Addressing Depression Symptoms Can Significantly Improve Asthma Outcomes

Screening patients for depression symptoms has significant potential for improving outcomes among those with asthma having difficulty controlling their disease, according to a study in the Journal of Allergy and Clinical Immunology: Global.¹ With researchers uncovering a link between depression and asthma, they suggested anticholinergic therapies can make an impact among patients—especially children—experiencing both conditions.

“Despite advances in asthma therapies in the past several decades, asthma still carries significant morbidity and even mortality,” wrote the authors of the study. “In 2019, there were more than 1.8 million emergency room visits for asthma and about 170,000 inpatient admissions. In 2021, approximately 3500 people died of asthma or as the result of complications associated with asthma.”

Among the 26 million patients with asthma across the US, 4.5 million of them are children. Within this population, asthma is the most prominent chronic disease, impacting 6.5% of all children 18 and under. However, despite the immense impact asthma has on general patient populations, the current makeup of therapies protecting against the disease has been insufficient, specifically due to varying asthma types.¹

According to the Cleveland Clinic, there are 4 known types of asthma, with a distinct condition overlap constituting the 5th type. There are allergic, cough-variant, exercise-induced, and occupational types of asthma. There is also what is known as asthma-COPD overlap syndrome, where asthma and chronic obstructive pulmonary disease (COPD) are present simultaneously.²

READ MORE: Chronic Corticosteroid Use Harms Health, Increases Cost for Patients With Asthma

Regarding one of the many subtypes of asthma that makes disease management much more challenging is the manifestation of depressive and anxiety symptoms.¹ With data showing that asthma commonly correlates with multiple different psychiatric disorders, researchers have since discovered that anxiety and depression are the most prevalent. Furthermore, as literature suggests these various asthma types exist under different domains, researchers have reported that all subtypes may have a common pathway.³

“Adults and children with asthma have higher levels of depressive symptoms than do persons with most other chronic medical illnesses,” continued the authors.¹ “The purpose of the present study was to examine the plausibility of a novel, depression-related, cholinergic-mediated ‘endotype’ of asthma that may benefit from inhaled anticholinergic medicines in a rescue and controller asthma regimen.”

Addressing Parasympathetic Activity Through Anticholinergic Therapy

Amid ongoing research further elucidating the relationship between depression and asthma, it’s important to understand the specific mechanisms of depression’s impact on asthma and just what therapies are being explored to address this relationship. Previous findings have shown that depression leads to an excess of cholinergic activation, meaning depressive symptoms can further constrict the airways of patients already experiencing asthma-related restriction.⁴

Anticholinergic medicines—ipratropium (Atrovent) and tiotropium (Spiriva) being examples used to treat asthma and COPD—are used to block a key neurotransmitter in patients’ parasympathetic nervous systems. These drugs are used in the parasympathetic nervous system to then balance out the sympathetic nervous system, otherwise known as the fight-or-flight response.⁵

With previous evidence providing direct links between depression and asthma, as well as depressive emotional states and parasympathetic activity, researchers conducted a review further exploring depression’s relationship with cholinergically mediated asthma and the potential of young patients being responsive to short-acting anticholinergic therapy.¹

The Effects of Ipratropium on Asthma and Depression

A total of 39 children (mean age, 12.9 years; 51.3% boys) with asthma were screened for depressive symptoms as part of the study. Using the Children’s Depression Inventory (CDI) to assess depression among the population, scores ranged from 37 to 78 with a mean of 47.5, showing that depressive symptoms were clinically significant in the study group.

To test out the impacts of anticholinergic therapy, participants were then administered ipratropium to explore its ability to improve forced expiratory volume in 1 second (FEV₁)—the metric used to display asthma outcomes.^1,6

“In the entire study sample, the mean change in FEV₁ percent predicted following ipratropium administration was 10.8% (range –9% to +33% change),” they wrote.¹ “There was a statistically significant positive correlation between CDI score and increase in FEV₁ percent predicted in response to ipratropium administration.”

Correctly choosing their hypothesis, researchers found a significant clinical correlation between greater depressive symptoms and responsiveness to ipratropium—detailing that this therapy, as well as anticholinergic drugs in general, may serve as a front-line option in patients with asthma experiencing heightened depressive symptoms. While more research is needed to better understand these relationships, pharmacists and other providers are getting a more detailed approach to addressing asthma by first addressing depression.

“Despite recent advances in asthma therapeutics, many patients still have difficult-to-control disease,” concluded the authors of the study.¹ “Our findings suggest that children with asthma and depressive symptoms may be particularly responsive to anticholinergic asthma therapies.”

READ MORE: Asthma Resource Center

Pharmacy practice is always changing. Stay ahead of the curve: Sign up for our free Drug Topics newsletter and get the latest drug information, industry trends, and patient care tips straight to your inbox.

REFERENCES

1. Lehman HK, Wood BL, Humayun Q, et al. Depression in children with asthma: testing a cholinergically mediated “endotype.” J Allergy Clin Immunol Glob. 2025;5(1):100581. https://doi.org/10.1016/j.jacig.2025.100581

2. Asthma. Cleveland Clinic. June 18, 2025. Accessed February 2, 2026. https://my.clevelandclinic.org/health/diseases/6424-asthma

3. Freitas J, Novais F. Review on the relationship of asthma and mental disorders. PMIP. 2025;51-52:100157. https://doi.org/10.1016/j.pmip.2025.100157

4. Lehman H. Defining and treating depression-related asthma. National Center for Biotechnology Information. December 6, 2023. Accessed February 2, 2026. https://clinicaltrials.gov/study/NCT04617015

5. Anticholinergic drugs. Cleveland Clinic. December 12, 2024. Accessed February 2, 2026. https://my.clevelandclinic.org/health/treatments/anticholinergic-drugs

6. Morales-Brown L. What is the link between FEV1 and asthma? Medical News Today. May 30, 2024. Accessed February 2, 2026. https://www.medicalnewstoday.com/articles/fev1-asthma