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Sharrad KJ, Sanwo O, Cuevas-Asturias S, Kew KM, Carson-Chahhoud KV, Pike KC. Psychological interventions for asthma in children and adolescents. Cochrane Database Syst Rev 2024; 1:CD013420. [PMID: 38205864 PMCID: PMC10782779 DOI: 10.1002/14651858.cd013420.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND Rates of asthma are high in children and adolescents, and young people with asthma generally report poorer health outcomes than those without asthma. Young people with asthma experience a range of challenges that may contribute to psychological distress. This is compounded by the social, psychological, and developmental challenges experienced by all people during this life stage. Psychological interventions (such as behavioural therapies or cognitive therapies) have the potential to reduce psychological distress and thus improve behavioural outcomes such as self-efficacy and medication adherence. In turn, this may reduce medical contacts and asthma attacks. OBJECTIVES To determine the efficacy of psychological interventions for modifying health and behavioural outcomes in children with asthma, compared with usual treatment, treatment with no psychological component, or no treatment. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register (including CENTRAL, CRS, MEDLINE, Embase, PsycINFO, CINAHL EBSCO, AMED EBSCO), proceedings of major respiratory conferences, reference lists of included studies, and online clinical databases. The most recent search was conducted on 22 August 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing psychological interventions of any duration with usual care, active controls, or a waiting-list control in male and female children and adolescents (aged five to 18 years) with asthma. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. symptoms of anxiety and depression, 2. medical contacts, and 3. asthma attacks. Our secondary outcomes were 1. self-reported asthma symptoms, 2. medication use, 3. quality of life, and 4. adverse events/side effects. MAIN RESULTS We included 24 studies (1639 participants) published between 1978 and 2021. Eleven studies were set in the USA, five in China, two in Sweden, three in Iran, and one each in the Netherlands, UK, and Germany. Participants' asthma severity ranged from mild to severe. Three studies included primary school-aged participants (five to 12 years), two included secondary school-aged participants (13 to 18 years), and 18 included both age groups, while one study was unclear on the age ranges. Durations of interventions ranged from three days to eight months. One intervention was conducted online and the rest were face-to-face. Meta-analysis was not possible due to clinical heterogeneity (interventions, populations, outcome tools and definitions, and length of follow-up). We tabulated and summarised the results narratively with reference to direction, magnitude, and certainty of effects. The certainty of the evidence was very low for all outcomes. A lack of information about scale metrics and minimal clinically important differences for the scales used to measure anxiety, depression, asthma symptoms, medication use, and quality of life made it difficult to judge clinical significance. Primary outcomes Four studies (327 participants) reported beneficial or mixed effects of psychological interventions versus controls for symptoms of anxiety, and one found little to no difference between groups (104 participants). Two studies (166 participants) that evaluated symptoms of depression both reported benefits of psychological interventions compared to controls. Three small studies (92 participants) reported a reduction in medical contacts, but two larger studies (544 participants) found little or no difference between groups in this outcome. Two studies (107 participants) found that the intervention had an important beneficial effect on number of asthma attacks, and one small study (22 participants) found little or no effect of the intervention for this outcome. Secondary outcomes Eleven studies (720 participants) assessed asthma symptoms; four (322 participants) reported beneficial effects of the intervention compared to control, five (257 participants) reported mixed or unclear findings, and two (131 participants) found little or no difference between groups. Eight studies (822 participants) reported a variety of medication use measures; six of these studies (670 participants) found a positive effect of the intervention versus control, and the other two (152 participants) found little or no difference between the groups. Across six studies (653 participants) reporting measures of quality of life, the largest three (522 participants) found little or no difference between the groups. Where findings were positive or mixed, there was evidence of selective reporting (2 studies, 131 participants). No studies provided data related to adverse effects. AUTHORS' CONCLUSIONS Most studies that reported symptoms of anxiety, depression, asthma attacks, asthma symptoms, and medication use found a positive effect of psychological interventions versus control on at least one measure. However, some findings were mixed, it was difficult to judge clinical significance, and the evidence for all outcomes is very uncertain due to clinical heterogeneity, small sample sizes, incomplete reporting, and risk of bias. There is limited evidence to suggest that psychological interventions can reduce the need for medical contact or improve quality of life, and no studies reported adverse events. It was not possible to identify components of effective interventions and distinguish these from interventions showing no evidence of an effect due to substantial heterogeneity. Future investigations of evidence-based psychological techniques should consider standardising outcomes to support cross-comparison and better inform patient and policymaker decision-making.
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Affiliation(s)
- Kelsey J Sharrad
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
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2
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Khan J, Moran B, McCarthy C, Butler MW, Franciosi AN. Management of comorbidities in difficult and severe asthma. Breathe (Sheff) 2023; 19:230133. [PMID: 38020342 PMCID: PMC10644109 DOI: 10.1183/20734735.0133-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Difficult-to-treat and severe asthma are challenging clinical entities. In the face of suboptimal asthma control, the temptation for clinicians is to reflexively escalate asthma-directed therapy, including increasing exposure to corticosteroids and commencement of costly but potent biologic therapies. However, asthma control is objectively and subjectively assessed based on measurable parameters (such as exacerbations or variability in pulmonary physiology), symptoms and patient histories. Crucially, these features can be confounded by common untreated comorbidities, affecting clinicians' assessment of asthma treatment efficacy.
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Affiliation(s)
- Jehangir Khan
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- Shared first authorship
| | - Barry Moran
- St Vincent's University Hospital, Dublin, Ireland
- Shared first authorship
| | - Cormac McCarthy
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
| | - Marcus W. Butler
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- Shared senior authorship
| | - Alessandro N. Franciosi
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- Shared senior authorship
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3
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McLoughlin RF, McDonald VM. The Management of Extrapulmonary Comorbidities and Treatable Traits; Obesity, Physical Inactivity, Anxiety, and Depression, in Adults With Asthma. FRONTIERS IN ALLERGY 2022; 2:735030. [PMID: 35387051 PMCID: PMC8974714 DOI: 10.3389/falgy.2021.735030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/19/2021] [Indexed: 12/31/2022] Open
Abstract
Asthma is a complex and heterogenous disease characterized by variability in disease expression and severity. Multiple extrapulmonary comorbidities and treatable traits are common in people with asthma, and there is an increasing appreciation of how these may complicate asthma management. This review will discuss the prevalence and impact of extrapulmonary comorbidities/risk factors or "traits," which have been found to co-exist in asthma (obesity, symptoms of depression and/or anxiety and physical inactivity), the impact these traits have on future outcomes (including exacerbation risk and quality of life) and asthma management, and how we should target treatment in asthma when these extrapulmonary traits are present.
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Affiliation(s)
- Rebecca F McLoughlin
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, New Lambton Heights, NSW, Australia.,School of Nursing and Midwifery, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Vanessa M McDonald
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, New Lambton Heights, NSW, Australia.,School of Nursing and Midwifery, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
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4
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Abstract
Clinicians who care for patients infected with coronavirus disease 2019 (COVID-19) must wear a full suite of personal protective equipment, including an N95 mask or powered air purifying respirator, eye protection, a fluid-impermeable gown, and gloves. This combination of personal protective equipment may cause increased work of breathing, reduced field of vision, muffled speech, difficulty hearing, and heat stress. These effects are not caused by individual weakness; they are normal and expected reactions that any person will have when exposed to an unusual environment. The physiologic and psychologic challenges imposed by personal protective equipment may have multiple causes, but immediate countermeasures and long-term mitigation strategies can help to improve a clinician's ability to provide care. Ultimately, a systematic approach to the design and integration of personal protective equipment is needed to improve the safety of patients and clinicians.
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5
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Sharrad KJ, Sanwo O, Carson-Chahhoud KV, Pike KC. Psychological interventions for asthma in children and adolescents. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2019. [DOI: 10.1002/14651858.cd013420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Kelsey J Sharrad
- University of South Australia; School of Health Sciences; Adelaide Australia
| | - Olatokunbo Sanwo
- William Harvey Hospital; East Kent Hospitals University NHS Foundation Trust; Ashford UK
| | | | - Katharine C Pike
- UCL Great Ormond Street Institute of Child Health; Respiratory, Critical Care & Anaesthesia; London UK
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6
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Central nervous system influences in asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 795:309-19. [PMID: 24162917 DOI: 10.1007/978-1-4614-8603-9_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Asthma is a biomedical disorder whose presentation can be markedly influenced by neurological and psychological factors. This chapter describes several approaches that provide insight into the role of psychological factors and brain function in asthma. These include the study of placebo responses and recent explorations using functional neuroimaging during the onset of asthma symptoms. Although the specific mechanisms involved remain uncertain, we are gaining an appreciation for some of the neurocircuitry that is involved. The insula and ACC may modulate inflammatory processes by their influence on neuroendocrine responses to stress, including highly studied effects on the HPA axis and its physiologic responses. However much we have recently learned, it is clear that further study of this topic is critical to fully explicate the role of the brain in asthma.
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7
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Depressiveness, symptoms of anxiety and cognitive dysfunctions in patients with asthma and chronic obstructive pulmonary disease (COPD): possible associations with inflammation markers: a pilot study. J Neural Transm (Vienna) 2014; 122 Suppl 1:S83-91. [PMID: 24532256 PMCID: PMC4529448 DOI: 10.1007/s00702-014-1171-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/30/2014] [Indexed: 11/26/2022]
Abstract
Psychiatric symptoms of anxiety, depression and cognitive dysfunction often occur in patients suffering from somatic conditions such as asthma and chronic obstructive pulmonary disease (COPD) which constitute a major and growing public health problem. In the present study we therefore aimed at analyzing depressive symptoms as well as symptoms of anxiety and cognitive problems in patients with mild to moderate asthma and COPD. 59 participants—17 with asthma, 24 with COPD and 18 healthy controls were enrolled. Depressiveness was assessed with the beck depression inventory (BDI); anxiety symptoms were measured with the State-Trait Anxiety Inventory Part 1 and 2, and cognitive function levels were estimated with the Trail Making Test Part A and B. A score above the threshold indicative for depression was found by 33 % (n = 8) of COPD patients, 29 % (n = 5) of asthma patients compared to 0.05 % (n = 1) of the control group. Clinically relevant anxiety levels were found in 42 % (n = 10) of the COPD group, 41 % (n = 7) of the asthma patients and 17 % (n = 3) of the controls. Patients with COPD performed significantly worse on the TMT than other groups. Psychoemotional state and cognitive functions were found to be correlated with exposure to tobacco smoke (measured in pack-years) and airway obstruction (measured with FEV1). In conclusion, patients with mild to moderate asthma and COPD exhibit significantly higher levels of depressive and anxiety symptoms as well as cognitive dysfunctions than controls. The prevalence of these symptoms is related to the amount of exposure to tobacco smoke and the severity of airflow obstruction.
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8
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Wu S, Harber P, Yun D, Bansal S, Li Y, Santiago S. Anxiety during respirator use: comparison of two respirator types. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2011; 8:123-128. [PMID: 21318920 DOI: 10.1080/15459624.2011.549780] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Anxiety may interfere with proper respirator use. This study directly compares the effect of two types of respirators--elastomeric half-face mask with dual-cartridges (HFM) and N95 filtering facepiece--on anxiety levels. Twelve volunteers with normal or mildly impaired respiratory conditions performed a series of simulated work tasks using the HFM and N95 on different days. The State-Trait Anxiety Inventory (STAI) measured state anxiety (SA) before and during respirator use. STAI also measured trait anxiety (TA), a stable personal characteristic. The effect of the respirator was measured as the difference between SA pre-use and during use. Work with HFM was associated with an increase in SA (2.92 units, p < .01), whereas work with the N95 had no observed effect. Anxiety should be considered in the selection of the best respirator for a user. Impact on anxiety should be considered for respirator design and certification purposes, particularly if the device is to be widely used in workplace and community settings.
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Affiliation(s)
- Samantha Wu
- Occupational & Environmental Medicine Division, Department of Family Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California, USA
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9
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Weiss P, Rundell KW. Imitators of exercise-induced bronchoconstriction. Allergy Asthma Clin Immunol 2009; 5:7. [PMID: 20016690 PMCID: PMC2794850 DOI: 10.1186/1710-1492-5-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 11/17/2009] [Indexed: 11/10/2022] Open
Abstract
Exercise-induced bronchoconstriction (EIB) is described by transient narrowing of the airways after exercise. It occurs in approximately 10% of the general population, while athletes may show a higher prevalence, especially in cold weather and ice rink athletes. Diagnosis of EIB is often made on the basis of self-reported symptoms without objective lung function tests, however, the presence of EIB can not be accurately determined on the basis of symptoms and may be under-, over-, or misdiagnosed. The goal of this review is to describe other clinical entities that mimic asthma or EIB symptoms and can be confused with EIB.
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Affiliation(s)
- Pnina Weiss
- Department of Pediatrics, Yale School of Medicine, P.O. Box 208064, New Haven, CT 06520-8064, USA.
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10
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The impact of affective states on the perception of dyspnea in patients with chronic obstructive pulmonary disease. Biol Psychol 2009; 84:129-34. [PMID: 21768011 DOI: 10.1016/j.biopsycho.2009.07.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 07/01/2009] [Accepted: 07/18/2009] [Indexed: 11/21/2022]
Abstract
Dyspnea is the cardinal symptom of chronic obstructive pulmonary disease (COPD). Affective states can profoundly impact upon the perception of dyspnea, but little is known about this relationship in patients with COPD. We, therefore, examined the impact of viewing positive versus negative affective picture series on perceived dyspnea during two cycle ergometer exercise tests (CEET) in 30 patients with COPD. Whereas cardiopulmonary measures indicated comparable exercise intensity during both CEETs, parallel viewing of negative affective pictures resulted in increased dyspnea ratings compared to positive affective pictures. Regression analyses showed that only during positive picture viewing increases in the affective unpleasantness of dyspnea, but not in the sensory intensity of dyspnea, during CEETs were predictive of greater dyspnea during everyday activities and reduced health-related quality of life. The results suggest that negative affective states increase perceived dyspnea in patients with COPD and underline the importance of targeting the affect-dyspnea-relationship in this patient group.
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11
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Laforest L, Van Ganse E, Devouassoux G, Osman LM, Pison C, El Hasnaoui A, Bauguil G, Chamba G. Factors influencing dispensing of psychotropic medications to patients with asthma: a community pharmacy-based survey. Ann Allergy Asthma Immunol 2008; 100:230-6. [PMID: 18426142 DOI: 10.1016/s1081-1206(10)60447-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND To our knowledge, the use of psychotropic medications (antidepressant, anxiolytic, and hypnotic agents) in patients with asthma has not been extensively explored. OBJECTIVE To identify factors associated with the use of these medications in patients with asthma. METHODS Regular customers (aged 18-50 years) of 348 pharmacies in 9 French regions were consecutively recruited from November 2003 to June 2004. Patients with a prescription for an asthma medication were included. Patients completed a questionnaire, complemented by the computerized records of their therapy dispensed in the past 12 months. Asthma control was measured with the Asthma Control Test. RESULTS Among 886 patients (mean age, 37.4 years; 55.0% female), during the 12 months before the survey, the proportions who received at least 1 U of anxiolytic, antidepressant, and hypnotic agents were 25.6%, 13.7%, and 13.0%, respectively. Higher dispensing levels of antidepressant, anxiolytic, and hypnotic agents were observed with decreasing asthma control (P < .001 for each drug class). Other correlates of receiving any of these classes included older age, female sex, smoking status, and dispensing of antireflux treatment (P < .001 for all). These results were confirmed in multivariate analyses. CONCLUSIONS Psychotropic drugs were commonly dispensed to patients with asthma, and correlates of receiving these drugs were identified in this population. The high use of psychotropic medication, particularly in patients with poorly controlled asthma, is of concern.
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12
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Strine TW, Mokdad AH, Balluz LS, Berry JT, Gonzalez O. Impact of depression and anxiety on quality of life, health behaviors, and asthma control among adults in the United States with asthma, 2006. J Asthma 2008; 45:123-33. [PMID: 18350404 DOI: 10.1080/02770900701840238] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
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.
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Affiliation(s)
- Tara W Strine
- Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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13
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[Economic aspects of severe asthma]. Presse Med 2007; 37:117-28. [PMID: 18037259 DOI: 10.1016/j.lpm.2007.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 05/31/2007] [Accepted: 06/01/2007] [Indexed: 11/23/2022] Open
Abstract
Severe asthma and difficult-to-treat asthma are major issues in public health, given the mortality and morbidity they induce and their detrimental effects on patients' quality of life. The economic consequences should not be overlooked either. Published studies suggest that asthma-related medical resource use increases with the degree of asthma severity. Medical resource use incurred by severe (and/or difficult-to-treat) asthma could be reduced in part by more appropriate treatment, better patient education, improved coordination of disease management and treatment of comorbid diagnoses. The specific difficulties in the management of severe asthma and/or difficult-to-treat asthma must nonetheless be kept in mind. Recent new treatments appear promising, but their costs and indications in actual medical practice require better definition.
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von Leupoldt A, Taube K, Schubert-Heukeshoven S, Magnussen H, Dahme B. Distractive Auditory Stimuli Reduce the Unpleasantness of Dyspnea During Exercise in Patients With COPD. Chest 2007; 132:1506-12. [PMID: 17890458 DOI: 10.1378/chest.07-1245] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Dyspnea is the primary symptom limiting exercise in patients with COPD. Recent research has demonstrated that psychological factors can substantially influence the perception of dyspnea, but little is known about the modulation of perceived intensity or unpleasantness of dyspnea by attentional distraction. Therefore, we examined the impact of distractive auditory stimuli on the perception of exercise-induced dyspnea and the affective state in patients with COPD during 6-min walking tests (6MWTs). METHODS Twenty patients with mild-to-severe COPD (mean FEV1, 55.9% predicted) underwent two 6MWTs. Under one exercise condition, distractive auditory stimuli were presented with headphones, while the other condition was performed without auditory distraction. Lung function (FEV1), heart rate (HR), pulse oximetric saturation (SpO2), perceived intensity of dyspnea (ie, visual analog scale for perceived intensity of dyspnea [VAS-I]), and perceived unpleasantness of dyspnea (visual analog scale for perceived unpleasantness of dyspnea [VAS-U]) were measured before and after exercise. In addition, the global level of dyspnea (Borg score), positive affectivity (PA), and negative affectivity were assessed after both conditions. RESULTS A similar exercise level during both conditions was confirmed by comparable results in FEV1, HR, SpO2, and distances walked. During auditory distraction, Borg scores and increases in VAS-U were smaller, while PA was higher compared to the nondistraction condition (p<0.05). VAS-I did not show differences across conditions. CONCLUSIONS Distractive auditory stimuli decrease the global level of exercise-induced dyspnea in patients with COPD by reducing the perceived unpleasantness of dyspnea and lead to an additional increase in PA. Auditory distraction might therefore serve as an intervention for the reduction of dyspnea during exercise in this patient group.
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Affiliation(s)
- Andreas von Leupoldt
- Department of Psychology, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany.
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Von Leupoldt A, Riedel F, Dahme B. The impact of emotions on the perception of dyspnea in pediatric asthma. Psychophysiology 2007; 43:641-4. [PMID: 17076821 DOI: 10.1111/j.1469-8986.2006.00453.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Inadequate symptom perception is increasingly recognized as a contributing factor in asthma morbidity. Recent research has shown that psychological factors can influence the perception of asthmatic symptoms such as dyspnea, but little is known, about the impact of emotions on the perception of dyspnea in pediatric asthma. Therefore, we examined the impact of viewing affective film clips of positive, neutral, and negative valence on perceived dyspnea during resistive load breathing in children with stable mild asthma. Perceived dyspnea decreased during the positive film compared to baseline and neutral film whereas the level of respiratory loading and respiratory resistance (R5) remained unchanged across conditions. The results underline the potential impact of psychological factors such as emotions on the perception of dyspnea in children with asthma.
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Goldbeck L, Koffmane K, Lecheler J, Thiessen K, Fegert JM. Disease severity, mental health, and quality of life of children and adolescents with asthma. Pediatr Pulmonol 2007; 42:15-22. [PMID: 17106900 DOI: 10.1002/ppul.20509] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Asthma has been found related to a higher risk of psychological problems. Inconsistent results have been reported with respect to the quality of life of children with asthma. So there may be a complex relationship between asthma severity, quality of life, and psychological factors. The aim of this study was to examine the impact of asthma severity and emotional/behavioral problems on the quality of life of children and adolescents and on their need for support. Eighty-one children and adolescents (7-18 years old, 62 boys, 19 girls) with asthma participating in different intervention and rehabilitation programs completed the Ulm Inventory for Children, an instrument for assessing health-related quality of life. Psychological problems were rated using the Child Behavior Checklist (CBCL). Caregivers judged the patients' need for support due to asthma and due to psychosocial problems. Asthma severity was rated according to the GINA classification. The participants showed elevated caregiver-reported emotional and behavioral symptoms compared with the normative sample (mean CBCL total score T=63). Quality of life and the need for social support were significantly correlated with psychological symptoms. Asthma severity was neither correlated with quality of life nor with emotional/behavioral symptoms, but it was associated with the need for support due to asthma. Therefore, in our study, comorbid emotional and behavioral symptoms rather than disease severity predicted quality of life of children and adolescents with asthma. Treatment should be adjusted to the special needs of children with asthma and comorbid mental health problems.
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Affiliation(s)
- Lutz Goldbeck
- Department for Child and Adolescent Psychiatry/Psychotherapy, University Clinic, Ulm, Germany.
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Le AV, Simon RA. The Difficult-to-Control Asthmatic: A Systematic Approach. Allergy Asthma Clin Immunol 2006; 2:109-16. [PMID: 20525155 PMCID: PMC2876179 DOI: 10.1186/1710-1492-2-3-109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
With the judicious use of inhaled corticosteroids, beta2 agonists, and leukotriene modifiers, most patients with asthma are easily controlled and managed. However, approximately 5% of asthmatics do not respond to standard therapy and are classified as "difficult to control." 1 Typically, these are patients who complain of symptoms interfering with daily living despite long-term treatment with inhaled corticosteroids in doses up to 2,000 mug daily. Many factors can contribute to poor response to conventional therapy, and especially for these patients, a systematic approach is needed to identify the underlying causes. First, the diagnosis of asthma and adherence to the medication regimen should be confirmed. Next, potential persisting exacerbating triggers need to be identified and addressed. Concomitant disorders should be discovered and treated. Lastly, the impact and implications of socioeconomic and psychological factors on disease control can be significant and should be acknowledged and discussed with the individual patient. Less conventional and novel strategies for treating corticosteroid-resistant asthma do exist. However, their use is based on small studies that do not meet evidence-based criteria; therefore, it is essential to sort through and address the above issues before reverting to other therapy.
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Affiliation(s)
- Annie V Le
- Division of Allergy, Asthma, and Immunology, The Scripps Clinic and the Scripps Research Institute, La Jolla, CA.
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von Leupoldt A, Seemann N, Gugleva T, Dahme B. Attentional distraction reduces the affective but not the sensory dimension of perceived dyspnea. Respir Med 2006; 101:839-44. [PMID: 16971103 DOI: 10.1016/j.rmed.2006.06.033] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2006] [Revised: 06/02/2006] [Accepted: 06/26/2006] [Indexed: 10/24/2022]
Abstract
The perception of dyspnea shows many similarities to the perception of pain. Both are multidimensional processes, which are not only influenced by sensory input but also by nonsensory factors like attention. Recent research has suggested that attentional distraction might reduce the perception of dyspnea but results are conflicting. Furthermore, the specific impact of attentional distraction on the distinct dimensions of perceived dyspnea has not been studied yet. Therefore, the present study examined the specific impact of changes in the attentional focus on the sensory and affective dimension of perceived dyspnea. Dyspnea was induced in forty-four healthy volunteers (mean age: 27.7 years, range: 18-47 years) by breathing through an inspiratory resistive load (3.57 kPa/L/s), while attention was directed either to breathing or distracted by reading texts. Inspiratory time (T(i)) and breathing frequency (f) were measured continuously. After each condition the experienced intensity (i.e., sensory dimension) and unpleasantness (i.e., affective dimension) of dyspnea were rated on separate visual analog scales (VAS), presented in randomized order. ANOVAs showed that attentional distraction during loaded breathing reduced the perceived unpleasantness of dyspnea (P<0.05), while the perceived intensity of dyspnea as well as T(i) and f remained unchanged. The results show that attentional distraction reduces the affective, but not the sensory dimension of induced dyspnea in healthy volunteers. Future studies are needed to clarify whether attentional distraction can effectively be used as intervention technique for reducing the unpleasant aspects of dyspnea in different patients groups.
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Affiliation(s)
- Andreas von Leupoldt
- Psychological Institute III, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany
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von Leupoldt A, Mertz C, Kegat S, Burmester S, Dahme B. The impact of emotions on the sensory and affective dimension of perceived dyspnea. Psychophysiology 2006; 43:382-6. [PMID: 16916434 DOI: 10.1111/j.1469-8986.2006.00415.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dyspnea is an impairing symptom in various diseases. Recent research has shown that the perception of dyspnea, like pain, consists of a sensory (intensity) and an affective (unpleasantness) dimension, but little is known about the specific impact of different emotions on these distinct dimensions. We therefore examined the impact of viewing affective picture series of positive, neutral, and negative valence on perceived dyspnea during resistive load breathing in healthy volunteers. Inspiratory time (Ti), breathing frequency (f), and oscillatory resistance (Ros) remained unchanged across conditions. Ratings for unpleasantness of dyspnea increased from positive to neutral to negative series, but ratings for intensity of dyspnea showed no changes. The results suggest that the affective dimension of the perception of dyspnea is particularly vulnerable to emotional influences, irrespective of objective lung function.
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Yen IH, Yelin EH, Katz P, Eisner MD, Blanc PD. Perceived neighborhood problems and quality of life, physical functioning, and depressive symptoms among adults with asthma. Am J Public Health 2006; 96:873-9. [PMID: 16571704 PMCID: PMC1470572 DOI: 10.2105/ajph.2004.059253] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2005] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated associations between perceived neighborhood problems and quality of life (QOL), physical functioning, and depressive symptoms among adults with asthma. METHODS Using cross-sectional data from adults with asthma in northern California (n=435), we examined associations between 5 types of perceived neighborhood problems (traffic, noise, trash, smells, and fires) and asthma-specific QOL (Marks instrument), physical functioning (Short Form-12 physical component summary), and depressive symptoms (Center for Epidemiological Studies-Depression). We used multivariate regression analysis. RESULTS When asthma severity and sociodemographics were taken into account, people reporting a score of 8 or higher on a scale of 0 to 25 for serious problems (the top quartile of seriousness) in their neighborhoods had significantly poorer QOL scores (mean difference=5.91; standard error [SE]=1.63), poorer physical functioning (mean difference=-3.04; SE=1.27), and almost a fivefold increase in depressive symptoms (odds ratio=4.79; 95% confidence interval=2.41, 9.52). CONCLUSIONS A high level of perceived neighborhood problems was associated with poorer QOL, poorer physical functioning, and increased depressive symptoms among people with asthma when disease severity and sociodemographic factors were taken into account.
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Affiliation(s)
- Irene H Yen
- Department of Medicine, University of California-San Francisco, 3333 California Street, Suite 335, San Francisco, CA 94143-0856, USA.
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21
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Rietveld S, van Beest I, Prins PJM. The relationship between specific anxiety syndromes and somatic symptoms in adolescents with asthma and other chronic diseases. J Asthma 2006; 42:725-30. [PMID: 16316865 DOI: 10.1080/02770900500306472] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The impact of a chronic disease on the emotional well-being of children and adolescents is controversial in the literature. This study tested the hypotheses that 1) a specific approach is required to assess emotional deviations in adolescents with chronic diseases and 2) specific anxiety symptoms are predictive of excessive somatic symptoms. METHODS Emotional and somatic symptoms were measured in four groups, selected from a community sample of 897 adolescents: 32 with asthma, 20 with other severe chronic diseases, 30 with median scores (the true comparison group), and 29 with minimal scores on common measures of trait anxiety and depression. RESULTS The asthma and chronic disease groups scored not significantly higher than the true comparison group on trait anxiety, depression, negative affectivity, five anxiety syndromes, anxiety-related physical, and miscellaneous somatic symptoms. The asthma and chronic disease groups scored only higher than the true comparison group on panic attacks and respiration symptoms. Regression analyses showed that severity of asthma was no significant factor, and the minimal group scored consistently lower than the other groups, except on physical injury fears. There were no group differences in positive affect. Girls scored higher than boys on specific anxiety syndromes (except on obsessive-compulsive disorder) and also on respiration symptoms. CONCLUSION Adolescents with severe chronic diseases deviated from a true comparison control group on panic attacks, but not on other negative and positive emotions.
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Affiliation(s)
- Simon Rietveld
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
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Alati R, O'Callaghan M, Najman JM, Williams GM, Bor W, Lawlor DA. Asthma and internalizing behavior problems in adolescence: a longitudinal study. Psychosom Med 2005; 67:462-70. [PMID: 15911911 DOI: 10.1097/01.psy.0000161524.37575.42] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Clinical studies of asthmatic children have found an association between lung disease and internalizing behavior problems. The causal direction of this association is, however, unclear. This article examines the nature of the relationship between behavior and asthma problems in childhood and adolescence. METHODS Data were analyzed on 5135 children from the Mater University Study of Pregnancy and its outcomes (MUSP), a large birth cohort of mothers and children started in Brisbane, Australia, in 1981. Lung disease was measured from maternal reports of asthma/bronchitis when the children were aged 5 and maternal reports of asthma symptoms when the children were aged 14. Symptoms of internalizing behaviors were obtained by maternal reports (Child Behavior Checklist) at 5 years and by maternal and children's reports at 14 years (Child Behavior Checklist and Youth Self Report). RESULTS Although there was no association between prevalence of asthma and externalizing symptoms, asthma and internalizing symptoms were significantly associated in cross-sectional analyses at 5 and 14 years. In prospective analyses, after excluding children with asthma at 5 years, internalizing symptoms at age 5 were not associated with the development of asthma symptoms at age 14. After excluding children with internalizing symptoms at 5 years, those who had asthma at 5 years had greater odds of developing internalizing symptoms at age 14. CONCLUSION Children who have asthma/bronchitis by the age of 5 are at greater risk of having internalizing behavior problems in adolescence.
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Affiliation(s)
- Rosa Alati
- School of Population Health, University of Queensland, Queensland 4101, Australia.
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De Peuter S, Van Diest I, Lemaigre V, Verleden G, Demedts M, Van den Bergh O. Dyspnea: the role of psychological processes. Clin Psychol Rev 2005; 24:557-81. [PMID: 15325745 DOI: 10.1016/j.cpr.2004.05.001] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2003] [Revised: 04/05/2004] [Accepted: 05/26/2004] [Indexed: 12/12/2022]
Abstract
Breathlessness or dyspnea-the subjective experience of breathing discomfort-is a symptom in many pulmonary, cardiovascular, and neuromuscular diseases. It occurs in normals as well during intense emotional states and heavy labor or exercise. In clinical cases, it generally causes severe suffering. Dyspnea has multifactorial causes and the explanation for the symptom may differ largely among patients. Explanatory models imply the involvement of mechanisms at several levels of functioning, such as afferent signals from the respiratory muscles or blood gas levels related to hypercapnia and hypoxia. Depending on the relative involvement of specific mechanisms and their interactions, dyspnea may be experienced differently and subtypes can be distinguished. More recently, perceptual-cognitive and emotional processes related to symptom perception and interpretation have been investigated in the context of dyspnea. In this review, we focus on the psychological processes that play part in the perception of dyspnea and formulate some practical guidelines for those who are confronted with dyspnea.
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Strine TW, Ford ES, Balluz L, Chapman DP, Mokdad AH. Risk behaviors and health-related quality of life among adults with asthma: the role of mental health status. Chest 2005; 126:1849-54. [PMID: 15596683 DOI: 10.1378/chest.126.6.1849] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Previous research indicates that asthma is strongly associated with depressive disorders. Depression among persons with asthma is associated with poor adherence to medication regimens, more severe asthma, and poorer disease outcomes. The objective of our study was to examine the association of frequent mental distress (FMD) [ie, > or = 14 days in the past 30 days in which respondents reported that their mental health was not good] with modifiable risk behaviors (ie, smoking, physical inactivity, and obesity) and health-related quality of life among adults with asthma. METHODS The Behavioral Risk Factor Surveillance System is an ongoing, state-based survey that is conducted by random-digit dialing of noninstitutionalized US adults aged > or = 18 years. In 2001, all 50 states administered the asthma and risk behavior questionnaires (15,080 questionnaires). A total of 12 states administered the health-related quality-of-life questionnaire (3,226 questionnaires). We estimated prevalences, 95% confidence intervals, odds ratios, and adjusted odds ratios (AORs) using a statistical software program to account for the complex survey design. RESULTS The prevalence of FMD among adults with asthma was 18.8%. After adjusting for sociodemographic characteristics, the overall associations between smoking and FMD (AOR, 1.9), and between physical inactivity and FMD (AOR, 1.7) were statistically significant. In addition, among those with asthma, persons with FMD were significantly more likely than those without FMD to report fair/poor general health, frequent physical distress, frequent activity limitations, frequent anxiety, and frequent sleeplessness. CONCLUSIONS FMD is highly prevalent among persons with asthma, suggesting an apparent synergistic effect of these two conditions. The assessment of the mental health status of persons with asthma by health-care providers appears to be warranted and may prevent the emergence of risk behaviors yielding deleterious effects on the management of this disease.
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Affiliation(s)
- Tara W Strine
- Division of Adult and Community Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop K-66, Atlanta, GA 30341, USA.
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Rietveld S, Karsdorp PA, Mulder BJM. Heartbeat sensitivity in adults with congenital heart disease. Int J Behav Med 2004; 11:203-11. [PMID: 15657020 DOI: 10.1207/s15327558ijbm1104_3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study tested the hypothesis that patients with a congenital heart disease are sensitive regarding heartbeat perception, reflected in enhanced attention for heartbeat, estimation of own heart rate, and a vulnerability to become anxious by listening to heartbeat sounds. Twenty adults with a congenital heart disease, and 20 healthy controls conducted 3 experimental tasks: a concentration task during distraction by heartbeat sounds, own heart rate estimation, and exposure to different patterns of heartbeat sounds. The results showed that patients were more distracted by heartbeat, and were also worse at estimating heart rate than controls. However, heartbeat sounds did not evoke anxiety. In conclusion, patients with a congenital heart disease may differ from controls in heartbeat perception, but there was no support for obsessive monitoring for heartbeat or excessive reactions to heartbeat sounds.
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Affiliation(s)
- Simon Rietveld
- Department of Psychology, University of Amsterdam, The Netherlands.
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Ortega AN, Goodwin RD, McQuaid EL, Canino G. Parental mental health, childhood psychiatric disorders, and asthma attacks in island Puerto Rican youth. ACTA ACUST UNITED AC 2004; 4:308-15. [PMID: 15264963 DOI: 10.1367/a03-169r1.1] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Previous research documents an association of poor parental mental health with asthma in children. This study aims to determine whether the associations between parental mental health problems and childhood asthma attacks persist after controlling for childhood anxiety and depression and other confounding factors. DESIGN/METHODS A community household sample of youth ages 4 to 17 years and their primary caregivers from the US Commonwealth of Puerto Rico was studied to determine the associations between parental mental health and childhood asthma attacks. Regression models that predicted asthma attacks in youth controlled for parental mental health problems, childhood anxiety and depression, zone of residence, and parents' age, education, and perception of poverty. RESULTS After adjusting for children's depressive and anxiety disorders as well as other important confounders, associations between parental depression, suicide attempts, ataque de nervios, and history of mental health treatment and asthma attacks in offspring, by parental report, persisted. Additionally, the frequency of parental mental health problems was associated with children's asthma attacks. CONCLUSION Parents with mental health problems were more likely to report histories of asthma attacks in their children compared with parents without mental health problems in Puerto Rico. These associations were not attributable to internalizing disorders in youth but persisted independent of childhood psychopathology and other confounding factors. Clinicians and researchers should recognize the relations between poor parental mental health and childhood asthma and explore the potential role of family psychosocial and behavioral factors related to the manifestation of the disease.
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Affiliation(s)
- Alexander N Ortega
- Division of Health Behavior and Health Promotion, The Ohio State University School of Public Health, Columbus, 43210, USA.
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Rietveld S, Rietvelt S, Houtveen JH. Acquired sensitivity to relevant physiological activity in patients with chronic health problems. Behav Res Ther 2004; 42:137-53. [PMID: 14975777 DOI: 10.1016/s0005-7967(03)00104-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2003] [Revised: 03/17/2003] [Accepted: 03/25/2003] [Indexed: 11/22/2022]
Abstract
The hypothesis that biased symptom perception toward excessive symptoms is common when relatively normal chronic patients enter symptom-relating situations, irrespective of emotional variables, was tested in 19 women with severe asthma, 18 with somatization-like characteristics, and 18 controls. Each underwent three experimental conditions: mental stress, resting, and physical exercise. Each condition included three breathing conditions: breathing normally, normal compressed air, and 5.5% CO2-enriched compressed air. Results yielded no group differences in physiological measures, e.g. elevated CO2 in exhaled air (end-tidal partial pressure of CO2, PetCO2), or lung function. Asthma patients experienced more breathlessness, and somatization-like participants more breathlessness, miscellaneous symptoms, and subjective stress than controls. Although these differences suggested acquired biased symptom perception, as it turned out, breathlessness in asthmatics was more influenced by PetCO2 and less by subjective stress compared to controls. Likewise, breathlessness in somatization-like participants was similarly influenced by PetCO2 and subjective stress compared to controls, and miscellaneous symptoms were even more influenced by PetCO2 and less by subjective stress compared to controls. It was concluded that acquired sensitivity to physiological activity associated with habitual symptoms may account for excessive symptoms in patients with chronic health problems.
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Affiliation(s)
- Simon Rietveld
- Department of Clinical Psychology, University of Amsterdam, Roetersstraat 15, 1018 WB Amsterdam, The Netherlands.
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&NA;. Psychiatric factors influence the diagnosis, treatment and self-management of asthma. DRUGS & THERAPY PERSPECTIVES 2003. [DOI: 10.2165/00042310-200319100-00004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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