A recent research study out of the University of Arizona that followed the use of albuterol as a rescue inhaler in 416 patients with chronic asthma determined that overuse of the therapy is linked to the onset of depression. As part of the study entitled “Albuterol Overuse: A Marker of Psychological Distress?” and published in the Journal of Allergy and Clinical Immunology, the researchers divided the participants up into three groups: over-users of albuterol, under-users of albuterol and expected users of albuterol.  They then monitored the participant’s symptoms and their use of chronic medications for asthma as well as their use of albuterol as a rescue inhaler.

Researchers found:

• About half of all participants used albuterol as expected, while 27 percent of participants overused albuterol and 22 percent underused albuterol.
• 45 percent of over-users used albuterol on a daily basis.
• Participants across the board used albuterol on symptom-free days about 20 percent of the time.
• Eighty-eight percent of daily users were over-users of albuterol.
• Over-users had more days in which they had symptoms and scored worse on the asthma control questionnaire, the shortness of breath questionnaire and the asthma symptom utility index.
• Over-users of albuterol had worse mental functioning when compared to expected users of albuterol.

As for depression, 32 percent of those who used albuterol too much had a higher risk for depression and a mean depression score of 16 or more.  This compared to 19 percent of those who underused albuterol and only 17 percent of those who used albuterol as expected.

What isn’t clear is whether depression leads to worsened asthma symptoms and an increase in albuterol use or whether albuterol use contributes to the development of depression. Asthma has a significant relationship with one’s mental status, and emotional states like anxiety can contribute to asthma exacerbations, leading to the need for a rescue inhaler.

It also isn’t clear whether or not albuterol over-users were more or less compliant with the chronic medications asthmatics take on a regular basis in order to avoid exacerbations of their disease process.  If this is the case, doctors need to educate patients — depressed or not — on the use of chronic asthma medications so rescue inhalers like albuterol are less necessary.

Clearly, patients with asthma can become depressed over their condition and often experience asthma in a more negative light.  This may explain their worsened scores on the various asthma questionnaires used in the study.  Depressed patients may use their perceived worsened condition to overuse albuterol to open their airways more often than those who perceive their asthma symptoms in a more positive light.