Abstract
BACKGROUND: Psychological stress is increasingly recognized as an important modifier of asthma severity and control. However, objective clinical data on asthma outcomes during prolonged armed conflict remain limited. This study aimed to evaluate changes in anxiety, depression, lung function, and asthma control among patients with persistent asthma living in a frontline region of Ukraine during periods of differing military intensity, and to examine their associations with clinical parameters and access to controller therapy. METHODS: This prospective observational study included 49 adults with persistent asthma and 21 healthy controls examined twice between May-June and September-October 2024 at a regional hospital in Sumy, Ukraine. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Asthma-related outcomes included forced expiratory volume in 1 s (FEV₁), Asthma Control Test (ACT) scores, blood eosinophils, and total IgE levels. Statistical analysis was performed using IBM SPSS Statistics 30.0. Pearson correlation analysis was applied to assess relationships between psychological and clinical variables. Binary logistic regression was used to identify factors associated with poor asthma control (ACT < 20), with anxiety and depression entered as continuous predictors and access to baseline therapy as a binary variable. RESULTS: Psychological distress increased significantly in both asthma patients and healthy individuals during the period of intensified hostilities. In patients with asthma, worsening security conditions were accompanied by significant declines in FEV₁ and ACT scores (p < 0.001), whereas eosinophil counts and total IgE levels remained unchanged. Anxiety was negatively correlated with both FEV₁ and ACT across study periods, while depression showed no significant correlations with clinical indices. Logistic regression revealed that higher anxiety levels were independently associated with poor asthma control in May-June (OR = 1.563, 95% CI 1.012-2.412) and September-October 2024 (OR = 1.539, 95% CI 1.032-2.294). Depression was not significantly related to asthma control at either time point. Limited access to baseline therapy in September-October was associated with increased odds of poor asthma control, but this did not reach statistical significance (OR = 2.889, 95% CI 0.60-13.83). CONCLUSION: Prolonged exposure to wartime stress was associated with progressive psychological deterioration and worsening asthma control. Anxiety - already evident after 2 years of conflict - emerged as a consistent determinant of impaired asthma outcomes, whereas depressive symptoms showed no independent association. These findings highlight the importance of integrating mental health screening into asthma management strategies in conflict-affected regions.