All patients will be assessed using our well established systematic evaluation protocol. Refractory asthma will be based on the definition of the American Thoracic Society Consensus Workshop, but for the purposes of this study will be defined as follows:
Persisting symptoms due to asthma (ACS ≥3) despite detailed assessment and management (non-adherence, alternative diagnoses and co-morbidities etc);
Minimal maintenance therapy of high dose inhaled steroids ( ≥800 mg BDP or equivalent) long acting Beta2-agonist and / or other maintenance therapies (theophylline / leukotriene receptor antagonist).
The requirement for maintenance oral steroids for ≥ 50% of the year or at least 3 courses of systemic steroids in the preceding 12 months.
Age 18-65 years
Refractory asthma
Agreement to take part in trial and to take anti-depressant medication
Hospital Anxiety and Depression Score ≥11
Hamilton Depression Rating Scale ≥ 17
You may not be if
Poor adherence with medication (prescription records, ≤50% of inhaled combination filled in previous 6 months)
Significant co-morbidity due to conditions other than asthma
Anti-depressant medication in previous 3 months
Pregnancy
Patients requiring non-steroidal anti-inflammatory drugs, aspirin or warfarin
Clareo Health | Study of Treatment of Depression in Refractory Asthma
