Editorial: Asthma and mental health: novel insights to the experience, etiology, longitudinal course and management of mental health in asthma and allergy

Chris Barton ^1* Lorraine Smith ² Jean-Marie Bruzzese ³

• ¹ Monash University, Melbourne, Australia
• ² The University of Sydney, Darlington, New South Wales, Australia
• ³ Columbia University, New York City, New York, United States

as increased, asthma control declined. In contrast, depressive symptoms were 5 not associated with asthma self-management in this study, suggesting that self-management, at 6 least those aspects assessed by the authors, are not an avenue by which depression impacts asthma 7 control in adolescents. 8 9 Parents are also important in the management of asthma, and caring for a child with asthma can 10 pose risks to the mental health of caregivers. Because children rely on caregivers to manage 11 medication administration, detecting families who are at risk for poor medication adherence is 12 important to improve asthma outcomes. Lu et al. investigated the association between asthma 13 routines, family asthma management knowledge and skills, and caregiver depressive symptoms with 14 daily controller medication adherence among Head Start preschool children in Baltimore City. They 15 found nearly a quarter of caregivers (24%) had clinically significant depressive symptoms and 16 demonstrated that better medication routine and family asthma management is associated with 17 higher medication adherence to daily asthma controller medications in a low-income, urban, 18 preschool group. 19 20 Recent experience of people living with asthma has included the need for special care with the 21 emergence of COVID-19. Respiratory viruses are a common asthma trigger. Regulatory guidelines 22 indicated that individuals with asthma were at higher risk for complications related to COVID-19 and 23 as such should take additional precautions to prevent transmission of COVID-19. Paradoxically, 24 people with chronic respiratory illnesses tended to have better control of their condition during the 25 pandemic. Although there were positive asthma-related morbidity and healthcare utilization 26 outcomes in the context of the pandemic, less was known about the relationship between pandemic 27 onset and youth and caregiver psychosocial functioning. This was addressed in the paper by 28 Sinisterra et al., who aimed to characterize youth asthma exacerbations, control, and quality of life 29 across three distinct phases of the COVID-19 pandemic, as well as to describe caregiver asthma-30 related quality of life in this context. They confirm earlier reports of better overall asthma found between the distinct phases of the pandemic for youth living with asthma and ratings of youth 1 asthma-related quality of life remained steadily high, on average, regardless of time of enrolment. 2 3The four papers published in this topic highlight the interplay between family dynamics, 4 routines, and mental health in managing asthma. They emphasise their interconnectedness and 5 offer valuable insights for healthcare providers and families. Collectively, they advance evidence of 6 the need to shift towards a more holistic approach to asthma management. They suggest that 7 interventions should focus on strengthening family support systems, educating families about 8 asthma management, and addressing mental health concerns in both patients and their caregivers. 9Additionally, recognizing and mitigating the impact of social determinants of health is crucial to 10 improving asthma outcomes, especially for disadvantaged communities. 11 12 As our understanding of the interplay between mental health conditions and asthma grows, future 13 asthma management. These might include tailored education, skills training, social support, and 16 collaborative models of care. By taking a more holistic and integrated approach to asthma research 17 and interventions, we can further improve the lives of people living with asthma and their families, 18 across the life course. 19 20