph, Dr Bacon, Julien, Drs Cartier, Favreau, Lavoie), Department of Exercise Science, Concordia University, Montreal, Quebec, Canada (Dr Bacon), Department of Psychology, University of Québec at Montréal (UQAM), Montréal, Quebec, Canada (Julien, Dr Lavoie), Department of Medicine, Université de Montréal, Montréal, Quebec, Canada (Dr Cartier), and Department of Psychology, McGill University, Montréal, Quebec, Canada (Dr Ditto).

Address correspondence to: Kim L. Lavoie, PhD, Montreal Behavioural Medicine Centre, Centre Intégré universitaire de santé et de services sociaux du Nord-del’Île-de-Montréal - Hôpital du Sacré-Cœur de Montréal, J-3190, 5400 Gouin West, Montreal, QC H4J 1C5, Canada (lavoie.kim@uqam.ca).

Clinical significance: Our results suggest that depression is associated with attenuated ANS responses, particularly in patients with OA, and with dysregulated immune responses that are more pronounced in patients without asthma. In patients under investigation and evaluation for OA, depression screening may be warranted to improve interpretations of diagnostic findings.

Funding support for this study was provided by the Institut de recherche en santé et sécurité au travail (IRSST) (KLL) and the Asthma in the Workplace Center (KLL, SLB). Postdoctoral Fellowship support was provided by Fonds de la recherche du Quebec - Sante (FRQS) (NJP) and the Canadian Institutes of Health Research [CIHR (MFE146764)] (NJP). Salary support for this work was provided by the Fonds de la recherche du Quebec - Sante (FRQS) (KLL & SLB) and the Canadian Institutes of Health Research (CIHR) (KLL & SLB). Doctoral scholarship support was provided by FRQS (HF, MJ), the Social Sciences and Humanities Research Council (SSHRC) (MJ), and Frederick Banting and Charles Best Doctoral Training Scholarship - Canadian Institutes of Health Research (CIHR) (CAJ).

Supplemental digital contents are available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.joem.org).

Lavoie, Paine, Joseph, Bacon, Julien, Cartier, Ditto, and Favreau have no relationships/conditions/circumstances that present potential conflict of interest.

The JOEM editorial board and planners have no financial interest related to this research.

Copyright © 2019 by the American College of Occupational and Environmental Medicine