Association between asthma medications and suicidal ideation in adult asthmatics

Asthma has been associated with suicidal ideation (SI), though the mechanisms remain poorly understood. Some asthma medications (e.g., theophylline and beta-2 adrenergic agonists) have been shown to provoke feelings of anxiety, fear, and irritability, but their link to SI among asthmatics has not been examined, which was the purpose of the present study.

664 adult asthma outpatient (39% male, M age = 49 ± 14.3) underwent a sociodemographic, psychiatric, and medical history interview. Patients reported asthma medication use, which was verified by chart review. All patients underwent spirometry and completed questionnaires including the beck depression inventory-II (BDI-II) which includes an item that assesses SI in the past two weeks.

11.5% of patients reported having SI in the past two weeks. After adjusting for age, sex, smoking, asthma severity, and depressive disorders, analyses indicated that theophylline use was associated with an increased likelihood of SI (OR = 2.67, 95% CI = 1.07-6.65). Sensitivity analyses including asthma control levels and benzodiazepine use as additional covariates did not alter this association (respectively: OR = 2.54, 95% CI = 1.04-6.37; OR = 2.71, 95% CI = 1.09-6.78), though adding cohabitation rendered it no longer statistically significant (OR = 2.34, 95% CI = 0.90-6.09). There were no associations between SI and LABA use.

Findings suggest that theophylline but not LABA use may be associated with an increased risk of SI among adult asthmatics independent of depressive disorders, asthma control levels, and asthma severity, but not cohabitation, suggesting that cohabitation may be important for SI in this population. Physicians should be cautious when prescribing theophylline or similar agents to asthmatics, and ensure adequate follow-up.