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Introduction Anxiety and depression are common respiratory comorbidities associated with poor disease control and risk of exacerbation. 1 Cognitive dysfunction and brain pathology have also been reported in people with chronic lung disease.2 The link between these important extrapulmonary comorbidities and delivery of respiratory care is poorly understood.Aims Describe the prevalence of mental health and cognitive impairment in a national cohort of hospitalised adults with asthma and COPD and explore associations with key performance indicators (KPIs) for the delivery of inpatient care.Methods This analysis used data from the National Respiratory Audit Programme (NRAP), which reports on hospitalised adults in England/Wales with COPD or asthma exacerbations and discharged 01/04/2023–31/03/2024. We compared demographic variables and KPIs using t-tests for categorical variables and Kruskal-Wallis test for age. Preliminary, unadjusted logistic regression was performed with mental health/dementia as the independent variable (baseline=none), and dependent variable the delivery of KPI.Results 38,969 adult COPD patients and 13,663 adult asthma patients were included. 26.1% asthma and 29.2% COPD patients had a documented history of mental health disease or cognitive impairment, with prevalence described in table 1. There was a female predominance in all groups. Patients with a mental health comorbidity were more likely to be current smokers. The severity of COPD exacerbations (based on NEWS2 score) was lower in the dementia group. Conversely, near-fatal asthma exacerbations were more frequent in the dementia group. Asthma and dementia/cognitive impairment were associated with lower documented delivery of specialist review, acute assessment and discharge bundle. In COPD, severe mental health and dementia/cognitive impairment was associated with lower documented spirometry, acute NIV, specialist review and discharge bundle.Abstract M22 Table 1Prevalence of documented diagnoses of anxiety, depression, severe mental health and dementia/cognitive decline in those hospitalised with exacerbations of asthma and COPD in NRAP between 01/04/2023–31/03/2024. Unadjusted logistic regression for the association between mental health diagnoses and delivery of KPIs Asthma n= 13663 None Anxiety Depression Anxiety & Depression Severe mental health Dementia or Cognitive impairment Total n (%) 10102 (73.9) 793 (5.8) 1125 (8.2) 1020 (7.5) 340 (2.5) 283 (2.1) KPI Unadjusted OR(CI 95%,P-value) 1. Respiratory review <24hrs - 1.13 (0.99–1.30) 1.05 (0.94–1.18) 1.29 (1.14–1.45) 1.03 (0.85–1.25) 0.55 (0.43–0.69) 2. PEF taken <1hr - 1.18 (0.95–1.46) 0.93 (0.76–1.13) 1.01 (0.82–1.23) 0.94 (0.65–1.31) 0.44 (0.23–0.75) 3. Systemic steroids <1hr - 1.01 (0.82–1.23) 0.99 (0.83–1.18) 1.00 (0.84–1.20) 1.15 (0.85–1.54) 0.58 (0.39–0.82) 4. Key components of DB on discharge - 1.05 (0.92–1.20) 0.99 (0.88–1.11) 1.16 (1.03–1.30) 0.83 (0.68–1.01) 0.57 (0.45–0.71) 5. Smoking cessation offered - 0.92 (0.68–1.27) 0.90 (0.70–1.18) 1.16 (0.90–1.52) 0.90 (0.64–1.29) 0.42 (0.18–1.02) 6. Discharged on ICS - 0.86 (0.69–1.08) 0.97 (0.80–1.19) 0.95 (0.78–1.17) 1.27 (0.89–1.89) 1.16 (0.79–1.78) COPD n= 38969 None Anxiety Depression Anxiety & Depression Severe mental health Dementia or Cognitive impairment Total n (%) 27600 (70.8) 2806 (7.2) 3025 (7.8) 2466 (6.3) 914 (2.3) 2158 (5.5) KPI Unadjusted OR(CI 95%,P-value) 1. Acute NIV <2hrs - 1.05 (0.82–1.35) 0.91 (0.70–1.18) 1.03 (0.79–1.34) 0.64 (0.43–0.92) 0.74 (0.51–1.06) 2. O2 prescribed to targeted sats - 1.79 (1.19–2.84) 1.12 (0.80–1.61) 1.54 (1.02–2.44) 1.95 (0.95–4.96) 0.91 (0.63–1.37) 3. Spirometry result available - 1.19 (1.10–1.28) 1.17 (1.09–1.26) 1.17 (1.08–1.27) 0.69 (0.60–0.79) 0.65 (0.60–0.71) 4. Smoking cessation offered - 1.05 (0.92–1.21) 1.12 (0.99–1.26) 1.23 (1.08–1.40) 0.99 (0.83–1.18) 0.72 (0.59–0.87) 5. Respiratory review <24hrs - 1.28 (1.18–1.39) 1.12 (1.04–1.22) 1.23 (1.13–1.34) 1.07 (0.94–1.23) 0.65 (0.59–0.71) 6. Key components of DB on discharge - 1.29 (1.19–1.40) 1.06 (0.98–1.16) 1.20 (1.10–1.32) 0.94 (0.81–1.10) 0.65 (0.58–0.72) CI, confidence interval; COPD, chronic obstructive pulmonary disease; DB, discharge bundle; ICS, inhaled corticosteroid; KPI, key performance indicators; NIV, non-invasive ventilation; OR, Odds ratio; PEF, peak expiratory flow; sats, peripheral oxygen saturations.Conclusions Up to one third of patients with asthma and COPD have a mental health or cognitive impairment documented during acute admission for exacerbation. The presence of these comorbidities is associated with lower odds of receiving basic respiratory care. Further work is needed to support these findings with adjusted analyses and investigate impact on clinical outcomes.References Laurin C, et al. Impact of anxiety and depression on chronic obstructive pulmonary disease exacerbation risk. AJRCCM 2012;185(9):918–23.Dodd JW. Lung disease as a determinant of cognitive decline and dementia. Alzheimers Res Ther. 2015;7(1):32.