The role of anxiety sensitivity-physical concerns in terms of quit day withdrawal symptoms and cravings: A pilot test among smokers with asthma

Objective: The aim of the current study was to conduct secondary analyses of data collected from a study examining a self-guided quit attempt of smokers with and without asthma in order to examine the unique predictive ability of precessation (i.e., baseline) anxiety sensitivity physical concerns in terms of quit day withdrawal symptoms and cravings among abstinent smokers with asthma. Methods: Participants were 24 regular cigarette smokers with asthma (50% female, M_age = 37.63 years, SD = 12.20) who participated in a self-guided-quit attempt and were able to maintain abstinence on their quit day. Results: After controlling for the effects of the cognitive and social concerns domains of anxiety sensitivity, anxiety sensitivity-physical concerns significantly predicted greater quit day withdrawal symptoms (20.8% unique variance) and urges to smoke (38.0% unique variance). Conclusions: These findings suggest that smokers with asthma who fear anxiety-related sensations due to their feared physical consequences are more likely to experience intense withdrawal symptoms and desire to smoke at the beginning of a quit attempt. Clinically, smokers with higher levels of anxiety sensitivity physical concerns may benefit from smoking cessation interventions that specifically target anxiety sensitivity as well as prolonged use of nicotine replacement therapies to target withdrawal symptoms and cravings.     

Associations between distress tolerance and asthma symptoms and quality of life

Objective: Given the robust associations between anxiety and asthma, the purpose of the current study was to explore associations between asthma outcomes and tolerance for negative affective states (i.e. distress tolerance) as well as tolerance for the specific negative emotional states of anxiety and fear. Methods: Participants were 61 nonsmoking adults with asthma (61.9% female, 54.8% African-American, M_age?=?34.72, SD?=?13.58) who underwent spirometry and completed self-report measures. Results: After controlling for the effects of age, race and the physical concerns domain of anxiety sensitivity, poorer global distress tolerance and tolerance for fear and anxiety each significantly predicted poorer lung function (8.7–13.8% variance), asthma control (4.9–8.8% variance) and asthma-related quality of life (6.7–8.9%). Conclusions: These findings suggest that targeting distress tolerance, specifically tolerance of fear and anxiety, may be helpful in improving asthma outcomes.     

Body mass index,asthma and exhaled nitric oxide in U.S. Adults, 2007–2010

Objective: Increases in asthma and obesity over the past three decades have led to speculation about a causal link between the two diseases. However, investigations of the relationship between body mass index (BMI) and fractional exhaled nitric oxide (FeNO) – a marker of eosinophilic airway inflammation – have produced mixed results. The purpose of this study was to evaluate the relationship between body mass index (BMI), asthma and FeNO in a sample of U.S. adults using data from the National Health and Nutrition Examination Surveys (NHANES) for 2007–2010. Methods: We assessed the relationship between FeNO and BMI in subjects with and without asthma using categorical and continuous models for BMI. All models controlled for age, gender, ethnicity, household income-to-poverty ratio, atopy and current smoking. Results: Adjusted asthma prevalence was positively associated with BMI, and subjects with asthma had higher adjusted FeNO levels than subjects without asthma. However, no association between FeNO and BMI was observed in either those with (β?=?0.002, p?=?0.74) or without (β?=?0.0014, p?=?0.51) asthma after adjusting for covariates. Conclusions: Our results suggest that in the U.S. adult population, BMI is not associated with eosinophilic airway inflammation.     

Effects of cigarette smoke on methacholine- and AMP-induced air trapping in asthmatics

Abstract

Objective: No information is available on the effect of cigarette smoke on bronchoconstrictor-induced air trapping in asthma. The aim of this study was to evaluate the additional influence of smoking on methacholine- and adenosine 5′-monophosphate (AMP)-induced air trapping in subjects with asthma. Methods: Airway responsiveness to methacholine and AMP, bronchial (J’aw_NO) and alveolar (CA_NO) nitric oxide (NO) and exhaled breath condensate pH were measured in 68 adults (23 current smokers with asthma, 23 non-smokers with asthma and 22 current or former smokers with chronic obstructive pulmonary disease; COPD). The degree of air trapping induced by each bronchoconstrictor agent was expressed by the percent fall in forced vital capacity (FVC) at a 20% fall in forced expiratory volume in 1?s relative to FVC after saline inhalation (ΔFVC%). Results: The ΔFVC% for AMP was higher in both smokers with asthma and patients with COPD than in non-smokers with asthma (p?<?0.001). By contrast, ΔFVC% for methacholine was similar in the three groups of subjects (p?=?0.69). In smokers with asthma, but not in the other two groups, there was a correlation between the residual volume/total lung capacity at baseline and the ΔFVC% induced by each bronchoconstrictor agent. Mean values for J’aw_NO were higher in non-smokers with asthma than in the other two groups (p?<?0.05). Conclusions: The results of this study suggest that factors underlying bronchoconstriction induced by indirect agonists are different in smokers and non-smokers with asthma. These observations might be clinically relevant, because triggers that frequently induce bronchial obstruction in the real world act by an indirect mechanism.     

Negative affect and smoking motives sequentially mediate the effect of panic attacks on tobacco-relevant processes

Introduction: Empirical work has documented a robust and consistent relation between panic attacks and smoking behavior. Theoretical models posit smokers with panic attacks may rely on smoking to help them manage chronically elevated negative affect due to uncomfortable bodily states, which may explain higher levels of nicotine dependence and quit problems. Methods: The current study examined the effects of panic attack history on nicotine dependence, perceived barriers for quitting, smoking inflexibility when emotionally distressed, and expired carbon monoxide among 461 treatment-seeking smokers. A multiple mediator path model was evaluated to examine the indirect effects of negative affect and negative affect reduction motives as mediators of the panic attack-smoking relations. Results: Panic attack history was indirectly related to greater levels of nicotine dependence (b?=?0.039, CI_95%?=?0.008, 0.097), perceived barriers to smoking cessation (b?=?0.195, CI_95%?=?0.043, 0.479), smoking inflexibility/avoidance when emotionally distressed (b?=?0.188, CI_95%?=?0.041, 0.445), and higher levels of expired carbon monoxide (b?=?0.071, CI_95%?=?0.010, 0.230) through the sequential effects of negative affect and negative affect smoking motives. Conclusions: The present results provide empirical support for the sequential mediating role of negative affect and smoking motives for negative affect reduction in the relation between panic attacks and a variety of smoking variables in treatment-seeking smokers. These mediating variables are likely important processes to address in smoking cessation treatment, especially in panic-vulnerable smokers.     

Cigarette smoking and emergency care utilization among asthmatic adults in the 2011 Asthma Call-back Survey

Objective: Estimate the association between smoking and emergency care in the past 12 months among asthmatic adults in a nationally representative sample. Methods: Using the 2011 Asthma Call-Back Survey, the association between smoking status and emergency department (ED) and urgent visits among asthmatic adults (n?=?12?339) was assessed through multivariable logistic regression by a cross-sectional study design. Analyses used survey weights for US population-based estimates. Attributable and population attributable risk were calculated to describe the potential benefits of smoking cessation. Results: Adjusting for potential confounders, during the past 12 months former smokers had 1.30 (95% CI: 0.97, 1.74) times the odds and current smokers had 1.46 (95% CI: 1.05, 2.03) times the odds of visiting the ED compared to never smokers. Former smokers had 1.28 (95% CI: 0.99, 1.65) times the odds and current smokers had 1.29 (95% CI: 0.96, 1.73) times the odds of urgent visits compared to never smokers. Among adult asthmatics, an estimated 9% of ED visits and 6% of urgent visits can be attributed to current smoking while 7% of ED visits and 7% of urgent visits can be attributed to former smoking. Conclusions: Current and former smokers are more likely to need emergency care than never smokers. About 10% of emergency care visits among asthmatics can be attributed to smoking assuming smoking is causally related to emergency care. Long-term effective management of asthma, particularly the prevention and cessation of smoking, could reduce emergency care use and health care costs.     

Childhood measles contributes to post‐bronchodilator airflow obstruction in middle‐aged adults: A cohort study

Background and objective

Chronic obstructive pulmonary disease (COPD) has potential origins in childhood but an association between childhood measles and post‐bronchodilator (BD) airflow obstruction (AO) has not yet been shown. We investigated whether childhood measles contributed to post‐BD AO through interactions with asthma and/or smoking in a non‐immunized middle‐aged population.

Methods

The population‐based Tasmanian Longitudinal Health Study (TAHS) cohort born in 1961 (n = 8583) underwent spirometry in 1968 before immunization was introduced. A history of childhood measles infection was obtained from school medical records. During the fifth decade follow‐up (n = 5729 responses), a subgroup underwent further lung function measurements (n = 1389). Relevant main associations and interactions by asthma and/or smoking on post‐BD forced expiratory volume in 1 s/forced vital capacity (FEV₁/FVC; continuous variable) and AO (FEV₁/FVC < lower limit of normal) were estimated by multiple regression.

Results

Sixty‐nine percent (n = 950) had a history of childhood measles. Childhood measles augmented the combined adverse effect of current clinical asthma and smoking at least 10 pack‐years on post‐BD FEV₁/FVC ratio in middle age (z‐score: −0.70 (95% CI: −1.1 to −0.3) vs −1.36 (−1.6 to −1.1), three‐way interaction: P = 0.009), especially for those with childhood‐onset asthma. For never‐ and ever‐smokers of <10 pack‐years who had current asthma symptoms, compared with those without childhood measles, paradoxically, the odds for post‐BD AO was not significant in the presence of childhood measles (OR: 12.0 (95% CI: 3.4–42) vs 2.17 (0.9–5.3)).

Conclusion

Childhood measles infection appears to compound the associations between smoking, current asthma and post‐BD AO. Differences between asthma subgroups provide further insight into the complex aetiology of obstructive lung diseases for middle‐aged adults.

     

The association between cigarette smoking,virologic suppression,and CD4+ lymphocyte count in HIV-Infected Russian women

Cigarette smoking among people living with HIV/AIDS is associated with significant morbidity and mortality, but findings regarding the association between cigarette smoking and HIV viral load and CD4+ lymphocyte counts have been inconsistent. This study characterized the prevalence of cigarette smoking among HIV-infected Russian women and examined the association between smoking frequency and quantity and HIV viral load and CD4+ lymphocyte counts. HIV-infected Russian women (N?=?250; M age?=?30.0) in St. Petersburg, Russia, completed an audio computer-assisted self-interview survey assessing cigarette use, antiretroviral medication adherence, and provided blood samples assayed for HIV viral load and CD4+ lymphocyte counts. The majority (60.4%) reported cigarette smoking in the past month; 49.0% of recent smokers were classified as moderate or heavy smokers, defined as smoking ≥10 cigarettes daily. Viral load status did not differ between infrequent smokers and regular smokers. However, moderate/heavy smokers (relative to light smokers) were more likely to have a detectable viral load (AOR?=?2.3, 95% CI: 1.1, 5.1). There were no significant differences in CD4+ lymphocyte counts by smoking frequency or quantity of cigarettes smoked. Results highlight the need for additional research to examine the association between cigarette smoking and virologic suppression and markers of HIV disease progression. Adverse health consequences of cigarette smoking coupled with a potential link between heavy smoking and poor virologic suppression highlight the need for assessment of cigarette use and provision of evidence-based smoking-cessation interventions within HIV medical care.     

Cluster analysis identifies characteristic phenotypes of asthma with accelerated lung function decline

Objective: While the majority of individuals with asthma retain normal lung function over time, some exhibit accelerated lung function decline. Preservation of lung function is an important aspect of asthma management. Whether the asthma guidelines can prevent lung function decline remains controversial. This study was performed to determine the distribution of asthmatic subjects with greater lung function decline and to identify characteristic clinical features of such subjects treated in accordance with clinical guidelines by using hierarchical cluster analysis. Methods: Eighty-six asthmatic subjects without a history of smoking were assessed with respect to eight variables selected from clinical phenotypes by using step-wise multiple regression analysis. Hierarchical cluster analysis using Ward’s method generated a dendrogram for estimation of the number of clusters within the population and the differences between them. Results: Three distinct clusters were identified. Cluster 1 (n?=?40) comprised women with late-onset asthma. Cluster 2 (n?=?17) comprised subjects with early-onset asthma, atopy and long disease duration. Cluster 3 (n?=?29) predominantly comprised older men who had late-onset asthma, a lower prevalence of exacerbation and a lower predicted % forced expiratory volume in 1?s (FEV₁) at baseline. Subjects in cluster 3 showed a mean decline in FEV₁ of 69?mL/year, which was the greatest lung function decline among the three clusters. Conclusion: We identified a subgroup of patients with accelerated lung function decline despite appropriate asthma treatment based on guidelines constructed by using subjective symptoms.     

Asthma and physical activity in multiracial girls from three US sites

Objective: Studies comparing physical activity levels in children with and without asthma have had mixed results. Our objective was to investigate the association between asthma diagnosis and physical activity and to examine differences in these associations by race/ethnicity, weight status and caregiver education. Methods: We investigated the association between asthma (defined as report of physician-diagnosed asthma with at least one asthma related symptom) and measures of physical and sedentary activity in a study of 6- to 8-year-old girls in the Breast Cancer and the Environment Research Project. We compared reported activity and pedometer measurements among girls with and without asthma, and examined modification of these associations by race/ethnicity, weight status and caregiver education. Results: Girls (n?=?1182) were included with 33.5% White, 4.8% Asian, 30.6% non Hispanic Black and 30.7% Hispanic. Asthma was present in 16.2% of girls. Overall, 38% of girls reported no participation in organized recreational activities and 58% had >2?h/day of television, video game and computer time combined. Girls with asthma whose parents were less educated reported fewer pedometer steps and less non-scheduled activity than girls without asthma with similar caregiver education level. Among girls with asthma, those on a controller medication had higher levels of sedentary activity and more structured physical activity but were less likely to report high intensity physical activity. Conclusions: Among girls whose parents are less educated, girls with asthma may have lower physical activity levels than girls without asthma. Use of a controller medication may be related to physical and sedentary activity.     

Optimal cutoff level of breath carbon monoxide for assessing smoking status in patients with asthma and COPD

STUDY OBJECTIVES: To assess the optimal cutoff level of breath CO concentration to distinguish actual smokers from nonsmokers among patients with asthma and COPD. SETTING: Kyoto University Hospital outpatient clinic. SUBJECTS AND METHODS: Three hundred thirty-one consecutive outpatients (161 with asthma and 170 with COPD) were examined cross-sectionally by self-reported smoking status, breath CO monitoring, and serum cotinine concentration. Actual smoking status was verified by serum cotinine concentration. RESULTS: Mean serum cotinine concentrations of never smokers, former smokers, and current smokers with asthma were 6.0 +/- 5.2 ng/mL, 12.1 +/- 25.0 ng/mL, and 198.3 +/- 181.7 ng/mL, respectively (+/- SD). Mean serum cotinine concentrations of former smokers and current smokers with COPD were 23.2 +/- 69.2 ng/mL and 191.1 +/- 109.8 ng/mL, respectively. Mean breath CO levels of never smokers, former smokers, and current smokers with asthma were 6.1 +/- 2.4 ppm, 7.7 +/- 3.2 ppm, and 19.9 +/- 17.3 ppm, respectively. Mean breath CO levels of former smokers and current smokers with COPD were 7.7 +/- 4.3 ppm and 13.5 +/- 6.5 ppm, respectively. The optimal cutoff level of breath CO to discriminate between actual smokers and nonsmokers was 10 ppm in patients with asthma and 11 ppm in patients with COPD, giving 85.0% and 73.1% sensitivity, and 85.8% and 84.7% specificity, respectively. CONCLUSION: The optimal cutoff level of breath CO to assess actual smoking status was 10 ppm in patients with stable asthma and 11 ppm in patients with stable COPD. In patients with asthma and COPD, breath CO levels were potentially influenced by underlying airway inflammation, suggesting misclassification in the assessment of smoking status by breath CO.     

Effects of Active Smoking on Airway and Systemic Inflammation Profiles in Patients With Chronic Obstructive Pulmonary Disease

BackgroundThe markers that characterize local and systemic inflammation in chronic obstructive pulmonary disease (COPD) remain unclear, as do their correlations with smoking status and presence of disease. The aim of this study was to assess markers of inflammation in the peripheral blood and airways of current smokers without COPD, of current smokers with COPD and of ex-smokers with COPD.MethodsIn this study, 17 current smokers with COPD (mean age: 58.2 ± 9.6 years; mean forced expiratory volume in 1 second [FEV₁]: 56.1 ± 15.9%), 35 ex-smokers with COPD (mean age: 66.3 ± 7.3 years; mean FEV₁: 47.9 ± 17.2%) and 20 current smokers without COPD (mean age: 49.1 ± 6.2 years; mean FEV₁: 106.5 ± 15.8%) were evaluated. Spirometry findings, body composition and serum/induced sputum concentrations of tumor necrosis factor α (TNF-α), interleukin (IL)-6, IL-8 and IL-10, together with serum C-reactive protein (CRP) levels, were assessed.ResultsSerum TNF-α concentration was higher in all current smokers than in ex-smokers with COPD. In current smokers without COPD, serum CRP level was lower than in ex-smokers with COPD and significantly lower than in current smokers with COPD. Sputum TNF-α concentration was higher in current and ex-smokers with COPD than in current smokers without COPD. Multiple regression analyses showed that serum TNF-α was associated with active smoking, and serum CRP and sputum TNF-α were associated with COPD diagnosis.ConclusionsSmoking is associated with higher systemic inflammation in patients with COPD. Current findings also support the hypothesis that smoking and COPD have different effects on the regulation of airway and systemic inflammatory processes.     

Effects of Asthma on Nicotine Dependence Development and Smoking Cessation Attempts in Adolescence

Objective. The aim of this study was to investigate whether asthma predicts the development of nicotine dependence and unsuccessful smoking cessation attempts in adolescent smokers. In addition, whether nicotine dependence could explain the relation between asthma and unsuccessful cessation attempts was also investigated. Methods. A longitudinal survey study was conducted among 286 adolescents (aged 12–15 at T1) who had never used tobacco at baseline and were current smokers at follow-up 22 months later. Regression analyses were applied to test the effects of four asthma indicators (current wheeze, indication of asthma, symptom severity, and current diagnosed asthma) on nicotine dependence and smoking cessation attempts. Results. Both adolescents who had an indication of asthma as well as adolescents with higher symptom severity developed higher levels of nicotine dependence over time and made a greater number of unsuccessful smoking cessation attempts in the past 12 months compared to those without asthma or less severe symptoms. Nicotine dependence partly mediated the effects of asthma symptoms on unsuccessful cessation attempts. Current wheezing and current diagnosed asthma did not predict nicotine dependence or unsuccessful quit attempts. Conclusions. Nicotine dependence develops more quickly in youth with symptoms of asthma, and this partly explains the increased number of unsuccessful cessation attempts of adolescents with asthma. Smoking prevention and smoking cessation programs are encouraged to provide additional support for youth with asthma, focusing on both the physiological and psychological aspects of dependence.     

Influence of current or former smoking on asthma management and control

BACKGROUND:

In patients with asthma, smoking has been associated with accelerated decline in pulmonary function, poor disease control and reduced responsiveness to corticosteroids.

OBJECTIVE:

To assess the influence of current and former smoking on self-reported asthma control and health care use in a large population of asthma patients.

METHODS:

The present analysis was conducted following a telephone survey of adult Canadians aged 18 to 54 years who had physician-diagnosed asthma and a smoking history of less than 20 pack-years.

RESULTS:

Of 893 patients, 268 were former smokers and 108 were current smokers. Daytime and nighttime symptoms, absenteeism from work or school, emergency care use for asthma in the past year, and use of a short-acting bronchodilator without controller medication were reported more frequently by current smokers than non-smokers and former smokers. Former smokers were not significantly different from nonsmokers with respect to most asthma outcomes.

CONCLUSIONS:

Current smokers with asthma show evidence of poorer asthma control and greater acute care needs than lifelong nonsmokers or former smokers. These observations stress the importance of smoking cessation to help achieve asthma control.     

Depression and anxiety in patients with AL amyloidosis as assessed by the SF-36 questionnaire: experience in 1226 patients#

Abstract

Background: Our study examines depression and anxiety in patients with immunoglobulin light chain (AL) amyloidosis, and determines the associations between the mental health problems and patient characteristics (age, gender, race, marital status, alcohol consumption, smoking status and cardiac involvement).

Methods: Patients with AL amyloidosis who completed the 36-item Short Form General Health Survey (SF-36) during initial evaluation at a single center were studied. The SF-36 included assessments of depression, anxiety, role limitation due to emotional problems and the mental health subscale score.

Results: From 1226 patients with AL amyloidosis, 37.0% reported depression and 46.7% reported anxiety. Patients with cardiac amyloidosis reported more anxiety (odds ratio (OR)?=?1.29, 95% confidence interval (CI) 1.03–1.61) and role limitation due to emotional problems (OR?=?1.32, 95%CI 1.05–1.65). No significant association between cardiac involvement and depression was found (OR?=?1.22, 95%CI 0.97–1.54). Men reported less anxiety (OR?=?0.72, 95%CI 0.57–0.91). Patients ≥65 years experienced greater role limitation (OR?=?1.36, 95%CI 1.08–1.71). Smokers (p?=?0.019) and women (p?=?0.006) scored lower on mental health subscales.

Conclusions: Many patients with AL amyloidosis suffer from depression, anxiety and functional limitations. Psychiatric assessment and treatment is important, and further research is needed to clarify the long-term effects of depression and anxiety in AL amyloidosis.

This current study was registered in ClinicalTrials.gov as NCT00898235.     

The effect of exercise on exhaled nitric oxide depends on allergic rhinoconjunctivitis in children

Objective: Fractional exhaled nitric oxide (FE_NO) and exercise testing are widely used for the evaluation of pediatric asthma. The evidence relating to the effects of strenuous exercise on FE_NO in children is conflicting. Little information is available on the association between exercise and FE_NO in relation to allergic rhinoconjunctivitis (AR). We aimed to investigate the effects of AR on children's FE_NO in response to a standardized treadmill exercise test. Methods: A total of 124 children with current asthma and 124 non-asthmatic children aged 8–16 years were studied. FE_NO was measured at baseline, at 1 and 30?min after an exercise challenge test using the single breath technique with EcoMedics Exhalyzer®. A structured parental interview, spirometry, serum allergen-specific IgE and skin prick tests were performed. Results: Baseline FE_NO was higher in both asthmatics and non-asthmatics with AR than without AR (both p?<?0.001). The FE_NO time trend was dependent on AR (p?=?0.039), irrespective of asthma (p?=?0.876). In children with AR, FE_NO had declined at 1?min by a mean of 6.1 ppb with a 95% confidence level of 5.1–7.5 ppb; at 30?min, the reduction was 2.8 (2.5–3.3) ppb. In children without AR, at 1?min the decline in FE_NO was 2.7 (2.1–3.5) ppb and by 30?min post-exercise it was 1.6 (1.3–2.0) ppb. Conclusions: The impact of exercise on FE_NO was dependent on the allergic phenotype, regardless of asthma status. FE_NO decreased immediately after exercise, and did not return to baseline level within 30?min.     

Smoking and Asthma in Men and Women with Normal Weight,Overweight, and Obesity

Background. There is a complex interrelationship among smoking, body weight, and asthma. It needs to be clarified whether smoking is related to an increased risk of asthma after taking into account for relative body weight. Objective. To examine the association between cigarette smoking and the prevalence of asthma in Canadian men and women with normal weight, overweight, and obesity. Methods. The analysis was based on data from 112,830 Canadians aged 18 years or more who participated in a national survey in 2007–2008. A questionnaire covered the information on prevalent asthma, smoking status, height, weight, and other factors. Logistic regression analysis was used to determine the association between smoking and the prevalence of asthma stratified by sex and body mass index (BMI). Results. The crude prevalence of asthma was 6.6% for men and 9.3% for women. After adjustment for covariates, the odds ratios (ORs) for current smoking associated with asthma was 1.20 [95% confidence interval (CI): 1.01–1.43] for men with normal weight, 0.98 (95% CI: 0.81, 1.18) for overweight men, and 1.02 (95% CI: 0.80–1.30) for obese men. For women, the corresponding adjusted ORs were 1.41 (95% CI: 1.23–1.62), 1.27 (95% CI: 1.05–1.54), and 1.28 (95% CI: 1.03–1.59), respectively. Conclusion. Current smoking was significantly associated with prevalent asthma in all women regardless of their relative body weight. In men, however, the association was only observed in those with under- or normal weight.     

Impact of Depression and Anxiety on Quality of Life,Health Behaviors,and Asthma Control Among Adults in the United States with Asthma, 2006

Background. Psychological factors such as anxiety and depression are increasingly being recognized as influencing the onset and course of asthma. Methods. We obtained Patient Health Questionnaire 8 depression data from 41 states and territories using the 2006 Behavioral Risk Factor Surveillance System. Heath risk behaviors, social and emotional support, life satisfaction, disability, and four health-related quality-of-life (HRQOL) questions were available for all states and territories (n = 18,856 with asthma). Five additional HRQOL questions were asked in three states (n = 1345 persons with asthma), and questions assessing asthma control were available for nine states (n = 3943 persons with asthma). Results. Persons with asthma were significantly more likely than those without asthma to have current depression (19.4% vs. 7.7%), a lifetime diagnosis of depression (30.6% vs. 14.4%), and anxiety (23.5% vs. 10.2%). For most domains examined, there was a dose-response relationship between level of depression severity and mean number of days of impaired HRQOL in the past 30 days, as well as an increased prevalence of life dissatisfaction, inadequate social support, disability, and risk behaviors, such as smoking, physical inactivity, and obesity, among those with asthma. Moreover, depression and anxiety were associated with a decreased level of asthma control, including more visits to the doctor or emergency room, inability to do usual activities, and more days of symptoms compared to those without depression or anxiety. Conclusion. This research indicates that a multidimensional, integrative approach to health care should be considered when assessing patients with asthma.