Introduction

Asthma is a chronic respiratory disease characterized by inflammation and reversible airway obstruction, affecting millions of people worldwide and posing a significant public health challenge. According to the World Health Organization (WHO), an estimated 262 million people had asthma in 2019, resulting in 455,000 deaths, the majority of which occurred in low- and middle-income countries, where underdiagnosis and inadequate treatment remain persistent problems [1].

The prevalence of asthma represents a major global health burden, with rates varying based on geographic, demographic, and socioeconomic factors. Recent studies show an increasing prevalence of asthma in many regions. In 2019, the global prevalence of asthma among individuals aged 5 to 69 years was estimated at 11.5% for current wheezing and 9.8% for lifetime asthma, translating to approximately 754.6 million and 645.2 million cases, respectively [2]. The highest prevalence of current wheezing was reported in the African region (13.2%), while the lowest was seen in the Americas (10.0%).

In China, the prevalence of asthma significantly increased from 2011 to 2020, with notable regional variations. Coastal areas reported higher incidence and awareness rates [3]. In the United States, the overall prevalence of asthma among adults was 8.41% between 2005 and 2018, with a particularly marked upward trend among young adults [4]. The SNAPSHOT program, which assessed asthma prevalence in five Middle Eastern countries, revealed rates ranging from 4.4% in Turkey to 7.6% in the Gulf region, with higher rates among women and older adults [5].

Asthma has a significant impact on the quality of life (QoL) of affected individuals. Numerous studies highlight the strong correlation between asthma control, patient education, and overall well-being. Poor asthma management often leads to a reduced QoL, emphasizing the need for effective self-care strategies and adequate patient education. A positive relationship between asthma control and QoL exists, with better-controlled asthma correlating with improved QoL scores [6]. Additionally, better patient knowledge about asthma management is linked to better QoL outcomes, as evidenced by a significant correlation between knowledge levels and QoL scores [7].

The association between asthma and psychological disorders such as anxiety and depression is well-documented, with a significant interaction that impacts asthma management. Studies indicate that individuals with asthma often experience higher levels of anxiety and depression, which can negatively affect asthma control. A study of 175 Jordanian adults with asthma found that 53.14% experienced both anxiety and depression, and 60.57% had inadequate asthma control [8]. A study in Thailand found that 17.86% of asthma patients experienced anxiety, and 8.92% suffered from depression, with higher rates observed in those with poorly controlled asthma [9]. In Portugal and Spain, 36% of patients with persistent asthma reported symptoms of anxiety, while 12% reported symptoms of depression [10].

The Moroccan healthcare system has made progress, but it faces significant challenges in managing chronic diseases like asthma. These challenges include a lack of qualified personnel, insufficient infrastructure, and limited access to quality treatments, especially in rural areas. Managing comorbidities such as cardiovascular diseases and diabetes remains difficult. Improved management strategies and better awareness within communities are needed for more effective asthma management. Although studies on asthma have been conducted in various regions, there is a lack of research specifically focusing on QoL, anxiety, and depression among asthma patients in the Moroccan context. The primary aim of this study is to examine the impact of asthma on QoL, anxiety, and depression in asthmatic patients in Morocco, and to identify their determinants.

Materials and methods

Results

Discussion

The primary objective of this study was to assess how asthma affects QoL, anxiety, and depression among asthmatic patients in Morocco while identifying the associated determinants. The results show that 50.7% of participants experience anxiety, and 35.8% suffer from depression. The high prevalence of these conditions may partly stem from the study setting, as the University Hospital Center (CHU) primarily treats patients with advanced stages of the disease. These findings align with several international studies, though some differences exist. For example, a study in Brazil reported that 58.5% of patients with severe asthma experienced anxiety, while 48.8% suffered from depression [20]. Additionally, a study in Jordan found that 53.14% of asthmatic patients experienced both anxiety and depression [8]. This prevalence is similar to the anxiety levels observed in our study, reinforcing the strong association between poor asthma control—commonly seen in the studied populations—and psychological disorders. However, researchers in Thailand and Europe (Portugal and Spain) reported lower proportions, particularly among patients with better asthma control [9, 10]. These differences underscore the impact of population characteristics and asthma control levels on the prevalence of psychological disorders.

Findings from both the literature and our study highlight several determinants of anxiety and depression in asthmatic patients. The prevalence of these psychological disorders is higher among female asthmatic patients, a trend also reported in studies by Rabelo et al. [20] and Karsaneh et al. [8]. This increased susceptibility may be attributed to hormonal differences, heightened stress sensitivity, or variations in emotional and social responses between genders.

A low level of education is another factor associated with higher rates of anxiety and depression. Our results, along with those from the literature, such as the study by Cunha et al. [10], indicate that illiterate patients or those with limited education experience greater psychological distress. This may be due to a lack of understanding of asthma management strategies, leading to poor disease control and increased psychological stress. Additionally, younger patients tend to exhibit higher anxiety rates, whereas depression is more pronounced in older individuals. This disparity, observed in multiple studies, may be linked to age-specific concerns: younger patients often worry about how asthma will affect their future, while older individuals may struggle with the cumulative impact of comorbidities and physical limitations. Moreover, the presence of comorbidities such as hypertension or diabetes further exacerbates the psychological burden in asthmatic patients. These conditions worsen disease perception and increase functional limitations, as observed in the study by Rabelo et al. [20]. Moreover, recent studies in neuroimmunology have revealed that inflammatory mechanisms may play a crucial role in the development of depression and anxiety in asthmatic patients. For example, Laumet et al. [21] demonstrated that CD3+ T cells are essential in resolving inflammatory pain and depressive-like behaviors, suggesting potential neuroimmune interactions that could explain the co-occurrence of asthma and psychological disorders [21]. This perspective could be explored further in future studies to better understand the complex relationship between asthma and mood disorders.

In this study, the QoL of asthmatic patients, assessed through PCS and MCS scores, was significantly influenced by various sociodemographic and clinical factors. The average PCS was 36.9 ± 13.1, while the MCS was 35.9 ± 19.4, reflecting an overall reduced QoL in this population. These scores are lower than those reported in some international studies, particularly in settings where asthma control is better. For instance, Ahmed et al. [7], found that patients with better asthma control had significantly higher QoL scores. In our study, this discrepancy may be attributed to the high prevalence of patients with advanced forms of the disease. The literature also underscores the impact of comorbidities, such as obesity and multimorbidity, on QoL and psychological well-being. In our study, conditions like hypertension and diabetes were associated with lower QoL scores, consistent with the findings of Tribuntceva et al. [22]. Managing asthma becomes more challenging with multimorbidity due to drug interactions, treatment side effects, and the worsening of chronic conditions such as diabetes or hypertension. In Morocco, cultural, socio-economic, and healthcare factors play a significant role in asthma management. Cultural beliefs, inequalities in access to care, and air pollution worsen the condition. Additionally, psychological disorders such as anxiety and depression negatively impact patients’ QoL. To improve asthma management, healthcare strategies must adopt a comprehensive approach that considers these factors.

This study addresses a major public health issue in Morocco: the impact of asthma on QoL, anxiety, and depression—an area that remains underexplored in this context. The use of validated scales, such as the SF-12 and HADS, ensures reliable assessments of the QoL in asthmatic patients, making the findings comparable to international data. The results offer valuable insights for improving asthma management, particularly by considering psychological aspects and addressing common comorbidities. By expanding local knowledge on asthma, this study facilitates comparisons with research conducted in other countries, enhancing its relevance both locally and internationally.

However, this study has several limitations. The cross-sectional nature prevents the establishment of causal links between the identified factors and QoL or psychological disorders. Additionally, the study population comes exclusively from a university hospital, which could introduce selection bias by including more patients with severe or advanced forms of asthma. This limits the generalizability of the results to the broader population of asthmatic patients, particularly those with milder forms of the disease. Another limitation is the potential bias introduced by non-respondents, as some patients could not be reached or chose not to participate in the telephone survey. Additionally, the use of medical records for data collection may have led to errors in data entry or missing information, which could impact the accuracy and completeness of the data. To address biases related to non-respondents, we implemented phone reminders and encouraged active participation to maximize the response rate. Furthermore, to minimize biases associated with medical record use, we ensured a rigorous approach to data collection and extraction by adhering to standardized protocols and cross-checking the extracted information whenever possible.

In conclusion, this study highlights the significant impact of asthma on patients’ QoL, particularly in relation to the interplay between depression, anxiety, comorbidities, and socio-demographic factors. The findings emphasize the need for a comprehensive approach to asthma management, one that addresses not only respiratory symptoms but also the psychological and social factors affecting patients. To optimize clinical outcomes and improve overall well-being, it is essential to integrate strategies for managing anxiety and depression into asthma treatment protocols.