Pain, respiratory symptoms, interpretation bias and death anxiety are associated with fear of disease progression in people with asthma

AIMS: Asthma is a chronic condition characterized by episodes of breathlessness. Although common, asthma is known to be associated with higher rates of depression and anxiety, but there are few studies that have attempted to document the nature of concerns that people with asthma experience. In this study, we investigated fear of progression (FOP) in people with asthma, aiming to identify predictors of both concurrent and prospective FOP at a 3-month follow-up. METHODS: We measured FOP at baseline and 3 months later and assessed psychopathology, respiratory symptoms, pain outcomes, quality of life, interpretation bias and death anxiety at baseline. RESULTS: Thirty-six per cent of the sample (n = 183) scored in the clinical range for FOP. People in the clinical range for FOP used more health care services; experienced more respiratory symptoms, pain and psychopathology; and reported a poorer quality of life than those who scored in the normal range for FOP. Those with clinically significant FOP also were more likely to interpret ambiguous words as health-related and reported higher death anxiety. Regression analyses indicated that controlling for demographic variables and psychopathology, current pain, respiratory symptoms, interpretation biases and death anxiety all contributed to independent variance in FOP concurrently. In addition, pain, respiratory symptoms and death anxiety contributed to independent variance in FOP 3 months later. Although pain, symptoms and death anxiety predicted subsequent FOP, they did not predict change in FOP over the 3-month period. DISCUSSION: This study confirms the important nature of fears of disease progression in people with asthma and identifies potentially modifiable targets for intervention, namely pain, respiratory symptoms, interpretation bias and death anxiety.