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Wisnivesky JP, Agrawal N, Ankam J, Gonzalez A, Busse P, Lin J, Federman A, Feldman J, Weiss JJ, Markowitz SB. World Trade Center workers with asthma and post-traumatic stress disorder perceive airflow limitation more accurately. Ann Allergy Asthma Immunol 2024; 132:62-68. [PMID: 37580015 DOI: 10.1016/j.anai.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a major risk factor for increased asthma morbidity among World Trade Center (WTC) workers. OBJECTIVE To investigate whether differences in perception of airflow limitation mediate the association of PTSD with worse asthma control in WTC workers. METHODS We collected data from WTC workers on asthma control (Asthma Control Questionnaire and Asthma Quality of Life Questionnaire) and daily peak expiratory flow (PEF) measures over 6 weeks. Perception of airway limitation was assessed by comparing guessed vs actual PEF values. Post-traumatic stress disorder was diagnosed using the Structured Clinical Interview. We used unadjusted and adjusted models to compare PEF and perception measures in WTC workers with PTSD with those of workers without PTSD. RESULTS Overall, 25% of 224 participants had PTSD. Post-traumatic stress disorder was associated with worse Asthma Control Questionnaire (2.2±0.8 vs 1.1±0.9, P < .001) and Asthma Quality of Life Questionnaire (3.9±1.1 vs 5.4±1.1, P < .001) scores. Adjusted analyses showed no significant differences in PEF between WTC workers with (351.9±143.3 L/min) and those without PTSD (364.6±131.6 L/min, P = .55). World Trade Center workers with PTSD vs those without PTSD had increased proportion of accurate perception (67.0±37.2% vs 53.5±38.1%, P = .01) and decreased underperception (23.3.0±32.1% vs 38.9±37.5%, P = .004) of airflow limitation during periods of limitation. Similar results were obtained in adjusted analyses. CONCLUSION This study indicates that differences in perception of airflow limitation may mediate the relationship of PTSD and increased asthma symptoms, given WTC workers with PTSD have worse self-reported asthma control, an increased proportion of accurate perception, and decreased underperception, despite no differences in daily PEF measures.
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Affiliation(s)
- Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Nikita Agrawal
- Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jyoti Ankam
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adam Gonzalez
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, New York
| | - Paula Busse
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jenny Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alex Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jonathan Feldman
- Ferkauf Graduate School of Psychology, Albert Einstein College of Medicine, Bronx, New York; Division of Academic General Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York; Division of Academic General Pediatrics, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Jeffrey J Weiss
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Steven B Markowitz
- Barry Commoners Center for Health and Environment, Queens College, City University of New York, New York
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Fruchter N, Arcoleo K, Rastogi D, Serebrisky D, Warman K, Feldman JM. Attention-Deficit Hyperactivity Disorder Symptoms, Underperception of Respiratory Compromise, and Illness Representations in Black and Latino Children With Asthma. J Pediatr Psychol 2023; 48:896-906. [PMID: 37743051 PMCID: PMC10653357 DOI: 10.1093/jpepsy/jsad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE This study examined the associations between attention-deficit/hyperactivity disorder (ADHD) symptoms, underperception of respiratory compromise, and illness representations in Black and Latino children with asthma. We hypothesized that increased child-reported ADHD symptoms, as well as parent reports for their child, would be associated with underperception of respiratory compromise, and maladaptive asthma beliefs. METHODS Two hundred ninety-six parent-child dyads were recruited from pediatric asthma and primary care clinics in the Bronx. Participants completed demographic questionnaires, the Conners-3 ADHD Index to measure ADHD symptoms, and the Asthma Illness Representation Scale to assess asthma beliefs. Perception of respiratory compromise was assessed by programmable electronic peak flow monitors that measured the child's subjective estimates of peak expiratory flow (PEF) and actual PEF, with underperception as the primary measure. RESULTS Child-reported ADHD symptoms were associated with greater underperception (β = .117, p = .049) of respiratory compromise. Parent-reported ADHD symptoms were associated with greater underperception (β = .129, p = .028) of respiratory compromise. Child-reported ADHD symptoms (β = -.188, p < .001) were associated with more maladaptive asthma beliefs, F(1, 341) = 13.135. Parent-reported ADHD symptoms (β = -.203, p ≤ .001) were associated with more maladaptive asthma beliefs, F(1, 341) = 15.644. CONCLUSIONS ADHD symptoms were associated with a greater underperception of respiratory compromise and more maladaptive asthma beliefs. Deficits of attentional processes and/or hyperactivity levels might be contributing factors. We emphasize the need for psychoeducation and interventions that improve perception and health beliefs in children with comorbid ADHD and asthma.
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Affiliation(s)
| | | | - Deepa Rastogi
- Division of Respiratory and Sleep Medicine, Albert Einstein College of Medicine/The Children's Hospital at Montefiore, USA
| | | | - Karen Warman
- Division of General Academic Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine/The Children’s Hospital at Montefiore, USA
| | - Jonathan M Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, USA
- Division of General Academic Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine/The Children’s Hospital at Montefiore, USA
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Ruppe NM, Clawson AH, Ankney RL, Welch G, Mullins LL, Chaney JM. Depressive Symptom Trajectories Across Adolescence and Adulthood Among Individuals With Asthma. J Pediatr Psychol 2023; 48:572-582. [PMID: 37130344 PMCID: PMC10321385 DOI: 10.1093/jpepsy/jsad022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE Individuals with asthma experience increased depressive symptoms, which is associated with deleterious health outcomes. No studies have examined depressive symptom trajectories among individuals with asthma despite increased risk. This study expanded prior literature by identifying the following: (1) depressive symptoms trajectories for individuals with and without asthma and (2) predictors of baseline levels and changes in symptoms across time for individuals with asthma. METHODS Adolescents with (N = 965) and without (N = 7,392) asthma self-reported on depressive symptoms (CESD-9) across development. Covariates included: demographics and persistence of asthma. Latent growth curve modeling (LGCM) was used to identify depressive symptom trajectories and their predictors. RESULTS A multigroup LCGM identified no significant differences between depressive symptom trajectories of individuals with and without asthma. Depressive symptoms followed a quadratic shape across time for individuals with asthma (Mintercept = 5.73, p < .00; Mlinear = -0.38,p < .001; Mquad = 0.03, p < .001), with a linear deceleration in depressive symptoms during adolescence and an acceleration of symptoms into adulthood. Next predictors of depressive trajectories among individuals with asthma were examined. Female sex (B = 0.58, p < .001), lower parent education (B = -0.57, p < .001), older age (B = 0.19, p < .001), and identifying as Black (B = 0.31, p = .04) were associated with greater baseline depressive symptoms. Older individuals exhibited faster linear symptom decelerations (B = -0.56, p < .001) and faster symptom accelerations (B = 0.73, p < .001). American Indian (AIAN) individuals exhibited faster linear symptom decelerations (B = -1.98, p = .005) and faster quadratic accelerations (B = 3.33, p = .007). DISCUSSION Our results suggest that the depressive symptom trajectories of individuals with asthma are curvilinear and similar to individuals without asthma. When examining predictors of depressive symptom trajectories for those with asthma, socioeconomic disadvantage and racial marginalization were associated with greater baseline depressive symptoms. Although AIAN youth demonstrated more favorable trajectories in adolescence, they also exhibited worse trajectories across young adulthood and adulthood. Findings suggest the need to better understand the impact of multilevel risk and protective factors on depressive symptoms trajectories for individuals with asthma, especially marginalized populations.
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Affiliation(s)
- Nicole M Ruppe
- Department of Psychology, Oklahoma State University, USA
- Center for Pediatric Psychology, Oklahoma State University, USA
| | - Ashley H Clawson
- Center for the Study of Tobacco, Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham St., #820, Little Rock, AR 72205, USA
| | | | - Ginger Welch
- Department of Human Development and Family Science, Oklahoma State University, USA
| | - Larry L Mullins
- Department of Psychology, Oklahoma State University, USA
- Center for Pediatric Psychology, Oklahoma State University, USA
| | - John M Chaney
- Department of Psychology, Oklahoma State University, USA
- Center for Pediatric Psychology, Oklahoma State University, USA
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Starr S, Wysocki M, DeLeon JD, Silverstein G, Arcoleo K, Rastogi D, Feldman JM. Obesity-related pediatric asthma: relationships between pulmonary function and clinical outcomes. J Asthma 2023; 60:1418-1427. [PMID: 36420526 PMCID: PMC10191971 DOI: 10.1080/02770903.2022.2152351] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/20/2022] [Accepted: 11/23/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We hypothesized that children with obesity-related asthma would have worse self-reported asthma control, report an increased number of asthma symptoms and have lower FEV1/FVC associated with worse clinical asthma outcomes compared to children with asthma only. METHODS Cross sectional analyses examined two hundred and eighteen (obesity-related asthma = 109, asthma only = 109) children, ages 7-15 that were recruited from clinics and hospitals within the Bronx, NY. Pulmonary function was assessed by forced expiratory volume in the first second (percent predicted FEV1) and the ratio of FEV1 to the forced vital capacity of the lungs (FEV1/FVC). Structural equation modeling examined if pulmonary function was associated with asthma control and clinical outcomes between groups. RESULTS Lower percent predicted FEV1 was associated with increased hospitalizations (p = 0.03) and oral steroid bursts in the past 12 months (p = 0.03) in the obesity-related asthma group but not in the asthma only group. FEV1/FVC was also associated with increased hospitalizations (p = 0.02) and oral steroid bursts (p = 0.008) in the obesity-related asthma group but not the asthma only group. Lower FEV1/FVC was associated with the number of asthma symptoms endorsed in the asthma only group but not in the obesity-related asthma group. Percent predicted FEV1 and FEV1/FVC was not associated with asthma control in either group. CONCLUSIONS Pulmonary function was associated with oral steroid bursts and hospitalizations but not self-reported asthma control, suggesting the importance of incorporating measures of pulmonary function into the treatment of pediatric obesity-related asthma.
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Affiliation(s)
- Sheena Starr
- Ferkauf Graduate School of Psychology, Yeshiva University, Rousso Building, 1165 Morris Park Ave., Bronx NY, 10467
| | - Matthew Wysocki
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Department of Pediatrics, Division of Academic General Pediatrics, Department of Psychiatry & Behavioral Sciences, 3415 Bainbridge Ave, Bronx, NY 10467
| | - Jesenya D. DeLeon
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Department of Pediatrics, Division of Academic General Pediatrics, Department of Psychiatry & Behavioral Sciences, 3415 Bainbridge Ave, Bronx, NY 10467
| | - Gabriella Silverstein
- Ferkauf Graduate School of Psychology, Yeshiva University, Rousso Building, 1165 Morris Park Ave., Bronx NY, 10467
| | - Kimberly Arcoleo
- University of Rhode Island, College of Nursing, 350 Eddy Street, Providence, RI 02903
| | - Deepa Rastogi
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Department of Pediatrics, Division of Academic General Pediatrics, Department of Psychiatry & Behavioral Sciences, 3415 Bainbridge Ave, Bronx, NY 10467
| | - Jonathan M. Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Rousso Building, 1165 Morris Park Ave., Bronx NY, 10467
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Department of Pediatrics, Division of Academic General Pediatrics, Department of Psychiatry & Behavioral Sciences, 3415 Bainbridge Ave, Bronx, NY 10467
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Ramos MS, Corona R, Dempster KW, Morton SCM, Everhart RS. The COVID-19 pandemic: asthma control, tobacco use, and mental health among African American and Latinx college students. J Asthma 2023; 60:496-507. [PMID: 35385676 DOI: 10.1080/02770903.2022.2062673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study investigated the impact of COVID-19 on tobacco use and mental health in US African American and Latinx college students with asthma. Associations among asthma control, tobacco use, and mental health were also examined. METHODS 105 African American and Latinx college students with asthma (18-23 years) completed two online questionnaires (June 2019-March 2020 for Time 1; August 2020-October 2020 for Time 2). Participants completed the Epidemic-Pandemic Impacts Inventory (measure of COVID-19 impact), Asthma Control Test, Generalized Anxiety Disorder scale, Patient Health Questionnaire (measure of depression), Perceived Stress Scale, and items related to tobacco use. RESULTS Asthma control improved (t = -3.326, p = 0.001) from Time 1 to 2, and e-vapor product use decreased (χ2104 = 6.572, p = 0.010). COVID-19 impact was positively associated with students' symptoms of anxiety, depression, and perceived stress (B = 0.201, p < 0.001; B = 0.179, p < 0.001; and B = 0.199, p = 0.001, respectively) at Time 2. These results remained significant with the Benjamini-Hochberg correction. Asthma control at Time 1 was negatively associated with anxiety symptoms at Time 2 (B = -0.418, p = 0.023); however, associations with perceived stress (B = -0.514, p = 0.019) and all other tobacco product use (B = -0.233, p = 0.030) did not remain significant with the Benjamini-Hochberg correction. CONCLUSIONS As hypothesized, a higher COVID-19 impact score was associated with students endorsing more mental health symptoms. Better control of asthma symptoms before the pandemic predicted fewer anxiety symptoms during the pandemic.
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Respiratory psychophysiology and COVID-19: A research agenda. Biol Psychol 2023; 176:108473. [PMID: 36535514 PMCID: PMC9756651 DOI: 10.1016/j.biopsycho.2022.108473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 12/03/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
After multiple waves of the COVID-19 pandemic, it has become clear that the impact of SARS-CoV-2 will carry on for years to come. Acutely infected patients show a broad range of disease severity, depending on virus variant, vaccination status, age and the presence of underlying medical and physical conditions, including obesity. Additionally, a large number of patients who have been infected with the virus present with post-COVID syndrome. In September 2020, the International Society for the Advancement of Respiratory Psychophysiology organized a virtual interest meeting on 'Respiratory research in the age of COVID-19', which aimed to discuss how research in respiratory psychophysiology could contribute to a better understanding of psychophysiological interactions in COVID-19. In the resulting current paper, we propose an interdisciplinary research agenda discussing selected research questions on acute and long-term neurobiological, physiological and psychological outcomes and mechanisms related to respiration and the airways in COVID-19, as well as research questions on comorbidity and potential treatment options, such as physical rehabilitation.
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7
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Kaur K, Arcoleo KJ, Serebrisky D, Rastogi D, Marsiglia FF, Feldman JM. Impact of caregiver depression on child asthma outcomes in Mexicans and Puerto Ricans. J Asthma 2022; 59:2246-2257. [PMID: 34793283 PMCID: PMC9534376 DOI: 10.1080/02770903.2021.2008427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/06/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Examine whether caregiver depressive symptoms at baseline predict longitudinal child asthma outcomes in the two populations with the largest asthma disparities: Mexicans and Puerto Ricans. METHODS Two hundred and sixty-seven Hispanic caregiver-child dyads (Mexican = 188, Puerto Rican = 79; children 5-12 years) were recruited from clinics and hospitals in Phoenix, AZ and the Bronx, NY. The Center for Epidemiological Studies Depression Scale assessed caregiver depressive symptoms; higher scores indicate greater depressive symptomology. Medical records verified child asthma diagnosis. Assessments for outcome variables occurred at baseline, 3, 6, 9, and 12-month follow-ups. Pulmonary function was measured by spirometry, asthma control was measured by the Asthma Control Test, steroid bursts and acute healthcare utilization were assessed by caregiver report and medical records, and adherence was measured by doser devices on controller medications. Structural equation modeling analyzed baseline caregiver depressive symptoms as a predictor of longitudinal child asthma outcomes, and differences between subgroups. RESULTS Higher caregiver depressive symptoms predicted better pulmonary function (β = .02, p = .001) in Mexican children, and fewer steroid bursts (β = -.41, p = .01) and better medication adherence (β = .02, p = .07) in Puerto Rican children. Caregiver depressive symptoms did not predict pediatric asthma control or acute healthcare utilization in either subgroup. CONCLUSIONS Caregiver depressive symptomology had unexpected effects on child asthma outcomes. Results may be explained by the Hispanic paradox, caregiver resilience, acculturation, and the study's longitudinal nature. Further research is needed on social determinants of health that may influence differences in child asthma outcomes in heterogeneous Hispanic communities.
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Affiliation(s)
- Karenjot Kaur
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | | | | | - Deepa Rastogi
- Children’s National Medical Center, GW University School of Medicine and Health Science, Washington, DC
| | | | - Jonathan M. Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, NY
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Fossati A, Challier C, Dalhoumi AA, Rose J, Robinson A, Perisson C, Galode F, Luaces B, Fayon M. Telehome Monitoring of Symptoms and Lung Function in Children with Asthma. Healthcare (Basel) 2022; 10:healthcare10061131. [PMID: 35742182 PMCID: PMC9222427 DOI: 10.3390/healthcare10061131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/25/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The ability to perceive bronchial obstruction is variable in asthma. This is one of the main causes of inaccurate asthma control assessment, on which therapeutic strategies are based. Objective: Primary: To evaluate the ability of physicians to characterize the bronchial obstruction perception profile in asthmatic children using a clinical and spiro-metric telemonitoring device. Secondary: To evaluate its impact on asthma management (control, treatment, respiratory function variability) and the acceptability of this telemonitoring system. Methods: 26 asthmatic children aged 6−18 years equipped with a portable spirometer and a smartphone application were home-monitored remotely for 3 months. Clinical and spiro-metric data were automatically transmitted to a secure internet platform. By analyzing these data, three physicians blindly and independently classified the patients according to their perception profile. The impact of telemonitoring on the quantitative data was assessed at the beginning (T0) and end (T3 months) of telemonitoring, using matched statistical tests. Results: Patients could initially be classified according to their perception profile, with a concordance between the three observers of 64% (kappa coefficient: 0.55, 95%CI [0.39; 0.71]). After discussion among the observers, consensus was reached for all patients but one. There was a significant >40% decrease in FEV1 and PEF variability, with good acceptance of the device. Conclusions: Clinical and spiro-metric tele-home monitoring is applicable and can help define the perception profile of bronchial obstruction in asthmatic children. The device was generally well accepted.
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Affiliation(s)
- Audrey Fossati
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Pediatrics Department, Pediatric Pulmonology, CEDEX, 33076 Bordeaux, France; (C.C.); (F.G.); (M.F.)
- Correspondence:
| | - Caroline Challier
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Pediatrics Department, Pediatric Pulmonology, CEDEX, 33076 Bordeaux, France; (C.C.); (F.G.); (M.F.)
| | - Aman Allah Dalhoumi
- Centre Hospitalier d’Agen-Nérac, Pediatrics Department, 47000 Agen, France; (A.A.D.); (B.L.)
| | - Javier Rose
- Paediatric Department, Seychelles Hospital, Victoria P.O. Box 52, Seychelles;
| | - Annick Robinson
- Centre Hospitalier Universitaire Mère Enfant Tsaralàlana, Department of Child Health, Teaching Hospital, Antananarivo 3GVF+76F, Madagascar;
| | - Caroline Perisson
- Centre Hospitalier Universitaire Réunion Sud, Service de Pédiatrie, 97410 Saint Pierre, France;
| | - François Galode
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Pediatrics Department, Pediatric Pulmonology, CEDEX, 33076 Bordeaux, France; (C.C.); (F.G.); (M.F.)
| | - Baptiste Luaces
- Centre Hospitalier d’Agen-Nérac, Pediatrics Department, 47000 Agen, France; (A.A.D.); (B.L.)
| | - Michael Fayon
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Pediatrics Department, Pediatric Pulmonology, CEDEX, 33076 Bordeaux, France; (C.C.); (F.G.); (M.F.)
- Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, Université de Bordeaux, 33000 Bordeaux, France
- Centre d’Investigation Clinique (CIC1401), INSERM, 33076 Bordeaux, France
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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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Lee J, Kim MS, Kim CH, Moon YJ, Choi YH. Factors Associated With Quality of Life in Children Receiving Pediatric Palliative Care. J Pain Symptom Manage 2022; 63:395-403. [PMID: 34656653 DOI: 10.1016/j.jpainsymman.2021.10.005] [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] [Received: 03/13/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT Since pediatric palliative care (PPC) aims to improve the health-related quality of life (HRQoL) of children with life-limiting conditions (LLC), assessment of their HRQoL and identification of its determinants is crucial. OBJECTIVES To examine the clinical and family factors associated with HRQoL of children with LLC METHODS: This was a cross-sectional study of 136 pediatric patients with LLC who were enrolled in the PPC services at Seoul National University Hospital in South Korea. Patients' HRQoL was measured using the Pediatric Quality of Life 4.0. Clinical and family characteristics were gathered from the medical records and PPC registry database. RESULTS Most children with LLC have a poor HRQoL at their enrollment for PPC services with significant variation in their total HRQoL scores according to the diagnostic categories. Patients with nonmalignant conditions showed significantly lower HRQoL scores than patients with malignancy. Lower HRQoL scores were associated with more caregiver depressive symptoms. In a multivariable regression model, total HRQoL scores of patients were significantly associated with diagnostic categories and caregiver's depressive symptoms after controlling for other clinical and family variables. Physical health summary scores were significantly associated with diagnostic categories and caregiver depressive symptoms. Psychosocial health summary scores were significantly associated with diagnostic categories, patient location, and caregiver's depressive symptoms. CONCLUSION The HRQoL of children with LLC receiving PPC differed among underlying disease categories. Lower HRQoL was associated with more caregiver depressive symptoms. These findings suggest the needs for optimized intervention in palliative care for children with nonmalignant conditions and family-centered intervention to address caregivers' psychosocial problems.
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Affiliation(s)
- Jung Lee
- Integrative Care Hub (J.L., Y.J.M.), Seoul National University Children's Hospital, Seoul, South Korea
| | - Min Sun Kim
- Department of Pediatrics (M.S.K.), Seoul National University Children's Hospital, Seoul, South Korea.
| | - Cho Hee Kim
- College of Nursing (C.H.K.), Seoul National University, Seoul, South Korea
| | - Yi Ji Moon
- Integrative Care Hub (J.L., Y.J.M.), Seoul National University Children's Hospital, Seoul, South Korea
| | - Yu Hyeon Choi
- Department of Pediatrics (Y.H.C.), Hanyang University Hospital, Seoul, South Korea
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11
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Becker JH, Feldman JM, Arora A, Busse PJ, Wisnivesky JP, Federman AD. Cognition, symptom perception, and medication non-adherence in older adults with asthma. J Asthma 2022; 59:607-615. [PMID: 33249956 PMCID: PMC8180526 DOI: 10.1080/02770903.2020.1856867] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cognitive impairment (CI) is highly prevalent in elderly asthmatics and is associated with worse asthma self-management (SM) and outcomes. CI may also explain why older adults may under-perceive asthma symptoms. We hypothesized that CI would be associated with low medication adherence and asthma symptom under-perception (ASP). We also hypothesized that ASP would mediate the relationship between CI and medication adherence. METHODS Participants of this longitudinal cohort study were asthmatics (N = 334) ≥60 years (51% Hispanic, 25% Black). Cognitive measures assessed general cognition, attention, processing speed, executive functioning, memory, and language. Measures of SM were self-reported and electronically measured adherence to controller medications. ASP was assessed for 6 weeks by participants entering estimates of peak expiratory flow (PEF) into a programmable peak flow meter, followed by PEF blows. Participants were blinded to actual PEF values. Percentage of time that participants were in the over-perception zone was calculated as an average. RESULTS In regression analyses, those with impairments in memory and general cognition had lower odds ratios (OR) for self-reported non-adherence (OR: 0.96, 95% CI 0.93 - 0.98 & OR: 0.90, 95% CI 0.83 - 0.96, respectively). CI was not associated with electronically measured non-adherence or ASP. In structural equation modeling, while CI was associated with adherence (β = 0.04, SE = 0.021, p = 0.04), ASP did not mediate this relationship. CONCLUSIONS While results confirmed the importance of cognition in asthma SM, these findings were not linked to ASP. Future analyses are needed to understand the role of confounding factors.
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Affiliation(s)
- Jacqueline H. Becker
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan M. Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA;,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Arushi Arora
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paula J. Busse
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan P. Wisnivesky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex D. Federman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA;,Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Wisnivesky JP, Becker JH, Ankam J, Markowitz SB, Doernberg M, Dickens B, Busse P, Crowley L, Federman A, Katz C, Weiss JJ, Gonzalez A. The Relationship Between Post-Traumatic Stress Disorder and Self-Management Behaviors in World Trade Center Workers with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:242-249. [PMID: 34534721 PMCID: PMC8973280 DOI: 10.1016/j.jaip.2021.08.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Comorbid posttraumatic stress disorder (PTSD) is highly prevalent and associated with increased morbidity among World Trade Center (WTC) rescue and recovery workers with asthma. However, the potential behavioral pathways underlying this relationship remain unclear. OBJECTIVE To evaluate whether PTSD is associated with lower adherence to asthma self-management behaviors among WTC workers with asthma. METHODS We used data from a prospective cohort of WTC workers with a physician diagnosis of asthma who were prescribed controller medications. Presence of comorbid PTSD was determined based on structured clinical interviews. Asthma self-management behaviors included medication adherence, inhaler technique, use of action plans, and trigger avoidance. We conducted unadjusted and multiple regression analyses to evaluate the association of PTSD with asthma self-management. RESULTS Overall, 30% of 276 WTC workers with asthma had comorbid PTSD. Posttraumatic stress disorder was associated with worse asthma control and poorer quality of life. However, PTSD was not significantly associated with medication adherence (odds ratio [OR] -0.15; 95% confidence interval [CI] -0.5 to 0.2), inhaler technique (OR -0.12; 95% CI -0.7 to 0.5), use of action plans (OR 0.8; 95% CI 0.4 to 1.8), or trigger avoidance (OR 0.9; 95% CI 0.4 to 1.8). CONCLUSIONS We did not find significant differences in key asthma self-management behaviors between WTC workers with and without PTSD. These results suggest that other mechanisms, such as differences in symptom perception or inflammatory pathways, may explain the association between PTSD and increased asthma morbidity.
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Affiliation(s)
- Juan P. Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY,Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacqueline H. Becker
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jyoti Ankam
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven B. Markowitz
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens, NY
| | - Molly Doernberg
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brittany Dickens
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens, NY
| | - Paula Busse
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Laura Crowley
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alex Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Craig Katz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey J. Weiss
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adam Gonzalez
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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13
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Improving knowledge and decreasing depressive symptoms in caregivers of children with asthma through the asthma academy: A randomized controlled trial. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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14
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Batmaz SB, Birinci G, Akpınar Aslan E. Quality of Life of Children with Allergic Disease: The effect of Depression and Anxiety of Children and Their Mothers. J Asthma 2021; 59:1776-1786. [PMID: 34503366 DOI: 10.1080/02770903.2021.1978480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: In comparison with the general population, several studies have reported higher anxiety and depression rates not only in children with allergic diseases but also in their parents. We aimed to evaluate the mental health of children and their mothers affecting quality of life (QoL) in children with allergic diseases, and to compare anxiety and depression in these patients and their parents with the general population.Methods: One hundred and sixty-eight patients aged 8-18 years diagnosed with an allergic disease who visited our outpatient clinic and a control group of 61 children who did not have any chronic or allergic diseases were included in the study. Patients completed the Pediatric QoL Inventory, Trait Anxiety Inventory for Children, and Children's Depression Inventory, while mothers completed the General Anxiety Disorder-7 (GAD-7) scale and the Patient Health Questionnaire-9 (PHQ-9). Independent samples' t-test was used to compare children's QoL, trait anxiety, and depression scores and mothers' GAD-7 and PHQ-9 scores between the controlled/mild and uncontrolled/moderate-severe groups. The effects of age, gender, disease severity, maternal depression/anxiety, and children's depression/anxiety on QoL were analyzed with multivariate regression analyses.Results: QoL was lower in children with allergic diseases than healthy children, and although the mean QoL score was lower in the group with high disease severity, QoL in children with allergic diseases was not associated with disease severity but inversely related to anxiety/depression and maternal depression.Conclusions: As per the results, QoL is impaired in children with allergic diseases. Both anxiety/depression in the child and maternal depression may adversely affect QoL in these patients.
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Affiliation(s)
- Sehra Birgül Batmaz
- Department of Pediatric Allergy and Clinical Immunology, Tokat State Hospital, Tokat, Turkey
| | | | - Esma Akpınar Aslan
- Department of Psychiatry, School of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
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15
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Feldman JM, Becker J, Arora A, DeLeon J, Torres-Hernandez T, Greenfield N, Wiviott A, Jariwala S, Shim C, Federman AD, Wisnivesky JP. Depressive Symptoms and Overperception of Airflow Obstruction in Older Adults With Asthma. Psychosom Med 2021; 83:787-794. [PMID: 33938504 PMCID: PMC8419010 DOI: 10.1097/psy.0000000000000951] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Older adults are at increased risk for depression and poor asthma outcomes. We examined whether depressive symptoms are associated with overperception of airflow obstruction and a pattern of worse asthma control, but not pulmonary function. METHODS We recruited a cohort of adults with asthma 60 years and older in East Harlem and the Bronx, New York. Baseline measures included the Geriatric Depression Scale, Asthma Control Questionnaire, and Mini Asthma Quality of Life Questionnaire. Spirometry was conducted at baseline to assess pulmonary function. Perception of airflow obstruction was assessed for 6 weeks following baseline by participants entering estimates of peak expiratory flow (PEF) into a programmable peak flow meter followed by PEF blows. Participants were blinded to actual PEF values. The percentage of time that participants were in the overperception zone was calculated as an average. RESULTS Among the 334 participants (51% Hispanic, 25% Black), depressive symptoms were associated with overperception of airflow obstruction (β = 0.14, p = .029), worse self-reported asthma control (β = 0.17, p = .003), and lower asthma-related quality of life (β = -0.33, p < .001), but not with lung function (β = -0.01, p = .82). Overperception was also associated with worse self-reported asthma control (β = 0.14, p = .021), but not lung function (β = -0.05, p = .41). CONCLUSIONS Depressive symptoms were associated with greater perceived impairment from asthma, but not pulmonary function. Overperception of asthma symptoms may play a key role in the relationship between depression and asthma outcomes in older adults.
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Affiliation(s)
- Jonathan M Feldman
- From the Ferkauf Graduate School of Psychology (Feldman, Greenfield, Wiviott), Yeshiva University; Division of Academic General Pediatrics, Department of Pediatrics (Feldman, DeLeon, Torres-Hernandez), Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx; Division of General Internal Medicine (Becker, Arora, Federman, Wisnivesky), Icahn School of Medicine at Mount Sinai, New York; Division of Allergy/Immunology, Department of Medicine (Jariwala), Albert Einstein College of Medicine/Montefiore Medical Center; Division of Pulmonary Medicine, Department of Medicine (Shim), Jacobi Medical Center/Albert Einstein College of Medicine, Bronx; and Division of Pulmonary, Critical Care and Sleep Medicine (Wisnivesky), Icahn School of Medicine at Mount Sinai, New York, New York
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16
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Weinstein SM, Pugach O, Rosales G, Mosnaim GS, Orozco K, Pappalardo AA, Martin MA. Psychosocial Moderators and Outcomes of a Randomized Effectiveness Trial for Child Asthma. J Pediatr Psychol 2021; 46:673-687. [PMID: 33616185 PMCID: PMC8291673 DOI: 10.1093/jpepsy/jsab011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Psychosocial factors play a role in child asthma morbidity and disparities, but their impact on asthma intervention effectiveness is less understood. This study examined how child, parent, and family psychosocial factors moderated asthma response to, and changed in response to, 2 community asthma interventions among urban minority youth. METHODS Asthma Action at Erie was a randomized comparative effectiveness trial examining a community health worker (CHW) home intervention versus certified asthma educator (AE-C) services for children aged 5-16 with uncontrolled asthma (N = 223; mean age = 9.37, SD = 3.02; 85.2% Hispanic). Asthma control was assessed via the Asthma Control Test (ACT)/childhood ACT and activity limitation. Baseline child/parent depression and posttraumatic stress disorder (PTSD) symptoms, family chaos, and social support were examined as treatment moderators. We also tested intervention effects on psychosocial outcomes. RESULTS For parents with higher baseline depression symptoms, youth in the CHW group had greater ACT improvement by 24 months (7.49 points) versus AE-C (4.76 points) and 51% reduction in days of limitation by 6 months versus AE-C (ß = -0.118; p = .0145). For higher parent PTSD symptoms, youth in CHW had 68% fewer days of limitation at 24 months versus AE-C (ß = -0.091; p = .0102). Psychosocial outcomes did not vary by group, but parent depression, parent and child PTSD symptoms, and social support improved for all. CONCLUSIONS CHW intervention was associated with improved asthma control among families with higher parent strain. Findings have implications for utilizing tailored CHW home interventions to optimize asthma outcomes in at-risk families.
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Affiliation(s)
| | - Oksana Pugach
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Genesis Rosales
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Giselle S Mosnaim
- Department of Allergy, Immunology & Asthma, NorthShore University Health System
| | - Kimberly Orozco
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Andrea A Pappalardo
- Department of Pediatrics, University of Illinois at Chicago
- Department of Medicine, University of Illinois at Chicago
| | - Molly A Martin
- Institute for Health Research and Policy, University of Illinois at Chicago
- Department of Pediatrics, University of Illinois at Chicago
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Griffiths D, Giancola LM, Welsh K, MacGlashing K, Thayer C, Gunnlaugsson S, Stamatiadis NP, Sierra GC, Hammond A, Greco KF, Simoneau T, Baxi SN, Gaffin JM. Asthma control and psychological health in pediatric severe asthma. Pediatr Pulmonol 2021; 56:42-48. [PMID: 33058494 PMCID: PMC7736198 DOI: 10.1002/ppul.25120] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Psychological comorbidities have been associated with asthma in adults and children, but have not been studied in a population of children with severe asthma. The aim of this study was to test the hypothesis that symptoms of anxiety or depression are highly prevalent in pediatric severe asthma and negatively effects asthma control. METHODS Longitudinal assessments of anxiety or depression symptoms (Patient Health Questionnaire-4 [PHQ-4]), asthma control (Asthma Control Test [ACT]), and lung function were performed in a single-center pediatric severe asthma clinic. Participant data were collected during routine clinical care. Primary outcomes were ACT and forced expiratory volume in 1 s per forced vital capacity (FEV1/FVC). RESULTS Among 43 subjects (with total 93 observations), 58.1% reported at least one anxious or depressive symptom and 18.6% had a PHQ-4 more than 2, the threshold for an abnormal test result. After adjusting for age, sex, race, and asthma medication step, there was a significant reduction in ACT for girls with PHQ-4 more than 2 (adjusted mean [SE] ACT for PHQ-4 > 2: 13.64 [0.59], ACT for PHQ-4 ≤ 2: 20.64 [1.25], p = .02) but not boys. Moreover, there was a significant differential effect of mental health impairment for girls than boys. ACT for girls with PHQ more than 2: 13.64 (0.59) compared with boys with PHQ-4 more than 2: 17.82 (0.95), adjusted mean difference ACT by sex = 4.18 points; 95% confidence interval, 0.63-7.73; p = .033. In adjusted models, there was no association between PHQ-4 more than 2 and FEV1/FVC. CONCLUSIONS Symptoms of anxiety and depression are common. In children with severe asthma, a PHQ-4 score more than 2 is associated with worse asthma symptom control in girls, but not boys.
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Affiliation(s)
- Delaney Griffiths
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lauren M Giancola
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kelly Welsh
- Department of Social Work, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kristen MacGlashing
- Department of Social Work, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christine Thayer
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sigfus Gunnlaugsson
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie P Stamatiadis
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Gabriella C Sierra
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Adam Hammond
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kimberly F Greco
- Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Tregony Simoneau
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Sachin N Baxi
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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18
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Difficult and Severe Asthma in Children. CHILDREN-BASEL 2020; 7:children7120286. [PMID: 33322016 PMCID: PMC7764801 DOI: 10.3390/children7120286] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 12/24/2022]
Abstract
Asthma is the most frequent chronic inflammatory disease of the lower airways affecting children, and it can still be considered a challenge for pediatricians. Although most asthmatic patients are symptom-free with standard treatments, a small percentage of them suffer from uncontrolled persistent asthma. In these children, a multidisciplinary systematic assessment, including comorbidities, treatment-related issues, environmental exposures, and psychosocial factors is needed. The identification of modifiable factors is important to differentiate children with difficult asthma from those with true severe therapy-resistant asthma. Early intervention on modifiable factors for children with difficult asthma allows for better control of asthma without the need for invasive investigation and further escalation of treatment. Otherwise, addressing a correct diagnosis of true severe therapy-resistant asthma avoids diagnostic and therapeutic delays, allowing patients to benefit from using new and advanced biological therapies.
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19
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Parents' Acceptance of Learning about Mindfulness for Managing Pediatric Asthma. CHILDREN-BASEL 2020; 7:children7120262. [PMID: 33260496 PMCID: PMC7760491 DOI: 10.3390/children7120262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/17/2020] [Accepted: 11/26/2020] [Indexed: 12/04/2022]
Abstract
Background: Emerging research suggests mindfulness may reduce stress and asthma symptoms in children, yet there is a gap in understanding parental views towards learning about mindfulness. Objective: This study aimed to compare the perceived acceptance to learn about mindfulness among parents of children with and without asthma, and to understand differences across income levels. Methods: This was a national, cross-sectional, online survey of parents of children 0–18 years. Acceptance was measured with questions on whether parents believe mindfulness could be beneficial while parenting, and if they would be willing to learn about mindfulness. Comparisons of mindfulness acceptance between income level were conducted using chi-square and Fisher’s exact test. Results: Parents of children with asthma were more likely to be interested in learning about mindfulness from their health care provider compared to those without asthma (46% vs. 38%, p < 0.0001). At all income levels examined in the study, parents (63–75%) of children with asthma indicated that they agreed or strongly agreed that mindfulness can be beneficial when parenting. Conclusion: Findings suggest an opportunity to incorporate mindfulness teaching into asthma care for pediatric patients of all income levels.
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20
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Wisnivesky JP, Markowitz SB, James S, Stone K, Dickens B, Busse P, Crowley L, Federman A, Katz C, Gonzalez A. Comorbid posttraumatic stress disorder and major depressive disorder are associated with asthma morbidity among World Trade Center workers. Ann Allergy Asthma Immunol 2020; 126:278-283. [PMID: 33098982 DOI: 10.1016/j.anai.2020.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/21/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND World Trade Center (WTC) rescue and recovery workers have a high burden of asthma, comorbid posttraumatic stress disorder (PTSD), and major depressive disorder (MDD). PTSD is associated with worse asthma outcomes. OBJECTIVE In this study, we evaluated whether the relationship between PTSD and asthma morbidity is modified by the presence of MDD. METHODS We used data from a cohort of WTC workers with asthma. Asthma control (asthma control questionnaire), resource utilization, and quality of life (asthma quality of life questionnaire) were evaluated. We used regression analyses to evaluate the adjusted association of PTSD and MDD with asthma control, resource utilization, and quality of life. RESULTS Of the study cohort of 293 WTC workers with asthma, 19% had PTSD alone, 2% had MDD alone, and 12% had PTSD and MDD. Adjusted mean differences (95% confidence interval) in asthma control questionnaire scores were 1.32 (0.85-1.80) for WTC workers with PTSD and MDD, 0.44 (0.03-0.84) for those with PTSD alone, and 0.50 (-0.38 to 1.38) for workers with MDD alone compared with those without MDD or PTSD. WTC workers with PTSD and MDD, PTSD alone, and MDD alone had mean (95% confidence interval) adjusted differences in asthma quality of life questionnaire scores of -1.67 (-2.22 to -1.12), -0.56 (-2.23 to -1.12), and -1.21 (-2.23 to -0.18), respectively, compared with workers without MDD or PTSD. Similar patterns were observed for acute resource utilization. CONCLUSION PTSD and MDD seem to have a synergistic effect that worsens asthma control and quality of life. Efforts to improve asthma outcomes in this population should address the negative impacts of these common mental health conditions.
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Affiliation(s)
- Juan P Wisnivesky
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Steven B Markowitz
- Occupational-Environmental Medicine, Queens College, City University of New York, Flushing, New York
| | - Shynah James
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kim Stone
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brittany Dickens
- Occupational-Environmental Medicine, Queens College, City University of New York, Flushing, New York
| | - Paula Busse
- Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laura Crowley
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alex Federman
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Craig Katz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adam Gonzalez
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
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21
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da Costa ADPV, Dos Santos LM, Feitosa CA, de Miranda CT. Maternal common mental disorder over time and asthma control: The role of social support. Pediatr Allergy Immunol 2020; 31:628-635. [PMID: 32202344 DOI: 10.1111/pai.13249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite therapeutic advances, asthma prevalence remains high. Psychosocial factors, including maternal mental disorders, may be involved. This study aims to evaluate the association of maternal common mental disorders (CMDs) and their change over time with asthma morbidity in the child and to observe the effect of social support on this association. METHODS This prospective study involved 189 dyads of mothers and their asthmatic children aged between 2 and 14 years, assisted in specialized outpatient clinics. We measured the association of maternal CMD evolution (absent, maintained, or improved over time) with asthma control and visits to the emergency department (ED) due to asthma attacks through Poisson regression analysis. We further stratified the sample according to social support levels to identify a possible effect of this variable on the association of maternal psychological symptoms with asthma morbidity. RESULTS Compared with mothers who maintained CMD over time, maternal CMD absence had a protective effect on the occurrence of visits to the ED (RR: 0.45; 95% CI: 0.26-0.79) and maternal CMD improvement was associated with lower risk of uncontrolled asthma in the child (RR: 0.60; 95% CI: 0.37-0.97). There was a stronger association of maternal CMD improvement with asthma control in the child only for the stratum of mothers with high social support in its three dimensions (affective-social interaction, emotional-informational, and material dimensions). CONCLUSIONS Maternal CMD absence and improvement over the study period were protective factors for uncontrolled asthma in the child, mainly in the presence of high social support.
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Affiliation(s)
| | - Leticia Marques Dos Santos
- Institute of Humanities Arts and Sciences Professor Milton Santos, Federal University of Bahia, Salvador, Brazil
| | - Caroline Alves Feitosa
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil.,UNIFESP, Federal University of São Paulo, São Paulo, Brazil
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Foronda CL, Kelley CN, Nadeau C, Prather SL, Lewis-Pierre L, Sarik DA, Muheriwa SR. Psychological and Socioeconomic Burdens Faced by Family Caregivers of Children With Asthma: An Integrative Review. J Pediatr Health Care 2020; 34:366-376. [PMID: 32299726 DOI: 10.1016/j.pedhc.2020.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Asthma affects nearly 1 in every 12 children in the United States. Caring for a child with asthma poses significant challenges for the parent or caregiver. The purpose of this integrative review was to identify the psychological and socioeconomic burdens faced by family caregivers of children with asthma. METHOD An integrative review was conducted to review and appraise 80 studies. RESULTS Psychosocial burdens included decreased mental health, quality of life, sleep, family stress, educational deficits, cultural and health disparities, and health care communication challenges. Socioeconomic burdens included poor access to care, as well as work and financial challenges. Studies demonstrated a link between family caregiver health and child health outcomes. Facilitators included education and empowerment, social support, and use of technology. DISCUSSION As the family caregiver's health directly affects the asthmatic child's health, addressing the burdens of family caregivers should be a key consideration in pediatric asthma care.
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McGovern CM, Arcoleo K, Melnyk B. COPE for asthma: Outcomes of a cognitive behavioral intervention for children with asthma and anxiety. ACTA ACUST UNITED AC 2020; 34:665-676. [PMID: 31697152 DOI: 10.1037/spq0000310] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Asthma is the most common childhood chronic condition and a major contributor to school absences and lost instructional time. Children with asthma have a higher risk of internalizing disorders, such as anxiety and depression, which can further complicate asthma management. The purpose of this pilot study was to assess the feasibility, acceptability, and preliminary effects of a manualized, cognitive-behavioral skills-building intervention for children with asthma and anxiety. The design for this study was a one-group, pre/posttest preexperimental with a 6-week follow-up. This article presents the immediate posttest follow-up results. Children between 8 and 12 years of age and their caregivers were recruited from three elementary schools in a large public school district in Ohio. Thirty-two children with asthma and symptoms of anxiety completed the Creating Opportunities for Personal Empowerment (COPE) for Asthma program. Caregivers completed surveys, but they did not participate in the intervention. Results indicated that the program was feasible to implement in small groups during the school day. Self-reported findings indicated a significant reduction in separation anxiety and increased personal beliefs, child-management self-efficacy, and asthma illness representations. Parents and caregivers reported symptom reduction in their children on the Pediatric Symptom Checklist. The subgroup of children scoring high on anxiety at baseline showed reductions with the intervention, having large positive effect sizes for separation and social anxiety as well as medium and large positive effect sizes on the personal beliefs and asthma illness representations, respectively. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Weinstein SM, Orozco K, Pugach O, Rosales G, Songthangtham N, Martin MA. Parent Nativity and Child Asthma Control in Families of Mexican Heritage: The Effects of Parent Depression and Social Support. Acad Pediatr 2020; 20:967-974. [PMID: 32407888 PMCID: PMC7483789 DOI: 10.1016/j.acap.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Research has repeatedly demonstrated that parent foreign nativity has a protective effect on child asthma outcomes among Mexican Americans, but the mechanisms underlying this relationship are not well understood. The current study explored parent depression as a mediator and social support as a moderator of the parent nativity-child asthma control pathway. METHODS Data come from the baseline sample of a trial (NCT02481986) testing community interventions for 223 children aged 5 to 16 with uncontrolled asthma. We focused on parent/child dyads of Mexican heritage (N = 165; mean age = 9.08, standard deviation = 2.94; 57.3% with Mexico-born parent). Asthma control was defined using the child and adult versions of the Asthma Control Test (ACT). Psychosocial factors included parent depression symptoms and social (instrumental, informational, and emotional) support. RESULTS Mexican-born parents had fewer depressive symptoms (β^ = -2.03, SE^ = 0.24) and children with better asthma control (β^ = 1.78, SE^ = 0.24) than US-born parents, P < .0001. Analyses suggested partial mediation of the nativity-ACT path via parent depression (P < .001). An interaction between Instrumental Support and Nativity was marginally significant (β^ = -0.10, SE^ = 0.05, P = .07), with protective effects only observed at higher support levels. Last, among Mexico-born parents, the protective nativity effects on ACT declined with increasing residential years in the United States through 12 years. CONCLUSIONS This study is novel in identifying parent depression as one mechanism underlying the effects of parent nativity on child asthma control, but results suggest that the health advantages may depend on availability of support. Providing resources for parent depression and instrumental support (transportation, childcare) can optimize asthma interventions in this population.
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Booster GD, Oland AA, Bender BG. Treatment Adherence in Young Children with Asthma. Immunol Allergy Clin North Am 2019; 39:233-242. [PMID: 30954173 DOI: 10.1016/j.iac.2018.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Treatment nonadherence in young children with asthma involves multiple factors and should be viewed within an ecological framework. Few interventions have targeted multiple bidirectional factors, however, and little research has examined which interventions may be most appropriate for young children. Additional research is needed to identify essential intervention components, and to determine how to sustain such interventions in at-risk communities. Pediatric psychologists, with training in psychosocial intervention, screening, and primary prevention models, may be uniquely equipped to partner with communities and medical settings to develop and sustain targeted interventions for young children with asthma.
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Affiliation(s)
- Genery D Booster
- National Jewish Health, Pediatric Behavioral Health, 1400 Jackson Street, Denver, CO 80206, USA.
| | - Alyssa A Oland
- National Jewish Health, Pediatric Behavioral Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Bruce G Bender
- National Jewish Health, Pediatric Behavioral Health, 1400 Jackson Street, Denver, CO 80206, USA
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Burg GT, Covar R, Oland AA, Guilbert TW. The Tempest: Difficult to Control Asthma in Adolescence. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:738-748. [PMID: 29747981 DOI: 10.1016/j.jaip.2018.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/02/2018] [Accepted: 02/03/2018] [Indexed: 02/06/2023]
Abstract
Severe asthma is associated with significant morbidity and is a highly heterogeneous disorder. Severe asthma in adolescence has some unique elements compared with the features of severe asthma a medical provider would see in younger children or adults. A specific focus on psychological issues and adherence highlights some of the challenges in the management of asthma in adolescents. Treatment of adolescents with severe asthma now includes 3 approved biologic phenotype-directed therapies. Therapies available to adults may be beneficial to adolescents with severe asthma. Research into predictors of specific treatment response by phenotypes is ongoing. Optimal treatment strategies are not yet defined and warrant further investigation.
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Affiliation(s)
- Gregory T Burg
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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Pappalardo AA, Weinstein S. The Anxiety-Asthma Relationship: Risk or Resilience? J Pediatr 2019; 214:8-10. [PMID: 31477380 DOI: 10.1016/j.jpeds.2019.07.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/24/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Andrea A Pappalardo
- Department of Pediatrics, Department of Medicine, University of Illinois at Chicago, Chicago, IL.
| | - Sally Weinstein
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
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Feldman JM, Kaur K, Serebrisky D, Rastogi D, Marsiglia FF, Arcoleo KJ. The Adaptive Effect of Illness-Specific Panic-Fear on Asthma Outcomes in Mexican and Puerto Rican Children. J Pediatr 2019; 214:178-186. [PMID: 31320144 PMCID: PMC7703716 DOI: 10.1016/j.jpeds.2019.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/17/2019] [Accepted: 06/04/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To examine baseline measures of illness-specific panic-fear (ie, the level of anxiety experienced specifically during asthma exacerbations) as a protective factor in pediatric asthma outcomes over a 1-year period. STUDY DESIGN The sample comprised 267 children (Mexican, n = 188; Puerto Rican, n = 79; age 5-12 years) from a longitudinal observational study conducted in Phoenix, AZ and Bronx, NY. Assessments were done at baseline and 3, 6, 9, and 12 months. The Childhood Asthma Symptom Checklist was administered at baseline to children and caregivers to assess children's illness-specific panic-fear. Asthma outcome variables quantified longitudinally included pulmonary function, the Asthma Control Test, acute healthcare utilization, and medication adherence, measured by devices attached to inhaled corticosteroids. RESULTS Child report of illness-specific panic-fear at baseline predicted higher forced expiratory volume in 1 second (FEV1) % across 1-year follow-up in Mexican children (β = 0.17, P = .02), better asthma control in Puerto Rican children (β = 0.45, P = .007), and less acute healthcare utilization for asthma in both groups (Mexicans: β = -0.39, P = .03; Puerto Ricans: β = -0.47, P = .02). Caregiver report of child panic-fear predicted higher FEV1% in Mexican (β = 0.30; P = .02) and Puerto Rican (β = 0.19; P = .05) children. Panic-fear was not related to medication adherence. CONCLUSIONS Illness-specific panic-fear had beneficial effects on asthma outcomes in both groups of Latino children. The heightened vigilance associated with illness-specific panic-fear may lead children to be more aware of their asthma symptoms and lead to better strategies for asthma management.
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Affiliation(s)
- Jonathan M. Feldman
- Ferkauf Graduate School of Psychology/Yeshiva University, Bronx, New York,Albert Einstein College of Medicine/Children’s Hospital at Montefiore, Bronx, New York
| | - Karenjot Kaur
- Ferkauf Graduate School of Psychology/Yeshiva University, Bronx, New York
| | | | - Deepa Rastogi
- Albert Einstein College of Medicine/Children’s Hospital at Montefiore, Bronx, New York
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Endrighi R, McQuaid EL, Bartlett YK, Clawson AH, Borrelli B. Parental Depression is Prospectively Associated With Lower Smoking Cessation Rates and Poor Child Asthma Outcomes. Ann Behav Med 2019. [PMID: 29538661 DOI: 10.1093/abm/kax011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Depressive symptoms are elevated in parents of asthmatic children compared with parents of healthy children. The role of depression in smoking cessation and pediatric asthma outcomes in this population is unclear. Purpose To prospectively examine the effect of parent depression on smoking cessation and child asthma outcomes. Methods Secondary analysis from a cessation induction trial involving Motivational Interviewing (MI) and biomarker feedback on secondhand smoke exposure (SHSe). Parents (n=341) had an asthmatic child (mean age=5.2 years) and did not have to want to quit smoking to enroll. Intervention included asthma education, MI, and SHSe feedback plus randomization to six counseling (MI; repeated feedback) or control calls (brief check on asthma) for 4 months. Depressive symptoms were defined as scoring ≥22 on the Center for Epidemiologic Study-Depression scale. Smoking outcomes were bioverified 7- and 30-day point-prevalence abstinence (ppa). Child asthma outcomes were past month functional limitation, health care utilization, and number of days with asthma symptoms. Data were obtained at baseline, 2, 4, and 6 months. Results Parental depression was associated with lower odds of abstinence (7-day ppa odds ratio [OR]=0.38, 95% confidence interval [CI]=0.23, 0.64; 30-day ppa OR=0.27, 95% CI=0.15, 0.47), greater odds of child health care utilization for asthma (OR=1.71, 95% CI=1.01, 2.92), and greater child asthma functional limitation (B=0.16, SE=0.06, p=.03) even after controlling for smoking status. Depression predicted a greater number of child asthma symptom days (B=1.08, SE=0.44, p=.01), but this became nonsignificant after controlling for smoking status. Conclusions Among parents who smoke, both depressive symptoms and smoking should be targeted for treatment aimed at improving pediatric asthma.
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Affiliation(s)
- Romano Endrighi
- Division of Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - Elizabeth L McQuaid
- Departments of Psychiatry and Human Behavior and Pediatrics, Alpert Medical School, Brown University, Providence, RI, USA
| | - Yvonne Kiera Bartlett
- Manchester Centre for Health Psychology, The University of Manchester, Manchester, UK
| | - Ashley H Clawson
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Belinda Borrelli
- Division of Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
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Weinstein SM, Pugach O, Rosales G, Mosnaim GS, Walton SM, Martin MA. Family Chaos and Asthma Control. Pediatrics 2019; 144:peds.2018-2758. [PMID: 31289192 PMCID: PMC6855822 DOI: 10.1542/peds.2018-2758] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Asthma is a highly prevalent childhood chronic disease, with particularly high rates among poor and minority youth. Psychosocial factors have been linked to asthma severity but remain poorly understood. This study examined (1) relationships between parent and child depression and posttraumatic stress disorder (PTSD) symptoms, family functioning, and child asthma control in a sample of urban minority youth with uncontrolled asthma and (2) family functioning as a pathway linking parent depression and asthma outcomes. METHODS Data were drawn from the baseline cohort of a randomized trial testing community interventions for children aged 5 to 16 with uncontrolled asthma (N = 223; mean age = 9.37, SD = 3.02; 85.2% Hispanic). Asthma control was defined by using the Asthma Control Test and Childhood Asthma Control Test, activity limitation, and previous-12-month asthma severity. Psychosocial measures included parent and child depression and PTSD symptoms, family chaos, and parent social support. RESULTS Parent and child depression symptoms, but not PTSD, were associated with worse asthma control (β = -.20 [SE = 0.06] and β = -.12 [SE = -.03]; P < .001). Family chaos corresponded to worse asthma control, even when controlling for parent and child depression (β = -.33; [SE = 0.15]; P < .05), and was a mediator of the parent depression-asthma path. Emotional triggers of asthma also mediated the parent depression-asthma relationship. CONCLUSIONS Findings highlight family chaos as a mechanism underlying the relationship between parent depression and child asthma control. Addressing parent and child depression, family routines, and predictability may optimize asthma outcomes.
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Affiliation(s)
| | | | | | | | - Surrey M. Walton
- Pharmacy Systems Outcomes and Policy, University of Illinois at Chicago, Chicago, Illinois; and
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Pateraki E, Vance Y, Morris PG. The Interaction Between Asthma and Anxiety: An Interpretative Phenomenological Analysis of Young People's Experiences. J Clin Psychol Med Settings 2019; 25:20-31. [PMID: 29322289 DOI: 10.1007/s10880-017-9528-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Asthma and anxiety are highly co-morbid, and their interaction leads to exacerbations for both conditions. This study explored the interplay between these two conditions from the perspective of children and adolescents. The objective was to identify potential mechanisms of interaction between asthma and anxiety, and to derive improvements for prevention and treatment. Eleven semi-structured interviews of young people (aged 11-15), who met criteria for both asthma and anxiety, were analysed using interpretative phenomenological analysis. Well-established qualitative research recommendations were followed to promote credibility and rigour in the findings. Eight themes emerged that were organised in three domains: (i) asthma affecting anxiety by inhibiting coping activities or developmental tasks and by triggering unhelpful thinking and behaviour; (ii) anxiety affecting asthma by impairing self-care and triggering hyperventilation; (iii) interactions between asthma and anxiety, including self-perpetuating feedback cycles and symptom confusion. The proposed mechanisms could help tailor cognitive-behavioural interventions to reduce anxiety and asthma complications.
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Affiliation(s)
- Eleni Pateraki
- Paediatric Psychology Service, Wishaw General Hospital, NHS Lanarkshire, Wishaw, ML2 0DP, Scotland, UK.
| | - Yvonne Vance
- Paediatric Psychology Service, Wishaw General Hospital, NHS Lanarkshire, Wishaw, ML2 0DP, Scotland, UK
| | - Paul Graham Morris
- Clinical and Health Psychology Department, University of Edinburgh, Edinburgh, Scotland, UK
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Arcoleo KJ, McGovern C, Kaur K, Halterman JS, Mammen J, Crean H, Rastogi D, Feldman JM. Longitudinal Patterns of Mexican and Puerto Rican Children's Asthma Controller Medication Adherence and Acute Healthcare Use. Ann Am Thorac Soc 2019; 16:715-723. [PMID: 30860858 PMCID: PMC6543480 DOI: 10.1513/annalsats.201807-462oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rationale: Researchers tend to study Latinos as a single group, but recent asthma research confirmed differences among Latino subgroups. Variations in controller medication adherence may be a factor in the observed health disparities between Mexican and Puerto Rican children. Adherence is not a stable phenomenon; however, there is a paucity of data on patterns of adherence, sociodemographic predictors of patterns, and variations in asthma-related acute healthcare use by adherence pattern among Latino subgroups. Objectives: To identify patterns of inhaled corticosteroid medication adherence over 12 months among Mexican and Puerto Rican children with persistent asthma, to examine sociodemographic predictors of adherence patterns by ethnicity, and to investigate asthma-related acute healthcare use based on these patterns. Methods: We analyzed controller medication Doser data from Mexican and Puerto Rican children (n = 123; ages 5-12 yr) with persistent asthma who participated with their caregivers in a longitudinal nonintervention study (Phoenix, AZ, and Bronx, NY). Interview and medical record data were collected at enrollment and at 3, 6, 9, and 12 months after enrollment. Results: Forty-seven to fifty-three percent of children had poor adherence (<50%) over each of the follow-up periods (cross-sectional). Children with lowest adherence were Puerto Rican, from nonpoor families, or female. Longitudinal latent class analysis yielded four adherence classes: poor, moderate, decreasing adherence, and increasing adherence. Puerto Rican children had significantly higher odds of "decreasing" (odds ratio [OR], 2.86; 95% confidence interval [CI], 0.40 to 20.50) and "poor" (OR, 5.62; 95% CI, 1.44 to 21.90) adherence than Mexican children. Females had significantly greater odds of "decreasing" (OR, 4.80; 95% CI, 0.73 to 31.74) and "poor" (OR, 5.20; 95% CI, 1.77 to 15.30) adherence group membership than males. The "decreasing" adherence group was comprised of only poor children. Children in the "poor" adherence class had the highest mean number of acute visits and emergency department visits/hospitalizations across all assessment periods. Conclusions: This study demonstrated that unique ethnicity within Latino populations may be associated with different risk levels for suboptimal controller medication adherence, which may be a factor in the observed asthma health disparities between Mexican and Puerto Rican children. Increased understanding of and attention to children's controller medication adherence patterns will provide evidence needed to identify children at highest risk for acute healthcare use and offer more-intensive intervention using less-intensive approaches for those at low risk. Clinical trial registered with www.clinicaltrials.gov (NCT01099800).
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Affiliation(s)
| | - Colleen McGovern
- 2 School of Nursing, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Karenjot Kaur
- 3 Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - Jill S Halterman
- 4 Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Jennifer Mammen
- 5 School of Nursing, University of Rhode Island, Providence, Rhode Island; and
| | | | - Deepa Rastogi
- 6 Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Jonathan M Feldman
- 3 Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
- 6 Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
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Abstract
This essay expounds on fundamental, quantitative elements of the exercise ventilation in children, which was the subject of the Tom Rowland Lecture given at the NASPEM 2018 Conference. Our knowledge about how much ventilation rises during aerobic exercise is reasonably solid; our understanding of its governance is a work in progress, but our grasp of dyspnea and ventilatory limitation in children (if it occurs) remains embryonic. This manuscript summarizes ventilatory mechanics during dynamic exercise, then proceeds to outline our current understanding of mechanisms of dyspnea, particularly during exercise (exertional dyspnea). Most research in this field has been done in adults, and the vast majority of these studies in patients with chronic obstructive pulmonary disease. To what extent conclusions drawn from this literature apply to children and adolescents-both healthy and those with cardiopulmonary disease-will be discussed. The few, recent, pertinent, pediatric studies will be reviewed in an attempt to provide an empirical basis for proposing a hypothetical model to study exertional dyspnea in youth. Just as somatic growth will have consequences for ventilatory and exercise capacity, so too will neural developmental plasticity and experience affect perception of dyspnea. Our path to understand how these evolving inputs and influences summate during a child's life will be Columbus' India.
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Forno E, Abraham N, Winger DG, Rosas-Salazar C, Kurland G, Weiner DJ. Perception of Pulmonary Function in Children with Asthma and Cystic Fibrosis. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2018; 31:139-145. [PMID: 30283712 DOI: 10.1089/ped.2018.0906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/30/2018] [Indexed: 11/13/2022]
Abstract
Background: Under-perception of pulmonary dysfunction may delay appropriate treatment, while over-perception may result in unnecessary treatments. Objectives: To evaluate the ability of patients with asthma or cystic fibrosis and their subspecialty caregivers to assess changes in lung function based on their subjective clinical impressions. Methods: Patients were asked to qualitatively describe how they felt compared to their prior visit (same/better/worse) and to quantitatively estimate their forced expiratory volume in 1 s (FEV1) after being reminded of their FEV1 at the prior visit. Providers made similar estimates based on history and physical examination and knowledge of prior FEV1. After adjusting for relevant clinical covariates, lung function estimates were categorized as accurate (±5% of measured FEV1), overestimated (>5% above measured), and underestimated (>5% below measured). Results: One hundred nine patients estimated FEV1 on 179 occasions. Concordance between patient qualitative assessment and FEV1-based categories was low (κ = 0.08); 44% of patients reported feeling better than the FEV1-based category showed. Quantitatively, 56% of patient estimates were accurate, 18% were underestimated, and 26% overestimated; accuracy improved with age (odds ratio = 1.16, P = 0.01). Concordance between provider qualitative assessments and FEV1-based category was moderate (κ = 0.35); about 19% said their patient looked better than the FEV1-based category showed. Quantitatively, 65% of provider estimates were accurate, 16% were underestimated, and 19% were overestimated; accuracy improved with years of experience. Conclusions: Patients' and providers' perceptions of lung function were low to moderately accurate. Relying on subjective impression may place patients at risk for unnecessary treatments or increased morbidity. These findings highlight the importance of objective lung function assessment.
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Affiliation(s)
- Erick Forno
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Neethu Abraham
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Daniel G Winger
- Department of Statistics, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christian Rosas-Salazar
- Division of Pediatric Allergy, Immunology and Pulmonology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Geoffrey Kurland
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Daniel J Weiner
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Bellin MH, Newsome A, Lewis-Land C, Kub J, Mudd SS, Margolis R, Butz AM. Improving Care of Inner-City Children with Poorly Controlled Asthma: What Mothers Want You to Know. J Pediatr Health Care 2018; 32:387-398. [PMID: 29540280 PMCID: PMC6026044 DOI: 10.1016/j.pedhc.2017.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/06/2017] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Low-income caregiver perspectives on asthma management are understudied but may illuminate strategies to improve care delivery and child outcomes. METHOD Purposive sampling methods were used to recruit 15 caregivers of children with frequent asthma emergency department visits. Interviews explored how poverty and stress affect asthma management. Grounded theory coding techniques were used to analyze the data. RESULTS Participants were the biological mother (100%) and were poor (75% had mean annual income ≤ $30,000). Their children (mean age = 6.9 years) were African American (100%), enrolled in Medicaid (100%), and averaged 1.5 emergency department visits over the prior 3 months. Four themes emerged: (a) Deplorable Housing Conditions, (b) Allies and Adversaries in School-Based Asthma Management, (c) Satisfaction With Asthma Health Care Delivery, and (d) Prevalent Psychological Distress. DISCUSSION Impoverished caregivers of children with frequent asthma emergency department visits describe stress that is multifaceted, overwhelming, and difficult to eradicate. Their experiences underscore the need for improved school-based asthma management and family-centered approaches to health care delivery.
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Affiliation(s)
| | | | - Cassie Lewis-Land
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
| | - Joan Kub
- University of Southern California School of Social Work-Department of Nursing
| | - Shawna S. Mudd
- Johns Hopkins University School of Nursing, Medicine and Public Health
| | | | - Arlene M. Butz
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
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36
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Ramratnam SK, Bacharier LB, Guilbert TW. Severe Asthma in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 5:889-898. [PMID: 28689839 DOI: 10.1016/j.jaip.2017.04.031] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/28/2022]
Abstract
Severe asthma in children is associated with significant morbidity and is a highly heterogeneous disorder with multiple clinical phenotypes. Cluster analyses have been performed in several groups to explain some of the heterogeneity of pediatric severe asthma, which is reviewed in this article. The evaluation of a child with severe asthma includes a detailed diagnostic assessment and excluding other possible diagnoses and addressing poor control due to comorbidities, lack of adherence to asthma controller medications, poor technique, and other psychological and environmental factors. Children with severe asthma require significant resources including regular follow-up appointments with asthma education, written asthma action plan, and care by a multidisciplinary team. Management of pediatric severe asthma now includes emerging phenotypic-directed therapies; however, continued research is still needed to further study the long-term outcomes of pediatric severe asthma and its treatment.
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Affiliation(s)
- Sima K Ramratnam
- University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Leonard B Bacharier
- Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Theresa W Guilbert
- Division of Pulmonology Medicine, Cincinnati Children's Hospital & Medical Center, Cincinnati, Ohio
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37
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Booster GD, Oland AA, Bender BG. Psychosocial Factors in Severe Pediatric Asthma. Immunol Allergy Clin North Am 2017; 36:449-60. [PMID: 27401618 DOI: 10.1016/j.iac.2016.03.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Asthma is the most common chronic illness among children in the United States and can impact nearly all aspects of functioning. Most research suggests that children with severe asthma display more emotional and behavioral problems than their healthy peers. These psychological difficulties are associated with increased risk for functional impairments and problematic disease course. Multidisciplinary teams that assess and treat these psychosocial factors using psychoeducational and behavioral interventions are important for children whose asthma is poorly controlled. Future research should examine the ways in which stress, emotions, and immune functions interact, so as to develop more preventative interventions.
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Affiliation(s)
- Genery D Booster
- Pediatric Behavioral Health, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
| | - Alyssa A Oland
- Pediatric Behavioral Health, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Bruce G Bender
- Pediatric Behavioral Health, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
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38
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Goodwin RD. Toward Improving Our Understanding of the Link between Mental Health, Lung Function, and Asthma Diagnosis. The Challenge of Asthma Measurement. Am J Respir Crit Care Med 2017; 194:1313-1315. [PMID: 27905847 DOI: 10.1164/rccm.201610-2016ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Renee D Goodwin
- 1 Department of Psychology City University of New York Queens, New York and.,2 Department of Epidemiology Columbia University New York, New York
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Al Ghriwati N, Winter MA, Everhart RS, Fiese BH. Family functioning and child asthma severity: A bio-behavioral approach. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2017; 35:439-449. [PMID: 28406652 PMCID: PMC5640451 DOI: 10.1037/fsh0000264] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Family factors are directly associated with the psychosocial adjustment of children with chronic illnesses such as asthma (Kaugars, Klinnert, & Bender, 2004). Research indicates that negative family factors may also contribute to child disease severity via bio-behavioral mechanisms of effect. For instance, children from more conflicted families often experience greater internalizing symptoms that subsequently impact their asthma severity (Wood et al., 2006). These pathways have yet to be examined with a comprehensive focus on strength-based family factors. This study examined whether factors such as family cohesion, problem-solving abilities, and communication influence asthma severity via their effects on child depression and anxiety symptoms. METHOD Participants were 215 children (136 males and 79 females), ages 5 to 12 years old, and their families. Primary caregiver, child, and teacher ratings of child and family functioning in addition to objective measures of parent-child interactions and asthma severity were collected. RESULTS Using structural equation modeling, the authors identified significant indirect associations between family factors and child asthma severity via child depressive symptoms; however, these associations were not present in models with child anxiety symptoms. DISCUSSION Results suggest an indirect effect of family functioning on children's lung function, with differential roles of anxiety and depression in these pathways. This article also highlights the importance of incorporating multirater multimethod measures to understand children's experiences in pediatric asthma. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Barbara H Fiese
- Department of Human Development and Family Studies, Family Resiliency Center, University of Illinois at Urbana-Champaign
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Oland AA, Booster GD, Bender BG. Psychological and lifestyle risk factors for asthma exacerbations and morbidity in children. World Allergy Organ J 2017; 10:35. [PMID: 29075362 PMCID: PMC5644196 DOI: 10.1186/s40413-017-0169-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/13/2017] [Indexed: 12/13/2022] Open
Abstract
Asthma is the most common childhood illness and disproportionately affects low-income, minority children who live in urban areas. A range of risk factors are associated with asthma morbidity and mortality, such as treatment non-adherence, exposure to environmental triggers, low-income households, exposure to chronic stress, child psychological problems, parental stress, family functioning, obesity, physical inactivity, and unhealthy diets. These risk factors often have complex interactions and inter-relationships. Comprehensive studies that explore the inter-relationships of these factors in accounting for asthma morbidity and mortality are needed and would help to inform clinical intervention. Considerable research has focused on interventions to improve adherence, asthma management, asthma symptoms, and quality of life for patients with asthma. Educational interventions combined with psychosocial interventions, such as behavioral, cognitive-behavioral, or family interventions, are beneficial and provide care in schools, homes, and emergency rooms can help to address barriers to accessing care for children and families. Additional recent research has explored the use of multidisciplinary, collaborative, integrated care with pediatric asthma patients, providing promising results. Integrated care could be ideal for addressing the multitude of complex psychosocial and wellness factors that play a role in childhood asthma, for increasing patient-centered care, and for promoting collaborative patient-provider relationships. Further research in this area is essential and would be beneficial.
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Steinberg DM, Serebrisky D, Feldman JM. Asthma in children of Caribbean descent living in the inner-city: comparing Puerto Rican and Afro-Caribbean children. PSYCHOL HEALTH MED 2017; 22:633-639. [PMID: 27666405 PMCID: PMC5570516 DOI: 10.1080/13548506.2016.1238490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ethnic minority children bear a disproportionate amount of the US asthma burden. We compared asthma morbidity and pulmonary function (%FEV1) in two Caribbean groups living in the Bronx, NY: Puerto Rican and Afro-Caribbean children. Caregiver-child dyads (Puerto Rican: n = 113, M age = 9.89 ± 2.05; Afro-Caribbean: n = 47, Mage = 10.35 ± 2.08) responded to sociodemographic and asthma-related questions, and children's %FEV1 was measured. Puerto Rican children had significantly greater (past year) asthma morbidity, yet there were no significant differences in %FEV1. This discrepancy between objective pulmonary function and asthma morbidity suggests the importance of considering sociocultural factors in pediatric asthma care.
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Affiliation(s)
- Dara M. Steinberg
- Yeshiva University, Ferkauf Graduate School of Psychology, Bronx, NY 10461
| | - Denise Serebrisky
- Albert Einstein College of Medicine, Department of Pediatrics, Bronx, NY 10461
- Jacobi Medical Center, Division of Pediatric Pulmonology, Bronx, NY 10461
| | - Jonathan M. Feldman
- Yeshiva University, Ferkauf Graduate School of Psychology, Bronx, NY 10461
- Albert Einstein College of Medicine, Department of Pediatrics, Bronx, NY 10461
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Abstract
The ability to perceive the onset and severity of symptoms of worsening asthma is important, not only for initial diagnosis but also for early identification of an asthma exacerbation and prompt management. There are subjective and objective methods for identifying symptoms. Symptom perception is affected by multiple mechanisms, and not all patients can accurately perceive symptoms of airflow limitation. Hyperperceivers will report substantial discomfort in the face of minimal bronchoconstriction, and poor perceivers will report no symptoms even in the presence of severe obstruction. The use of objective measures of airflow limitation is essential for such patients. Regimens for training perception in children and adults have been studied and are available.
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Walker VG. Exploration of the Influence of Factors Identified in the Literature on School-aged Children's Emotional Responses to Asthma. J Pediatr Nurs 2017; 33:54-62. [PMID: 28065421 PMCID: PMC5376515 DOI: 10.1016/j.pedn.2016.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/09/2016] [Accepted: 11/28/2016] [Indexed: 01/16/2023]
Abstract
Approximately 6.3 million US children suffer from asthma. The purpose of this study was to explore factors on school-aged children's emotional responses to asthma, N=85, ages 6-12. Correlations included Asthma related child emotional functioning QOL and (a) asthma severity, r=-0.30, p<0.01, (b) child internalizing behaviors, r=-0.26, p<0.05, (c) child externalizing behaviors r=-0.43, p<0.001; Caregiver emotional functioning QOL and (a) asthma severity, r=-0.39, p<0.001, (b) child internalizing behaviors, r=-0.22, p<0.05, (c) child externalizing behaviors, r=-0.25; p<0.05. Multiple regression analysis revealed that asthma severity and child externalizing problems accounted for 26% of the variance in asthma related child emotional functioning QOL, F (4, 79)=7.051, p<0.001 (asthma severity, β=-0.31, p<0.01; child externalizing problem behaviors, β=-0.43, p<0.001). Findings imply that asthma research should consider problem behaviors of school-aged children when addressing asthma related emotional functioning QOL.
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Bruzzese JM, Reigada LC, Lamm A, Wang J, Li M, Zandieh SO, Klein RG. Association of Youth and Caregiver Anxiety and Asthma Care Among Urban Young Adolescents. Acad Pediatr 2016; 16:792-798. [PMID: 27049680 PMCID: PMC5047850 DOI: 10.1016/j.acap.2016.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 03/16/2016] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine the association of adolescent asthma-related anxiety, social anxiety, separation anxiety, and caregiver asthma-related anxiety with asthma care by urban adolescents. METHODS Participants were 386 ethnic minority adolescents (mean age 12.8 years) with persistent asthma and their caregivers. Adolescents reported what they do to prevent asthma symptoms and to manage acute symptoms, and if they or their caregiver is responsible for their asthma care. Adolescents completed the Youth Asthma-Related Anxiety Scale, and the social and separation anxiety subscales of the Screen for Child Anxiety and Emotional Disorders (SCARED); caregivers completed the Parent Asthma-Related Anxiety Scale. Linearity of the associations was assessed by generalized additive models. When there was no evidence for nonlinearity, linear mixed effects models were used to evaluate the effects of the predictors. RESULTS Adolescent asthma-related anxiety had a strong curvilinear relationship with symptom prevention (P < .001). Adolescents took more prevention steps as their anxiety increased, with a plateau at moderate anxiety. There was a linear relationship of adolescent asthma-related anxiety to symptom management (β = 0.03, P = .021) and to asthma responsibility (β = 0.11, P = .015), and of caregiver asthma-related anxiety to adolescent symptom prevention (β = 0.04, P = .001). Adolescent social and separation anxiety had weak to no relationship with asthma care. Results remained consistent when controlling for each of the other anxieties. CONCLUSIONS Asthma-related anxiety plays an important, independent role in asthma care. When low, adolescents may benefit from increased support from caregivers and awareness of the consequences of uncontrolled asthma. When elevated, health providers should ensure the adolescents are not assuming responsibility for asthma care prematurely.
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Affiliation(s)
- Jean-Marie Bruzzese
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Laura C. Reigada
- Department of Psychology, Brooklyn College of the City University of New York, 2900 Bedford Avenue, Brooklyn, NY 11210, USA
| | - Alexandra Lamm
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Jing Wang
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Meng Li
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Stephanie O. Zandieh
- Department of Pediatrics, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Rachel G. Klein
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
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Cui W, Zack MM, Zahran HS. Health-related quality of life and asthma among United States adolescents. J Pediatr 2015; 166:358-64. [PMID: 25454936 PMCID: PMC4590981 DOI: 10.1016/j.jpeds.2014.10.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 09/16/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the direction and the magnitude of associations between asthma and health-related quality of life (HRQoL) in a population-based sample of US adolescents. STUDY DESIGN We obtained data from the 2001-2010 cross-sectional National Health and Nutrition Examination Survey. We used multinomial logistic regression and negative binomial regression to estimate corresponding percentages, prevalence ratios (PRs), and predicted days of 4 domains of HRQoL by 3 asthma status categories: never having asthma, having asthma without symptoms, and having asthma with symptoms. RESULTS Compared with those who never had asthma, adolescents with asthma with symptoms of dry cough or wheezing reported significantly worse self-rated health (13.58% [95% CI, 10.32%-17.67%] vs 7.54% [95% CI, 6.50%-8.72%] for fair or poor health), significantly impaired physical health (PR = 1.34, P = .004; adjusted physically unhealthy days, 2.7 days vs 2 days), and impaired mental health (PR = 1.26, P = .025). Among adolescents having asthma with symptoms, those who currently smoked reported 1 more physically unhealthy day and 2.4 more mentally unhealthy days than those who did not smoke and did not have asthma. Those reporting limited physical functioning reported 2 more physically unhealthy days and 1.5 more mentally unhealthy days than those who did not report limited functioning. CONCLUSION Adolescents with asthma and symptoms reported worse HRQoL compared with those with asthma not reporting symptoms and those without asthma. Those who smoked or reported limited physical functioning reported worse physical and mental HRQoL. Reducing symptoms, quitting smoking, and improving physical functioning may improve HRQoL among adolescents with asthma.
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Affiliation(s)
- Wanjun Cui
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Matthew M. Zack
- Division of Population Health, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Hatice S. Zahran
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
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Goodwin RD, Scheckner B, Pena L, Feldman JM, Taha F, Lipsitz JD. A 10-year prospective study of respiratory disease and depression and anxiety in adulthood. Ann Allergy Asthma Immunol 2014; 113:565-70. [PMID: 25216970 DOI: 10.1016/j.anai.2014.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/29/2014] [Accepted: 08/04/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several cross-sectional studies have found an association between respiratory disease and increased mood or anxiety disorders among adults. Little is known about the nature of these associations over time or the role of potential confounders in these links. OBJECTIVES To investigate the association between respiratory disease and incident and persistent depression or anxiety disorders 10 years later and to examine potential pathways of these associations. METHODS Data were drawn from the Midlife Development in the United States survey, a representative sample of adults in the United States ages 18 to 74 years. Participants (N = 2,101) were interviewed on a range of health domains at baseline at wave 1 (1994) and again at wave 2 (2005). RESULTS Respiratory disease was associated with increased odds of depression and anxiety disorders cross-sectionally at both time points. Respiratory disease at wave 1 was not associated with incident depression or anxiety disorders at wave 2. Respiratory disease at wave 1 was associated with increased odds of persistent depression or anxiety disorders 10 years later among those with depression or anxiety disorders at wave 1. Associations were not explained by differences in demographic characteristics, secondhand smoke exposure, cigarette smoking, or history of exposure to childhood maltreatment. CONCLUSION Findings shed new light on the association between respiratory disease and depression or anxiety disorders. Individuals with respiratory disease appear to have higher prevalence of concurrent depression or anxiety disorders and persistent depression or anxiety disorders compared with those without respiratory disease. However, a history of respiratory disease does not appear to confer increased risk of new onset of depression or anxiety disorders.
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Affiliation(s)
- Renee D Goodwin
- Department of Psychology, Queens College and The Graduate Center, City University of New York, Flushing, New York; Department of Epidemiology, Mailman School of Public Health, New York, New York.
| | - Bari Scheckner
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - Lillian Pena
- Department of Psychology, Queens College and The Graduate Center, City University of New York, Flushing, New York
| | - Jonathan M Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Farah Taha
- Department of Psychology, Queens College and The Graduate Center, City University of New York, Flushing, New York
| | - Joshua D Lipsitz
- Department of Psychology, Ben Gurion University of the Negev, Beer-Sheva, Israel
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van Oers HA, Haverman L, Limperg PF, van Dijk-Lokkart EM, Maurice-Stam H, Grootenhuis MA. Anxiety and Depression in Mothers and Fathers of a Chronically Ill Child. Matern Child Health J 2014; 18:1993-2002. [DOI: 10.1007/s10995-014-1445-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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