Asthma and serious psychological distress: prevalence and risk factors among US adults, 2001-2007

Work-related asthma in adults with severe asthma from the Korean Severe Asthma Registry (KoSAR)

Background

Exposure to allergens or irritants in the workplace may affect asthma control and the quality of life (QoL) of patients with asthma.

Objective

To examine the prevalence and characteristics of work-related asthma (WRA) in adult patients with severe asthma.

Methods

We analyzed data from the Korean Severe Asthma Registry (KoSAR), which is a nationwide multicenter observational study on severe asthma in Korea. Severe asthma was defined according to the American Thoracic Society (ATS) and the European Respiratory Society (ERS) guidelines. WRA was identified on the basis of asthma symptom aggravation at the workplace, as indicated by responses to a structured questionnaire. We compared the demographic and clinical characteristics and QoL between adult patients with severe asthma and WRA and those without WRA.

Results

Among 364 patients with severe asthma who were employed at the time of enrollment, 65 (17.9%) had WRA. There were no significant differences in age, sex, obesity, or smoking history between the WRA and non-WRA groups. However, individuals with WRA exhibited a higher prevalence of anxiety (7.7% vs 2.4%, P = 0.046) and depression (12.3% vs 3.7%, P = 0.010) than those without. The levels of asthma control, lung function, and frequency of asthma exacerbations were similar between the two groups, but patients with WRA reported lower QoL, as determined by the Quality of Life Questionnaire for Adult Korean Asthmatics (56.6 ± 14.6 vs. 63.5 ± 13.9, P < 0.001).

Conclusion

Patients with severe asthma and WRA are more likely to experience anxiety and depression and have lower QoL than those without WRA.

Psychological distress and associated factors among asthmatic patients in Southern, Ethiopia, 2021

BACKGROUND

There is an increased prevalence of psychological distress in adults with asthma. Psychological distress describes unpleasant feelings or emotions that impact the level of functioning. It is a significant exacerbating factor in asthma control. Addressing factors that contribute to psychological distress in those asthma patients improves asthma outcomes. So, this study aimed to assess the prevalence of psychological distress and associated factors among asthmatic patients at Hawassa public hospitals, Ethiopia, 2021.

METHODS

Institution-based cross-sectional study design was used to select 394 asthma patients. Proportional allocation and systematic sampling techniques were used to select study participants. A logistic regression model was used to assess the predictors and psychological distress of the asthmatic patient. The association was interpreted using the odds ratio and 95% confidence interval.

RESULT

A total of 394 asthma patients participated in the study, giving a response rate of 93.4%. The prevalence of psychological distress among asthmatic patients was 51% [95%CI: 46%-56%]. Participants who had comorbid medical illness [AOR: 6.049, 95% CI (3.131-11.684)], experienced stigma [AOR: 3.587, 95%CI (1.914-6.723)], chewed khat [AOR: 7.268, 95%CI (3.468-15.231)], had poor social support and had uncontrolled asthma were significantly associated with psychological distress in asthmatic patients.

CONCLUSION

This study demonstrated that the prevalence of psychological distress was found to be high among asthmatic patients. Social support, stigma, chewing khat, comorbid medical illness, and poor asthmatic control had significantly associated with psychological distress in asthmatic patients.

Allergen induces depression-like behavior in association with altered prefrontal-hippocampal circuit in male rats

Allergic asthma is a common chronic inflammatory condition associated with psychiatric comorbidities. Notably depression, correlated with adverse outcomes in asthmatic patients. Peripheral inflammation's role in depression has been shown previously. However, evidence regarding the effects of allergic asthma on the medial prefrontal cortex (mPFC)-ventral hippocampus (vHipp) interactions, an important neurocircuitry in affective regulation, is yet to be demonstrated. Herein, we investigated the effects of allergen exposure in sensitized rats on the immunoreactivity of glial cells, depression-like behavior, brain regions volume, as well as activity and connectivity of the mPFC-vHipp circuit. We found that allergen-induced depressive-like behavior was associated with more activated microglia and astrocytes in mPFC and vHipp, as well as reduced hippocampus volume. Intriguingly, depressive-like behavior was negatively correlated with mPFC and hippocampus volumes in the allergen-exposed group. Moreover, mPFC and vHipp activity were altered in asthmatic animals. Allergen disrupted the strength and direction of functional connectivity in the mPFC-vHipp circuit so that, unlike normal conditions, mPFC causes and modulates vHipp activity. Our results provide new insight into the underlying mechanism of allergic inflammation-induced psychiatric disorders, aiming to develop new interventions and therapeutic approaches for improving asthma complications.

Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review

Anxiety disorders are the most common group of mental disorders, but they are often underrecognized and undertreated in primary care. Dysfunctional breathing is a hallmark of anxiety disorders; however, mainstays of treatments do not tackle breathing in patients suffering anxiety. This scoping review aims to identify the nature and extent of the available research literature on the efficacy of breathwork interventions for adults with clinically diagnosed anxiety disorders using the DSM-5 classification system. Using the PRISMA extension for scoping reviews, a search of PubMed, Embase, and Scopus was conducted using terms related to anxiety disorders and breathwork interventions. Only clinical studies using breathwork (without the combination of other interventions) and performed on adult patients diagnosed with an anxiety disorder using the DSM-5 classification system were included. From 1081 articles identified across three databases, sixteen were included for the review. A range of breathwork interventions yielded significant improvements in anxiety symptoms in patients clinically diagnosed with anxiety disorders. The results around the role of hyperventilation in treatment of anxiety were contradictory in few of the examined studies. This evidence-based review supports the clinical utility of breathwork interventions and discusses effective treatment options and protocols that are feasible and accessible to patients suffering anxiety. Current gaps in knowledge for future research directions have also been identified.

Social isolation exacerbates acute ozone inhalation induced pulmonary and systemic health outcomes

Psychosocially-stressed individuals might have exacerbated responses to air pollution exposure. Acute ozone exposure activates the neuroendocrine stress response leading to systemic metabolic and lung inflammatory changes. We hypothesized chronic mild stress (CS) and/or social isolation (SI) would cause neuroendocrine, inflammatory, and metabolic phenotypes that would be exacerbated by an acute ozone exposure. Male 5-week-old Wistar-Kyoto rats were randomly assigned into 3 groups: no stress (NS) (pair-housed, regular-handling); SI (single-housed, minimal-handling); CS (single-housed, subjected to mild unpredicted-randomized stressors [restraint-1 h, tilted cage-1 h, shaking-1 h, intermittent noise-6 h, and predator odor-1 h], 1-stressor/day*5-days/week*8-weeks. All animals then 13-week-old were subsequently exposed to filtered-air or ozone (0.8-ppm) for 4 h and immediately necropsied. CS, but not SI animals had increased adrenal weights. However, relative to NS, both CS and SI had lower circulating luteinizing hormone, prolactin, and follicle-stimulating hormone regardless of exposure (SI > CS), and only CS demonstrated lower thyroid-stimulating hormone levels. SI caused more severe systemic inflammation than CS, as evidenced by higher circulating cytokines and cholesterol. Ozone exposure increased urine corticosterone and catecholamine metabolites with no significant stressor effect. Ozone-induced lung injury, and increases in lavage-fluid neutrophils and IL-6, were exacerbated by SI. Ozone severely lowered circulating thyroid-stimulating hormone, prolactin, and luteinizing hormone in all groups and exacerbated systemic inflammation in SI. Ozone-induced increases in serum glucose, leptin, and triglycerides were consistent across stressors; however, increases in cholesterol were exacerbated by SI. Collectively, psychosocial stressors, especially SI, affected the neuroendocrine system and induced adverse metabolic and inflammatory effects that were exacerbated by ozone exposure.

A Cross-Sectional Study on Physical Activity and Psychological Distress in Adults with Asthma

Physical Activity (PA) could contribute to decreasing psychological distress and improving Self-Perceived Health (SPH) in adults with Asthma. The main objective of this study was to analyse the associations between the Physical Activity Level (PAL) Perceived Social Support (PSS) and Mental Health, using the Goldberg General Health Questionnaire (GHQ-12), and SPH in the adult population with Asthma. This descriptive cross-sectional study is based on data from the 2017 Spanish National Health Survey, including 1040 participants with Asthma in the study. The Kruskal-Wallis test was performed to study the hypothetical differences between the PAL and the different variables derived from the GHQ-12. In addition, correlations between the variables generated and the items of the GHQ-12, together with the PAL and the Duke-UNC-11, were analysed using Spearman's rho correlation coefficients. Inverse correlations were found between Mental Health and PSS (rho: -0.351) and between Mental Health and PAL (rho: -0.209), as well as in the rest of the GHQ-12 items: successful coping (rho: -0.197), self-esteem (rho: -0.193) and stress (rho: -0.145). The more active subjects had better SPH. Therefore, the research showed how higher PAL and positive SPH are related to lower psychological distress in adults with Asthma.

Sex-Specific Association between Environmental Tobacco Smoke Exposure and Asthma Severity among Adults with Current Asthma

Background: Tobacco smoke has been associated with negative health outcomes, including those with chronic respiratory illnesses, such as asthma. This study aimed to assess the relationship between exposure to environmental tobacco smoke (ETS), as well as tobacco use (cigarette and electronic cigarettes), on asthma severity among adults with current asthma, with stratification by sex to understand potential biological sex differences. Methods: The study population consisted of Californian adults 18 years or older with self-reported physician/health care diagnosis of asthma and still having current asthma from 2020 California Health Interview Survey. All descriptive statistics and analyses were sex-stratified and survey-weighted. Crosstabulations were used to understand the association between asthma attack and ETS or firsthand smoke exposure, while binary logistic regression models were used to assess the effect of ETS exposure, current smoking status, and control variables on asthma attack in the past 12 months, with a sub-analysis among non-smoking adults with asthma. Results: Among the primary variable of interest, 35% of males and 30% of females reported ETS exposure in the past 12 months, while 13% of males and 6% of females reported being a current smoker. Past year asthma attack was reported among 43% and 55% of males and females, respectively. Among males, after adjusting for all control variables, asthma attack was significantly higher among those with ETS exposure (OR: 1.75, 95% CI: 1.01–3.02) and among current smokers (OR: 3.82, 95% CI: 1.49, 9.81). Male non-smokers with ETS exposure had a 109% higher odds of asthma attack, compared to non-exposure individuals. Conclusion: Using a population-based survey, our results highlight the ongoing burden of tobacco use and exposure particularly among males with current asthma, further corroborate the literature on the relationship between tobacco and asthma, and highlight putative sex-specific outcomes.

Serious psychological distress and cannabis use among pregnant women in the United States: Findings from the National Survey of Drug Use and Health, 2015-2018

BACKGROUND

Cannabis use in pregnancy has been shown to be associated with a past diagnosis of mental health disorders. This study aimed to evaluate the association between serious psychological distress (SPD) and cannabis use in pregnant women in the United States.

METHODS

Using cross-sectional data from the 2015-2018 National Survey on Drug Use and Health (NSDUH), we compared likelihood of cannabis use among pregnant women who reported acute, recent or no SPD based on the Kessler K-6 Distress Scale. Weighted analyses were conducted to describe study population and differences in cannabis use patterns in women with SPD compared to those without. Multivariate logistic regression models were fit to determine whether the relationship between SPD and cannabis use differed by acute, recent or no SPD status.

RESULTS

Our final study sample consisted of 2,277,425 pregnant women. In adjusted analyses, pregnant women with any SPD (acute or recent) had 3.1 (95% confidence interval: 2.1, 4.5) times the odds of being current cannabis users compared to pregnant women without SPD. Compared to those with no SPD, pregnant women adjusted with acute SPD had 3.9 (2.5, 6.1) the adjusted odds and recent SPD had 2.4 (1.3, 4.4) times the odds of being current cannabis users. Cannabis use rates in each trimester were significantly higher in women with SPD compared to women without.

CONCLUSION

Women who report recent or acute SPD are significantly more likely to use cannabis during all trimesters of pregnancy than those who report no SPD.

Risk factors for completed suicide in the general population: A prospective cohort study of 242, 952 people

BACKGROUND

The estimated global burden of suicide is almost 1 million deaths per year, representing 57% of all violent deaths worldwide. In order to better identify at risk individuals and develop effective prevention strategies at the population level, a comprehensive understanding of the biological, psychological and social risk factors is required.

METHOD

Data from the National Health Interview Survey (1997- 2004) were analyzed. Multivariable Cox proportional hazards regression models were used to compute hazard ratios (HRs) and accompanying 95% confidence intervals (CI).

RESULTS

During a mean 6.3 years of follow-up of 242, 952 people (1.56 million person-years), 180 deaths due to suicide occurred. Of 18 risk factors, eight revealed associations with suicide. Participants who had never been married (HR, 2.58; 95% CI, 1.44-4.62), current smokers (HR, 2.26; 1.49-3.43), current drinkers (HR, 1.93; 1.14-3.27]), participants with serious psychological distress (HR, 3.34; 1.81-6.18), and a history of emphysema (HR, 2.79; 1.18-6.59), liver disease (HR, 4.63; 2.10-10.20), kidney disease (HR, 2.26; 1.00-5.06) and cancer (HR, 2.18; 1.32-3.59) were at increased risk of completed suicide.

LIMITATIONS

Due to the observational nature of this study, we cannot exclude the possibility of reverse or bi-directional causality.

CONCLUSIONS

This large, prospective cohort study identified a series of biopsychosocial risk factors that may have utility in suicide prevention.

Investigation of the relationship between chronic montelukast treatment, asthma and depression-like behavior in mice

In 2008, the Food and Drug Administration of the US issued a warning about the neuropsychiatric side effects of montelukast. Previous clinical studies on montelukast have reported conflicting results and, to the best of our knowledge, no experimental studies concerning these side effects had been conducted. In the current study, the effect of montelukast on depression-like behavior in an ovalbumin (OVA)-induced mouse model was investigated. A total of 3 OVA challenges were applied at 2 week intervals for the persistence of asthma. Depression-like behavior was assessed using forced swim tests following each challenge and locomotor activities were evaluated using open field tests. At the end of the current study, plasma montelukast concentrations were measured and the development of asthma and effect of montelukast treatment were histopathologically examined. Inflammation scores that were increased in the OVA mice following all challenges were indicated to be reduced by montelukast treatment. The immobility time of mice increased beginning with the first challenge and this was also reduced by montelukast treatment. Montelukast administration to the control mice did not alter immobility times. Moreover, motor activity of the OVA and montelukast-treated mice were not altered. The results indicated there was no association between chronic montelukast treatment and depression. Furthermore, the chronic administration of montelukast to non-asthmatic mice did not increase immobility. However, depressive behavior increased at all time points in the OVA mice. These results indicated that chronic montelukast treatment is not associated with depression-like behavior and confirmed the association between asthma and depression. Further studies are required to provide an improved understanding of the neuropsychiatric side effects of montelukast.

Patient Advocates for Low-Income Adults with Moderate to Severe Asthma: A Randomized Clinical Trial

BACKGROUND

Few interventions have targeted low-income adults with moderate to severe asthma despite their high mortality.

OBJECTIVE

To assess whether a patient advocate (PA) intervention improves asthma outcomes over usual care (UC).

METHODS

This 2-armed randomized clinical trial recruited adults with moderate to severe asthma from primary care and asthma-specialty practices serving low-income neighborhoods. Patients were randomized to 6 months of a PA intervention or UC. PAs were recent college graduates anticipating health care careers, who coached, modeled, and assisted participants with preparations for asthma-related medical visits, attended visits, and confirmed participants' understanding of provider recommendations. Participants were followed for at least a year for patient-centered asthma outcomes: asthma control (primary outcome), quality of life, prednisone requirements, emergency department visits, and hospitalizations.

RESULTS

There were 312 participants. Their mean age was 51 years (range, 19-93 years), 69% were women, 66% African American, 8% Hispanic/Latino, 62% reported hospitalization for asthma in the year before randomization, 21% had diabetes, and 61% had a body mass index of 30 or more. Asthma control improved over 12 months, more in the intervention group (-0.45 [95% CI, -0.67 to -0.21]) than in the UC group (-0.26 [95% CI, -0.53 to -0.01]), and was sustained at 24 months but with no statistical difference between groups. The 6-month rate of emergency department visits decreased in the intervention (-0.90 [95% CI, -1.56 to -0.42]) and UC (-0.42 [95% CI, -0.72 to -0.06]) groups over 12 months. The cost of the PA program was $1521 per patient. Only 64% of those assigned had a PA visit.

CONCLUSIONS

A PA may be a promising intervention to improve and sustain outcomes in this high-risk population if expanded to address factors that make keeping appointments difficult.

Chronic Stress and Glucocorticoid Receptor Resistance in Asthma

PURPOSE

Chronic and persistent exposure to negative stress can lead to adverse consequences on health. Particularly, psychosocial factors were found to increase the risk and outcome of respiratory diseases like asthma. Glucocorticoids (GCs) are the most efficient anti-inflammatory therapy for asthma. However, a significant proportion of patients don't respond adequately to GC administration. GC sensitivity is modulated by genetic and acquired disease-related factors. Additionally, it was proposed that endogenous corticosteroids may limit certain actions of synthetic GCs, contributing to insensitivity. Psychological and physiological stresses activate the hypothalamic-pituitary-adrenal axis, increasing cortisol levels. Here, we review the mechanism involved in altered GC sensitivity in asthmatic patients under stressful situations. Strategies for modulation GC sensitivity and improving GC therapy are discussed.

METHODS

PubMed was searched for publications on psychological chronic stress and asthma, GC resistance in asthma, biological mechanisms for GC resistance, and drugs for steroid-resistant asthma, including highly potent GCs.

FINDINGS

GC resistance in patients with severe disease remains a major clinical problem. In asthma, experimental and clinical evidence suggests that chronic stress induces inflammatory changes, contributing to a worse GC response. GC resistant patients can be treated with other broad-spectrum anti-inflammatory drugs, but these generally have major side effects. Different mechanisms of GC resistance have been described and might be useful for developing new therapeutic strategies against it. Novel drugs, such as highly potent GCs, phosphoinositide 3-kinase-delta inhibitors that reestablish histone deacetylase-2 function, decrease of GC receptor phosphorylation by p38 mitogen-activated protein kinase inhibitors, or phosphatase activators, are currently in clinical development and might be combined with GC therapy in the future. Furthermore, microRNAs (small noncoding RNA molecules) operate as posttranscriptional regulators, providing another level of control of GC receptor levels. Empirical results allow postulating that the detection and study of microRNAs might be a promising approach to better characterize and treat asthmatic patients.

IMPLICATIONS

Many molecular and cellular pathobiological mechanisms are responsible of GC resistance. Therefore detecting specific biomarkers to help identify patients who would benefit from new therapies is crucial. Stress consitutes a negative aspect of current lifestyles that increase asthma morbidity and mortality. Adequate stress management could be an important and positive intervention.

Asthma, atopy and serious psychological distress: prevalence and risk factors among young people in the Melbourne atopy cohort study

Background: While atopic conditions are associated with increased risk of mental health problems, the evidence that a range of allergic conditions are associated with psychological distress in young people is less clear.Methods: We recruited a longitudinal birth cohort study of 620 children with a family history of allergic disease. At the 18-year follow up, atopic sensitization was determined by skin prick testing. Surveys were used to determine psychological distress (Kessler 6), quality of life (SF12), respiratory symptoms and management, presence of current eczema and hay fever. Regression models were used to identify predictors of psychological distress and quality of life, while controlling for potential confounders.Results: Prevalence of serious psychological distress was quite low (n = 22, 5.3%), and there were no associations between psychological distress and current atopic sensitization, symptoms of hay fever, eczema or asthma. Smoking status and lower level of maternal education were associated with lower physical quality of life (SF12 PCS subscale). Psychological distress total score, lower maternal education, smoking, female sex, and current eczema were associated with worse mental quality of life (SF12 MCS subscale).Conclusion: We found relatively low levels of psychological distress in this cohort of young adults, despite a high prevalence of allergic diseases. Positive social factors may serve to buffer psychological distress amongst the cohort accounting for the low prevalence of serious psychological distress observed.

Depression is associated with poor control of symptoms in asthma and rhinitis: A population-based study

BACKGROUND

Although many studies have highlighted the link between asthma/rhinitis and depression, it is still unclear which characteristics of these diseases are associated with the risk of depression. We aimed to explore the relationship between depression and asthma or rhinitis in a representative sample of the Italian general population.

METHODS

The data were collected in GEIRD, an Italian multicenter, population-based, multicase-control study. 2227 participants (age 21-86 years, female 50%) underwent standardized interviews, skin prick and lung function tests, and were divided into cases of current asthma (n = 528), rhinitis without asthma (n = 972), and controls (n = 727). Two specific questions from the Patient Health Questionnaire (PHQ-2) were asked to identify symptoms of depressed mood and anhedonia, which were used as a proxy of major depression disorder.

RESULTS

The prevalence of depression was 16.7%, 11.9%, and 5.1% in subjects with asthma, rhinitis and controls, respectively. Both in asthma and rhinitis, subjects with depression had worse respiratory-health related quality of life and more frequent disease-related symptoms than their non-depressed counterparts. In asthma, depression was associated with poorer disease control. In rhinitis, depression was significantly associated with a disease-related limitations in daily activities and greater risk of symptom exacerbations and prescriptions of medicines for breathing. Cases of rhinitis with depression were less likely to be atopic.

CONCLUSIONS

Our results suggest that rhinitis exacerbations, particularly in non-atopic subjects, and low asthma control are strongly related to the presence of depressed mood in adults from the general population.

Relationship of Anxiety and Depression with Respiratory Symptoms: Comparison between Depressed and Non-Depressed Smokers in Singapore

The rising prevalence of smokers in the community, specifically psychiatric patients, necessitates smoking cessation as an important strategy for reducing the harmful effects of tobacco. This study aims to compare the profiles of depressed and non-depressed smokers and evaluate how psychiatric symptoms influence respiratory symptoms. A cross-sectional survey was administered to 276 non-depressed adult smokers in the community and 69 adult smokers who had been formally diagnosed with depression in the outpatient clinic of a University Hospital in Singapore. Participants were administered questionnaires on smoking attitudes and perceptions, psychiatric symptoms, and respiratory symptoms. Correlations and multiple regression analyses were conducted. The mean age of smokers in the study was 35.32 ± 13.05 years. Smokers in the community and psychiatric samples were largely similar on all of the sociodemographic factors, except that fewer depressed people were employed (χ² = 8.35, p < 0.01). Smokers with depression also reported more attempts to quit smoking (χ² = 7.14, p < 0.05), higher mean depressive, anxiety, and stress symptom (DASS) scores (t = −10.04, p < 0.01), and endorsed more respiratory symptoms than smokers in the community (t = −2.40, p < 0.05). The DASS scores, number of cigarettes smoked daily, years of smoking, general perception of smokers getting heart disease, and presence of lung disease were positively and significantly correlated with respiratory symptoms. On multiple regression, only anxiety symptoms (β = 0.26, p < 0.05) and the presence of lung disease (β = 0.22, p < 0.001) were significantly correlated with respiratory symptoms. Depressed smokers reported greater difficulty in quitting tobacco use, and they perceived more severe respiratory symptoms compared to non-depressed counterparts. Anxiety symptoms were positively associated with the severity of respiratory symptoms. Smoking cessation campaigns need to specifically target psychological symptoms in smokers and focus more psychoeducation on the risk of cardiovascular disease in the middle-aged population.

Development and Psychometric Properties of the Inflammatory Bowel Disease Distress Scale (IBD-DS): A New Tool to Measure Disease-Specific Distress

BACKGROUND

Inflammatory bowel disease (IBD) imposes a heavy psychosocial burden, with many patients reporting anxiety, depression, and distress. In diseases such as diabetes, disease-specific distress is associated with concordance with treatments and disease control. IBD distress, distinct from anxiety and depression, is evident in people with IBD. We aimed to develop a questionnaire for assessing IBD-specific distress, validate this against a gold standard distress measure for diabetes, and demonstrate the difference between anxiety, depression, and distress.

METHODS

The 94-item IBD Distress Scale (IBD-DS) was developed through secondary analysis of 3 qualitative data sets from previous IBD studies. Items were then refined through cognitive interviews in 2 stages (n = 15, n = 3). Three supplementary unscored questions were added to enable patients to identify their overall level of distress, their perceived level of disease activity, and their 3 most distressing issues. Subsequently, the 55-item IBD Distress Scale was subjected to test-retest. Two hundred seventy-five people received the test draft IBD-DS, and 168 responded (60.4%). Of these, 136 (82%) returned the retest draft of IBD-DS 3 weeks later. After analysis, further item reduction was informed by response rates, kappa values, and correlation coefficients, and test-retest was repeated. One hundred fifty-four people received the test final 28-item IBD-DS, and 123 people responded (58.8%). Of these, 95 (77%) returned the retest final IBD-DS.

RESULTS

The 94 items were reduced to 28 items. Good intraclass correlation (ICC) was found between test-retest scores on 72 complete data sets with unchanged disease status (ICC, 0.92; 95% confidence interval, 0.88-0.95). Cronbach's alpha was 0.95, indicating excellent internal consistency. Factor analysis indicated scoring the items as a single domain (score range, 0-168).

CONCLUSION

The final IBD-DS performs well and offers a tool for assessing IBD-specific distress.

The interplay between neuroendocrine activity and psychological stress-induced exacerbation of allergic asthma

Psychological stress is recognized as a key factor in the exacerbation of allergic asthma, whereby brain responses to stress act as immunomodulators for asthma. In particular, stress-induced enhanced type 2 T-helper (Th2)-type lung inflammation is strongly associated with asthma pathogenesis. Psychological stress leads to eosinophilic airway inflammation through activation of the hypothalamic-pituitary-adrenal pathway and autonomic nervous system. This is followed by the secretion of stress hormones into the blood, including glucocorticoids, epinephrine, and norepinephrine, which enhance Th2 and type 17 T-helper (Th17)-type asthma profiles in humans and rodents. Recent evidence has shown that a defect of the μ-opioid receptor in the brain along with a defect of the peripheral glucocorticoid receptor signaling completely disrupted stress-induced airway inflammation in mice. This suggests that the stress response facilitates events in the central nervous and endocrine systems, thus exacerbating asthma. In this review, we outline the recent findings on the interplay between stress and neuroendocrine activities followed by stress-induced enhanced Th2 and Th17 immune responses and attenuated regulatory T (Treg) cell responses that are closely linked with asthma exacerbation. We will place a special focus on our own data that has emphasized the continuity from central sensing of psychological stress to enhanced eosinophilic airway inflammation. The mechanism that modulates psychological stress-induced exacerbation of allergic asthma through neuroendocrine activities is thought to involve a series of consecutive pathological events from the brain to the lung, which implies there to be a "neuropsychiatry phenotype" in asthma.

Factors associated with depressive symptoms in uncontrolled asthmatics

RATIONALE

Recent epidemiological data indicate that approximately 6.7% of US adults suffer from depression in any given year. The purpose of the study is to identify factors associated with depressive symptoms in a large diverse group of patients with poorly controlled asthma. The factors include quality of life (QOL), lung function, asthma knowledge, attitudes, self-efficacy, symptoms and control of disease.

METHODS

Baseline characteristics of a cohort of 599 subjects with asthma recruited from twenty Asthma Clinical Research Centers across the United States were examined. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to stratify subjects into those with depressive symptoms (CES-D score ≥ 16) and those without depressive symptoms (CES-D < 16). Bivariate statistics were used to compare the two groups; additionally, logistic regression was used to determine factors that have the greatest association with depressive symptoms.

RESULTS

Subjects with depressive symptoms had significantly lower QOL scores and less knowledge about their disease than subjects with no depression; however, lung function (FEV1%) and asthma control were not significantly associated with depressive symptoms in the logistic regression analysis. Subjects who were non-white had lower household income, high school diploma or less, and those who were unemployed or disabled had significantly higher scores for depressive symptoms.

CONCLUSION

Subjects with depressive symptoms have significantly less knowledge of their disease and poorer QOL compared to those without depressive symptoms. Evaluating depressive symptoms in subjects with asthma will provide a more complete picture of their overall condition. The role of asthma education on depressive symptoms in this population needs to be further investigated. The effect of QOL on treating depression in asthma patients also needs to be studied.

Do racial patterns in psychological distress shed light on the Black-White depression paradox? A systematic review

PURPOSE

Major epidemiologic studies in the US reveal a consistent "paradox" by which psychiatric outcomes such as major depressive disorder (MDD) are less prevalent among Blacks relative to Whites, despite greater exposure to social and economic stressors and worse physical health outcomes. A second paradox, which has received less attention and has never been systematically documented, is the discrepancy between these patterns and Black-White comparisons in psychological distress, which reveal consistently higher levels among Blacks. By systematically documenting the latter paradox, this paper seeks to inform efforts to explain the first paradox.

METHODS

We conduct a systematic review of the literature estimating the prevalence of MDD and levels of psychological distress in Blacks and Whites in the US.

RESULTS

The literature review yielded 34 articles reporting 54 relevant outcomes overall. Blacks have a lower prevalence of MDD in 8 of the 9 comparisons observed. In contrast, Blacks have higher levels of psychological distress (in terms of "high distress" and mean scores) than Whites in 42 of the 45 comparisons observed. Tests of statistical significance, where available, confirm this discrepant pattern.

CONCLUSIONS

A systematic review of the epidemiologic evidence supports the existence of a "double paradox" by which Blacks' lower prevalence of MDD relative to Whites' is inconsistent with both the expectations of social stress theory and with the empirical evidence regarding psychological distress. Efforts to resolve the Black-White depression paradox should account for the discordant distress results, which seem to favor artifactual explanations.

The Anti-Inflammatory Effects of Invigorating Kidney and Supplementing Qi Chinese Herbal Formulae in Asthma Patients

BACKGROUND

The theories of Shen-reinforcement and Qi-supplementation are important in asthma treatment based on traditional Chinese medicine theories. Early studies suggested that Invigorating Kidney and Supplementing Qi herbal formulae, Bu Shen Fang Chuan (BSFC) and Bu Shen Yi Qi (BSYQ), conveyed promising results in asthma treatment. However, the efficacy and safety of the formulae need to be further investigated by a randomized double-blind clinical trial.

METHODS

328 eligible patients were randomly sent to BSFC, BSYQ, and placebo group. The two formulae were received as add-on therapy. The primary endpoints were rate of asthma exacerbation and Hamilton Rating Scale for Depression (HAM-D) score. The secondary endpoints included HPA axis function and inflammatory cytokine production profile. All indexes were measured before and after treatment.

RESULTS

The primary endpoints were not improved in both groups; however, the depression levels of subgroup patients with HAM-D score > 5 were improved in BSFC group. HPA axis functions and inflammatory cytokines level were also improved by two formulae. The incidences of adverse events were similar among groups.

CONCLUSIONS

The two formulae had multiple advantage effects on neuroendocrine-immune system. They are worth used as a replacement therapy in asthma.

TRIAL REGISTRATION

This trial is registered with clinical trial number ChiCTR-PRC-09000529.

A patient advocate to facilitate access and improve communication, care, and outcomes in adults with moderate or severe asthma: Rationale, design, and methods of a randomized controlled trial

Few interventions to improve asthma outcomes have targeted low-income minority adults. Even fewer have focused on the real-world practice where care is delivered. We adapted a patient navigator, here called a Patient Advocate (PA), a term preferred by patients, to facilitate and maintain access to chronic care for adults with moderate or severe asthma and prevalent co-morbidities recruited from clinics serving low-income urban neighborhoods. We describe the planning, design, methodology (informed by patient and provider focus groups), baseline results, and challenges of an ongoing randomized controlled trial of 312 adults of a PA intervention implemented in a variety of practices. The PA coaches, models, and assists participants with preparations for a visit with the asthma clinician; attends the visit with permission of participant and provider; and confirms participants' understanding of what transpired at the visit. The PA facilitates scheduling, obtaining insurance coverage, overcoming patients' unique social and administrative barriers to carrying out medical advice and transfer of information between providers and patients. PA activities are individualized, take account of comorbidities, and are generalizable to other chronic diseases. PAs are recent college graduates interested in health-related careers, research experience, working with patients, and generally have the same race/ethnicity distribution as potential participants. We test whether the PA intervention, compared to usual care, is associated with improved and sustained asthma control and other asthma outcomes (prednisone bursts, ED visits, hospitalizations, quality of life, FEV1) relative to baseline. Mediators and moderators of the PA-asthma outcome relationship are examined along with the intervention's cost-effectiveness.

Anti-asthmatic and anxiolytic effects of Herissantia tiubae, a Brazilian medicinal plant

Herissantia tiubae (HtE) is a Brazilian plant used in folk medicine to treat inflammatory diseases. Our aim was to determine whether the HtE has anti-inflammatory and anxiolytic effects in a murine model of asthma. Ovalbumin (OVA)-sensitized BALB/c mice were treated with HtE (50, 100, or 200 mg/kg) or dexamethasone before each OVA challenge. After the last challenge, animals were subjected to anxiety tests and respiratory measurements. Following euthanasia, we quantified immune cells in the bronchoalveolar lavage (BAL), serum IgE titer and cytokine levels, cellular infiltration and mucus content in the lung tissues, and cellular composition of the mediastinal lymph nodes. OVA challenge in sensitized animals caused: (1) reduction of mean respiratory and dominant respiratory rate (from 398 ± 12 to 286 ± 20 cicles per minute (cpm) and from 320 ± 14 to 162 ± 15 cpm, respectively); (2) increase in behavioral markers of anxiety tests; (3) substantial pro-inflammatory effects, including rise in OVA-specific IgE titer (from 0 to 1:2048) and these inflammatory effect diminished the titer to 1:512 after HtE treatment; rise in plasma IL-13 (from 13 ng/mL in saline to 227 ng/mL in OVA and HtE treatment restored to 1.29 ng/mL; rise in total BAL cell count (from 0.742 cells/mL in saline to 11.77 cells/mL in OVA), with prominent eosinophilia. H. tiubae extract affected respiratory parameters similarly to aminophylline, behavioral changes comparable to diazepam, and inflammation being as efficient as dexamethasone. H. tiubae extract (HtE) possesses both anti-inflammatory and anxiolytic properties in the murine model of asthma.

Association of asthma and anxiety: A nationwide population-based study in Taiwan

BACKGROUND

Few studies have investigated the bidirectional relationship between asthma and anxiety; we sought to investigate asthma and anxiety in a large national sample.

METHODS

Cases were identified from Taiwan's National Health Insurance Research Database with a new primary diagnosis of asthma (ICD-9:493) aged more than 15 years between 2000 and 2007. Case status required the presence of any inpatient diagnosis of asthma and/or at least one year diagnosis of asthma in outpatient service. These 22,797 cases were compared to 22,797 sex-, age-, residence- and insurance premium-matched controls and both groups were followed until the end of 2008 for instances of anxiety, defined as ICD-9 codes 300.0, 300.01, 300.02, 300.2, 300.21, 300.23, 300.3. Competing risk adjusted Cox regression analyses were applied, adjusting for sex, age, residence, insurance premium, prednisone use, Charlson comorbidity index, cardiovascular disease, diabetes, depression disorder, and hospital admission days for any disorder. The effect of asthma on the risk of panic disorder and the effect of anxiety disorder on the risk of later asthma were also examined as competing risk adjusted Cox regression analyses

RESULTS

Of the 45,594 subjects, 2792 were ascertained as having anxiety during a mean (SD) follow-up period of 5.3 (2.5) years. Asthma, females, older age, rural residence, depression disorder, and prednisone use were independent risks on anxiety in the fully adjusted model. Anxiety, older age, rural residence, and prednisone use were independent risks on asthma in the fully adjusted model.

LIMITATIONS

The severity of asthma and anxiety disorder, the duration of prednisone treatment and adherence, stressful life events, smoking, family history and relationship were not evaluated.

CONCLUSIONS

Bidirectional relationship between asthma and anxiety disorder was confirmed in this population, in dependent of a number of potential confounding factors.

Relationship of serious psychological distress to quality of life in adults with diabetes

OBJECTIVE

To examine the association between serious psychological distress (SPD) and the Physical and Mental Health components of Quality of Life (QOL) while controlling for depression in a national sample of adults with diabetes.

METHODS

SPD was assessed in 1,659 adults with diabetes who participated in the 2007 Medical Care Expenditure Survey (MEPS). SPD was measured by the 6-item Kessler scale. Depression was assessed with the PHQ-2 screen. Quality of life was measured with the physical (PCS) and mental (MCS) components of the SF-12. We used multiple linear regression to assess the relationship between SPD and quality of life while controlling for relevant covariates and depression screen results to assess the independent effect of SPD on QOL above and beyond the effect of depression.

RESULTS

Among US adults with diabetes, 9% had SPD and 15.4% screened positive for depression. Among those with SPD, 85.8% had depression and among those with depression, 50.5% had SPD. In the adjusted model for socio-demographic factors and comorbidities, SPD was significantly associated with lower PCS scores (-5.51 95% CI -7.55; -3.45) and MCS scores (-18.99 95% CI -20.81; -17.18). In the adjusted model that also controlled for depression, SPD was still significantly associated with lower PCS scores (-3.03 95% CI -5.63; -0.43) and MCS scores (-9.46 95% CI -11.67; -7.24).

CONCLUSIONS

Among U. S. adults, SPD is associated with significantly diminished QOL above and beyond the effects of depression. Targeted interventions to mitigate the adverse effects of SPD are needed, independent of programs to address depression.

Prevalence and risk factors for depression in Korean adult patients with asthma: is there a difference between elderly and non-elderly patients?

Depression is an important comorbidity of asthma. However, little information is available about depression and its potential impact on asthma control in Korean adult asthma patients. We aimed to estimate the prevalence and risk factors for depression in Korean adults with persistent asthma. The 127 non-elderly (20-64 yr) and 75 elderly (≥65 yr) patients with asthma were recruited. Demographic and clinical data were extracted, and the patients completed the Asthma Specific Quality of Life (AQOL) questionnaire and asthma control test (ACT). Depression status was defined using the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Depression was more prevalent in non-elderly (18.9%) than in elderly patients with asthma (13.3%). Patients with depression were significantly younger, had lower economic status, shorter disease duration, poorer asthma control, and worse AQOL scores (P<0.05). Within the non-elderly group, younger age and shorter disease duration were significantly associated with depression (P<0.05). Within the elderly group, a higher body mass index and current smoking status were significantly associated with depression (P<0.05). The PHQ-9 score was significantly correlated with worse ACT and AQOL scores in both groups. In conclusion, depression is strongly associated with poor asthma control and quality of life in Korean adult asthma patients. Our results provide important clues that used to target modifiable factors which contribute to development of depression in asthma patients.

Impact of anxiety and depression on respiratory symptoms

Psychological factors such as anxiety and depression are prevalent in patients with asthma. The purpose of this study was to investigate the relationship between respiratory symptoms and psychological status and to estimate the importance of psychological status in comparison with other factors that are known to be associated with respiratory symptoms. This study included 2270 subjects aged 20-44 (52% female) from Sweden, Iceland, and Norway. Each participant underwent a clinical interview including questions on respiratory symptoms. Spirometry and methacholine challenge were performed. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Eighty-two percent of the subjects reported no anxiety or depression whatsoever, 11% reported anxiety, 2.5% depression and 4% reported both anxiety and depression. All respiratory symptoms, such as wheezing, breathlessness and nightly symptoms, were more common, at a statistically significant level, in participants who had depression and anxiety, even after adjusting for confounders (ORs 1.33-1.94). The HADS score was the most important determinant for nightly symptoms and attacks of breathlessness when at rest whereas bronchial responsiveness was the most important determinant for wheezing, and breathlessness when wheezing. The probability of respiratory symptoms related to HADS score increased with increasing HADS score for all respiratory symptoms. In conclusion, there is a strong association between respiratory symptoms and psychological status. There is therefore a need for interventional studies designed to improve depression and anxiety in patients with respiratory symptoms.

The impact of asthma control on salivary cortisol level in adult asthmatics

Asthma is a chronic disease causing psychological stress which leads to the activation of hypothalamus-pituitary-adrenal axis. The purpose of this study is to compare morning salivary cortisol levels in persistent asthma patients according to their disease severities and control status. Total 206 adult asthma patients were recruited from four university hospitals. Spirometry, questionnaire of Asthma Quality of Life (AQOL) and Asthma Control Test (ACT) were completed, and saliva samples were collected prospectively to measure morning cortisol level. The mean patient age was 56.5±15.3 years with mean asthma duration of 9.1±11.1 years. Sixty five patents (31.6%) were classified as mild persistent asthma, and 141 patients (68.4%) were classified as moderate persistent asthma according to the Expert Panel Report 3. The mean predicted FEV1 was 88.8%±18.4%, and the methacholine PC20 was 9.6±8.5 mg/mL in all study population. The mean ACT score for all patients was 19.9±3.6, and there were 71 (34.5%) patients in poorly controlled and 135 (65.5%) in well controlled asthma. The poorly controlled asthma patients were characterized by significantly lower FEV1 (84.6%±17.6% vs 91.1%±18.5%, P=0.018), lower AQOL scores (46.0±13.9 vs 73.8±26.3, P<0.001), and lower salivary cortisol levels (0.14±0.08 vs 0.18±0.11 µg/dL, P=0.04) compared to well controlled asthma. The ACT score was significantly related to salivary cortisol levels (P=0.034) after adjusting for age. There was no significant difference in salivary cortisol levels (0.17±0.12 vs 0.16±0.08, P=0.725) when analyzed according to the dose of used corticosteroid and lung function. Asthma control status affects morning salivary cortisol level. Measuring the morning salivary cortisol level might be a simple and new way to assess asthma control status.

Operational definitions of asthma in recent epidemiological studies are inconsistent

OBJECTIVE

The best combination of questions to define asthma in epidemiological asthma studies is not known. We summarized the operational definitions of asthma used in prevalence studies and empirically assess how asthma prevalence estimates vary depending on the definition used.

METHODS

We searched the Thomson Reuters ISI Web of knowledge and included (1) cross-sectional studies (2) on asthma prevalence (3) conducted in the general population and (4) containing an explicit definition of asthma. The search was limited to the 100 most-cited papers or published since January 2010. For each paper, we recorded the asthma definition used and other variables. Then we applied the definitions to the data of the Portuguese National Asthma survey (INAsma) and of the 2005-2006 National Health and Nutrition Examination Survey (NHANES) computing asthma prevalence estimates for the different definitions.

RESULTS

Of 1738 papers retrieved, 117 were included for analysis. Lifetime asthma, diagnosed asthma and current asthma were defined in 8, 12 and 29 different ways, respectively. By applying definitions of current asthma on INAsma and NHANES data, the prevalence ranged between 5.3%-24.4% and 1.1%-17.2%, respectively.

CONCLUSIONS

There is considerable heterogeneity in the definitions of asthma used in epidemiological studies leading to highly variable estimates of asthma prevalence. Studies to inform a standardized operational definition are needed. Meanwhile, we propose a set of questions to be reported when defining asthma in epidemiological studies.

The involvement of glucocorticoids in psychological stress-induced exacerbations of experimental allergic asthma

BACKGROUND

Psychological stress is associated with the aggravation of asthma symptoms. Glucocorticoids (GC), which are stress hormones released upon exposure to stress, have the potential to shift immune responses towards a predominant Th2 response by priming antigen-presenting cells to produce lower levels of IL-12 as well as reducing the development of regulatory T cells. However, the involvement of GC in psychological stress-induced exacerbations of allergic asthma has not yet been clarified.

METHODS

Sensitized mice were exposed to restraint stress followed by forced swimming stress, during which a GC receptor antagonist or a GC synthesis inhibitor was administered, and then antigen was inhaled. Corticosterone levels in the blood were measured in stressed and nonstressed mice. After antigen inhalation, the airway responses to aerosolized methacholine, epithelial mucus secretion and airway inflammation were evaluated, and the IL-13 contents in bronchoalveolar lavage fluid were measured.

RESULTS

The exposure to stress significantly increased corticosterone levels. Allergic airway responses and the increase of IL-13 contents evoked by antigen inhalation were significantly higher in stressed mice than in nonstressed mice. The administration of a GC receptor antagonist and a GC synthesis inhibitor during stress exposure significantly reduced the exacerbation of the airway responses and the increase of IL-13 contents in stressed mice challenged with antigen.

CONCLUSIONS

These results indicate that the increased release of GC upon exposure to stress has a priming effect on the aggravation of allergic airway responses following the exposure, suggesting a pathophysiological role for the neuroendocrine axis in linking psychological stress to asthma exacerbations.

Asthma and depression: the Cooper Center Longitudinal Study

BACKGROUND

Prior research suggests a possible association between asthma and depression.

OBJECTIVE

To examine the association between asthma and depressive symptoms, controlling for asthma medications, lung function, and overall health.

METHODS

We conducted a cross-sectional study of 12,944 adults who completed physician-based preventive health examinations at the Cooper Clinic from 2000 to 2012. Information on medical histories, including asthma and depression, and medications were collected. Participants reported overall health status, completed spirometry testing, and underwent depression screening using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). Dependent variables of current depressive symptoms (CES-D scores ≥10) and lifetime history of depression were separately modeled using logistic regression with independent variables, including demographics, spirometry, asthma controller medications, and patient-reported health status.

RESULTS

The sample was predominantly white and well educated. The prevalence of asthma was 9.0%. Asthma was associated with an odds ratio (OR) of 1.41 (95% CI, 1.16-1.70; P < .001) of current depressive symptoms based on CES-D score. Asthma was also associated with lifetime history of depression (OR, 1.66; 95% CI, 1.40-1.95; P < .001). Neither lung function nor asthma controller medications were significantly associated with depression.

CONCLUSION

Asthma was associated with increased prevalence of current depressive symptoms and lifetime depression in a large sample of relatively healthy adults. These findings suggest that the increased likelihood of depression among patients with asthma does not appear to be exclusively related to severe or poorly controlled asthma. People with asthma, regardless of severity, may benefit from depression screening in clinical settings.

Evaluation of asthma control and patient's perception of asthma: findings and analysis of a nationwide questionnaire-based survey in China

BACKGROUND

Little is known about asthma control and perception of asthma among asthmatic patients on a national scale in China due to the difficulty of conducting a survey of the large, vastly distributed population of the country. We know that the medical insurance system may not evenly cover all patients and that socioeconomic status varies greatly across cities.

OBJECTIVE

This study marks the first survey conducted on a national scale that was aimed at obtaining baseline information on asthma control and patients' perceptions of asthma and providing a point of reference for future studies.

METHODS

This face-to-face, questionnaire-based survey was conducted from April 2007 to March 2008 in 3069 asthmatic patients from the respiratory outpatient clinics of 36 general hospitals located in 10 geographically dispersed cities.

RESULTS

Per the Global Initiative for Asthma (GINA) guidelines, 28.7% and 45.0% of our patients achieved complete or partial asthma control, respectively. Of patients in the study, only 21.8% had used a peak flow meter (PFM) and 6.6% of these patients used it daily. Inhaled corticosteroids (ICS) plus a long-acting β2 agonist and ICS were the two most common medication regimens and were used in 45.6% and 30.4% of patients, respectively. Asthma had a significant effect on patients' life and work. A considerable number of hospitalizations, emergency department visits and sick days were also observed.

CONCLUSIONS

Despite improvements in asthma control and ICS and PFM compliance compared with past literature, the current level of asthma control countrywide continues to fall short of the goals set in the GINA.

Serious psychological distress among non-Hispanic whites in the United States: the importance of nativity status and region of birth

PURPOSE

Serious psychological distress (SPD) is an understudied health topic. When studied, estimates for minority groups are compared to that of non-Hispanic whites. Non-Hispanic whites are heterogeneous, and comprise individuals from Europe, North Africa or the Middle East. The objectives of this study are to estimate and compare the sex- and age-adjusted prevalence of SPD first by nativity status and then by region of birth (Europe, Middle East and Russia) while controlling for potential confounders.

METHODS

The sample consisted of 196,483 participants, 18 years of age or older in the National Health Interview Survey (2000-2010). To measure SPD, Kessler's K6 Likert scale was used. Individuals with scores greater than or equal to 13 were considered to have SPD.

RESULTS

The age- and sex- adjusted prevalence of SPD was 3 % for foreign-born non-Hispanic whites. Of this, estimates were 6 % for those from the Middle East, 3 % for Europe and 2 % for Russia (p = 0.00). In the fully adjusted multivariable model, foreign-born non-Hispanic whites from the Middle East were more likely (OR = 1.76; 95 % CI = 1.01, 3.04) to report SPD when compared to US-born non-Hispanic whites. Within the foreign-born population, non-Hispanic whites from the Middle East were more than twice as likely to report SPD (OR = 2.43; 95 % CI = 1.15, 5.14) compared to foreign-born non-Hispanic whites from Europe after controlling for confounders.

CONCLUSIONS

This study's findings will help researchers understand which subgroups within non-Hispanic whites suffer most from SPD, which will facilitate tailored prevention intervention efforts.

Examining the role of location-specific associations between ambient air pollutants and adult asthma in the United States

This study examined the association between ozone and fine particulate (PM2.5) exposure and asthma risk by place of residence. We linked 412,832 adult respondents from the 2009 U.S. Behavioral Risk Factor Surveillance System to their residence counties. Observed and interpolated ozone and PM2.5 concentration data from 2006 to 2009 were used as exposures. We linked self-reported current asthma status and other individual risk factors to county-level risk factors in multilevel logistic regressions. Results indicated spatially varied asthma risks and spatially varied associations between ambient air pollution and asthma risk. Residents in counties not located within a metropolitan statistical area (MSA) and in inner ring suburbs had a relatively higher asthma risk. Positive ozone-asthma associations were detected across all spatial settings, while positive PM2.5-asthma associations were detected only in central cities of an MSA and in outer ring suburbs, indicating that residence location modified the relationship between ambient air pollution and asthma risk.

The association between hospitalization for asthma in childhood and alcohol use disorder hospitalization during adolescence and early adulthood among males in an Australian birth cohort

OBJECTIVE

Associations between asthma and a range of mental disorders have been increasingly reported from cross-sectional studies. The aim of this study is to investigate whether hospitalization for asthma during childhood is associated with an increased risk of hospitalization for alcohol use disorders during adolescence and early adulthood.

METHOD

This study used a population-based birth-cohort design and included males (n = 56369) born between 1980 and 1984 in Western Australia (WA). Hospitalizations for asthma and alcohol use disorders were identified using ICD-9 codes and ICD-10 codes. Survival analysis and multivariate Poisson regression model were used in the analysis.

RESULTS

The risk of alcohol use disorder hospitalization was significantly higher among participants who had been hospitalized for asthma during ages 3-6 years and 12-18 years.

CONCLUSION

In this cohort study of Western Australian males, hospitalizations for asthma during childhood were associated with an increased risk of alcohol use disorder hospitalization among males.

Antidepressant medication dispensing among montelukast initiators

OBJECTIVE

This study investigates the potential association between montelukast use and psychiatric adverse events by monitoring changes in antidepressant medication dispensing rates before and after initiating montelukast.

METHODS

The primary study group of montelukast initiators was identified using the Wolters Kluwer's SOURCE Lx® pharmacy claims database (WK). This group included 232,159 patients ≤45 years old who had at least two montelukast prescriptions from 2003 to 2007. Comparison groups comprised of 264,704 fluticasone initiators and 89,635 long-acting β-agonist corticosteroid (LABA/ICS) initiators were also identified. Antidepressant medication dispensing rates in these three groups were determined using WK, and changes in rates before and after the first asthma controller medication prescription date were evaluated using interrupted time-series analysis (ITS). ITS was performed separately for four age categories, with a focus on youth (12-17 years) and young adult (18-24 years).

RESULTS

For patients 18-24 years old, antidepressant medication dispensing rates increased significantly after initiating montelukast [1.93% (1.55-2.32%, p < 0.001)] but also after initiating fluticasone and LABA/ICS [1.72% (1.30-2.15%, p < 0.001) and 2.76% (2.35-3.17%, p < 0.001)]. Similar patterns were observed across the three medication groups for other age categories but these differences were not all significant.

CONCLUSIONS

Small increases in antidepressant medication dispensing rates occurred after initiating montelukast. However, similar increases were observed in the fluticasone and LABA/ICS comparison groups. The results of this study cannot support a specific association between initiation of montelukast treatment and an increase in psychiatric adverse effects.

A review of psychological dysfunction in asthma: affective, behavioral and cognitive factors

BACKGROUND

The research on psychological dysfunction in asthma is extensive but heterogeneous. We undertook a narrative review about the effects of psychological dysfunction on asthma.

METHODS

Electronic searches of MEDLINE, EMBASE, CINAHL and the Cochrane Library were conducted, supplemented by hand-searching bibliographies and seeking expert opinion.

RESULTS

The impact of psychological factors on asthma can be classified according to dysfunction in the domains of affect, behavior and cognition. Affective or emotional disturbance may lead to poor asthma control by directly modulating disease activity. Maladaptive behaviors may occur in asthma patients. These include maladaptive breathing behaviors, such as impaired voluntary drive to breathe and dysfunctional breathing, as well as impaired asthma health behaviors, that is, a coordinated range of activities performed to maintain good disease control. Dysfunctional cognitions (thoughts and beliefs) about asthma and impaired cognitive processing of the perception of dyspnea are associated with poorly controlled disease and asthma deaths, respectively. The three domains of psychological dysfunction are often closely intertwined, leading to vicious circles.

CONCLUSIONS

We have conceptualized psychological dysfunction in asthma using a framework consisting of affect, behavior and cognition. Their influences are intertwined and complex. Future research should focus on the formulation of a psychological assessment tool based on this framework and evaluating its efficacy in improving asthma outcomes.

Asthma and wheezing are associated with depression and anxiety in adults: an analysis from 54 countries

Background. Asthma and depression are important public-health concerns worldwide. While some epidemiologic studies have shown asthma and wheezing to be associated with depression and anxiety, the patterns are unclear at the multinational level due to the lack of cross-study comparability. Our study examined the associations of self-reported asthma diagnosis and current wheezing with self-reported depression diagnosis and 30-day anxiety using an international survey. Methods. Using the 2002 World Health Survey, a standardized international survey conducted by the WHO, we estimated the associations between diagnosed asthma and current wheezing with diagnosed depression and 30-day anxiety via multiple logistic regressions for 54 countries worldwide. Results. Diagnosed depression and 30-day anxiety were associated with diagnosed asthma in 65% and 40% of the countries, respectively. Diagnosed depression and 30-day anxiety were associated with current wheezing in 83% and 82% of the countries, respectively. Conclusions. The association between asthma and depression was generally seen at the global level. These results indicated the importance of addressing the asthma-depression comorbidity as public-health and clinical management priorities, in order to improve the overall health of the countries.

Neighborhood incarceration rate and asthma prevalence in New York City: a multilevel approach

OBJECTIVES

We examined the association between neighborhood incarceration rate and asthma prevalence and morbidity among New York City adults.

METHODS

We used multilevel modeling techniques and data from the New York City Community Health Survey (2004) to analyze the association between neighborhood incarceration rate and asthma prevalence, adjusting for individual-level sociodemographic, behavioral, and environmental characteristics. We examined interactions between neighborhood incarceration rate, respondent incarceration history, and race/ethnicity.

RESULTS

The mean neighborhood rate of incarceration was 5.4% (range = 2.1%-12.8%). Neighborhood incarceration rate was associated with individual-level asthma prevalence (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.03, 1.10) in unadjusted models but not after adjustment for sociodemographic characteristics (OR = 1.01; 95% CI = 0.98, 1.04). This association did not differ according to respondent race/ethnicity.

CONCLUSIONS

Among New York City adults, the association between neighborhood incarceration rate and asthma prevalence is explained by the sociodemographic composition of neighborhoods and disparities in asthma prevalence at the individual level. Public health practitioners should further engage with criminal justice professionals and correctional health care providers to target asthma outreach efforts toward both correctional facilities and neighborhoods with high rates of incarceration.

Airway inflammation and hypothalamic-pituitary-adrenal axis activity in asthmatic adults with depression

OBJECTIVE

To investigate the features of airway inflammation and hypothalamic-pituitary-adrenal axis (HPAA) activity in patients with asthma accompanied by depression.

METHODS

Adult asthmatics were recruited and enrolled into one of the two groups based on scores on the Hamilton Depression Rating Scale (HAMD): asthmatics with depression (HAMD score ≥8, n = 23), and asthmatics without depression (HAMD score <8, n = 41). In addition, 27 healthy individuals and 21 adults with depression only were enrolled as controls. Induced sputum and blood samples were collected for measurement of cytokines and other inflammatory factors. The diurnal rhythm profiles of salivary cortisol and other hormones were obtained for assessment of the HPAA activity.

RESULTS

For the group of asthmatics with depression, the mean HAMD score was 19.0, and for the group of asthmatics without depression, the HAMD score averaged 4.9(p < .001). Serum and sputum tumor necrosis factor alpha (TNF-α) were significantly higher in asthmatics with depression than those in the other groups (p < .05) while serum interferon-gamma (IFN-γ) was lower in asthmatics with depression than that in the other groups (p < .05). Twenty-four-hour urinary cortisol, salivary cortisol at 8 a.m. and 4 p.m. were lower in asthmatics with depression compared to other groups (p < .05).

CONCLUSIONS

As compared to healthy individuals and those with asthma or depression alone, individuals with comorbid depression and asthma showed the highest level of pro-inflammatory cytokines and the lowest level of anti-inflammatory cytokines and cortisol. These observations may serve as a valuable reference for diagnosis and clinic therapies of depression in asthmatics.

Factors associated with health-related quality of life in adults with asthma. A cross-sectional study

Background

The measurement of health-related quality of life (HRQoL) is increasingly recognized as an important endpoint, as a reflection of the effects of the disease from a patient perspective. Our aim was to evaluate the factors determining the HRQoL in patients with asthma, according to the EQ-5D questionnaire.

Methods

Patients were included using multi-stage sampling, from Primary Care clinics from all the Autonomous Communities in Spain. The patients included were: over 18 years-old, with a confirmed diagnosis of asthma for at least one year, and had visited a Health Centre in the previous 2 years. The characteristics of the asthma disease, the adherence to treatment, the socio-demographic variables, the smoking habits, and the asthma control were collected using a questionnaire. The influence of the different variables included in the study on the EQ-5D was evaluated using multivariate logistic regression analysis.

Results

A total of 2,125 patients were finally included (57.7% females, mean age 48 years). The response rate was 95.4%. Some factors showed a considerable detrimental effect on the HRQoL of asthmatics. Advanced age, lower educational level and poor control of asthma are significantly associated with a worse quality of life in all the dimensions assessed by the EQ-5D scale. The baseline severity of the asthma, and having been admitted to hospital are related to a worse quality of life in 5 of the 6 dimensions analyzed.

Conclusion

In our study, we could identify some factors related to quality of life in asthma patients. The most important were advanced age, lower education level, and poor control of the asthma.

Relationship between posttraumatic stress disorder and asthma among New York area residents exposed to the World Trade Center disaster

OBJECTIVE

The heightened prevalence rates of respiratory problems and posttraumatic stress disorder (PTSD) among New York area residents following the World Trade Center disaster on September 11, 2001, have received national attention. Although there is some evidence suggesting that PTSD is associated with increased risk for asthma, this relationship has not been well documented in this population at high risk for both disorders. There is also a need to examine this relationship while controlling for notable confounds, including dust exposure and smoking.

METHOD

This study examined the association between symptoms indicative of probable PTSD and the diagnosis of asthma following 9/11 among the individuals who participated in the World Trade Center Health Registry (WTCHR) baseline study between September 2003 and November 2004. A total of 71,437 participants enrolled in this study and completed questionnaires pertaining to exposure, physical health symptoms before and after 9/11, and self-reported PTSD symptoms.

RESULTS

Logistic regression revealed that, compared to participants without probable PTSD, individuals with probable PTSD were 1.65 times more likely to be diagnosed with asthma following 9/11, which was significant after controlling for the effects of gender, ethnicity, income, smoking status, dust exposure, and nonspecific psychological distress [Wald χ(2) (1)=52.375, P<.001].

CONCLUSION

These results suggest that PTSD symptoms are associated with the development of asthma following 9/11 and that this relationship is not explained by sociodemographic, environmental, and lifestyle factors.

Asthma prevalence among US elderly by age groups: age still matters

OBJECTIVE

For over three decades, the greatest burden of asthma deaths has occurred among persons aged 65 years and older. This study analyzed the association between increasing age and asthma prevalence among age groups within the US elderly population.

METHODS

We analyzed aggregated data on 54,485 civilian, noninstitutionalized US adults aged 65 years and older from the 2001-2010 National Health Interview Survey (NHIS). We estimated the prevalence of current asthma, lifetime asthma, and chronic obstructive pulmonary disease (COPD) among US elderly by 5-year age groups and age stages ("young elderly" aged 65-84 years and "oldest old" aged ≥85 years). We calculated adjusted odds ratios (AOR) and 95% confidence intervals (CI) to identify asthma prevalence patterns among elderly populations.

RESULTS

From 2001 to 2010, the estimated average annual prevalence of current asthma among US elderly was 7.0%. Estimates of lifetime asthma, COPD, and co-occurring current asthma and COPD were 9.9%, 9.7%, and 3.0%, respectively. Prevalence of asthma decreased with advancing age while prevalence of COPD increased with advancing age. When controlling for study variables and significant interactions (p = .05) with COPD, the odds of reporting current asthma decreased with advancing age: 0.87 (95% CI, 0.76-1.01) for 70- to 74-year-olds; 0.76 (95% CI, 0.66-0.87) for 75- to 79-year-olds; 0.62 (95% CI, 0.51-0.75) for 80- to 84-year-olds; and 0.45 (95% CI, 0.36-0.55) for ≥85-year-olds, as compared to 65- to 69-year-olds.

CONCLUSIONS

Asthma continues to affect a substantial proportion of the US elderly population. Increased diagnosis of COPD may overshadow correct diagnosis and treatment in populations with advancing age. Treatment guidelines should focus on preventable risk behaviors to increase the quality of life within this population.

Mental health among adults with asthma and chronic bronchitis. A population-based study in Spain

OBJECTIVES

To analyze the conditions of psychological dysfunction and positive mental health in patients with asthma and chronic bronchitis (CB), as compared to healthy individuals, and to identify the factors associated with these mental health indicators.

METHODS

Cross-sectional study based on data obtained from the European Health Interview Survey for Spain (EHISS, 2009). We identified individuals with asthma and CB using a specific questionnaire. In order to assess mental health, two indicators extracted from questionnaire SF-36 were used: psychological dysfunction and positive mental health status.

RESULTS

Out of 19,598 subjects included in the study, 8.3% were classified as asthmatic and 7.4% as CB. Healthy individuals had significantly higher psychological dysfunction scores than those with asthma and CB. The same occurred with positive mental health. The variables independently associated with lower scores out of these variables were gender female, a greater number of chronic diseases and obesity. On the contrary, alcohol consumption and physical exercise were associated with a higher score in the aforementioned variables.

CONCLUSIONS

Healthy individuals have significantly higher scores in psychological dysfunction and positive mental health than patients with asthma and CB. This suggests that their mental health is much better. The variables related with lower scores out of these variables, and therefore with worse mental health, are: being female, having a greater number of chronic diseases and obesity. On the contrary, alcohol consumption and the practicing of physical exercise are associated with a higher score in the aforementioned variables, thus indicating a greater degree of mental health.

Effect of current depression on the association of work-related asthma with adverse asthma outcomes: a cross-sectional study using the Behavioral Risk Factor Surveillance System

BACKGROUND

Depression has been associated with a decreased level of asthma control. The aim of our study was to examine associations between health-professional diagnosed work-related asthma (WRA) and current depression and the effect of current depression on the associations of WRA with adverse asthma outcomes.

METHOD

We analyzed data from the 2006 and 2008 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey and the Anxiety and Depression Module conducted in 25 states and District of Columbia for ever-employed adults with current asthma. We computed weighted proportions and prevalence ratios adjusted for age, sex, race/ethnicity, education, current employment status, and smoking status. Survey participants who were ever told by a doctor or other health professional that their asthma was related to any job they ever had were determined to have WRA. Participants with current depression were identified using self-report of depressive symptoms.

RESULTS

Of ever-employed adults with current asthma, an estimated 9.1% had WRA and 17.0% had current depression. Persons with WRA were significantly more likely than those with non-WRA to have current depression. Persons with either WRA, current depression, or both WRA and current depression were significantly more likely to have adverse asthma outcomes than persons with asthma and neither condition. The associations with adverse asthma outcomes were stronger when both current depression and WRA were present.

LIMITATIONS

This is a cross-sectional and hypothesis-generating study.

CONCLUSIONS

Depression may play an important role in asthma management and should be considered when assessing patients with asthma and, in particular, those with WRA.

Treatment of asthma and food allergy with herbal interventions from traditional chinese medicine

Prevalence of asthma and allergy has increased over the past 2-3 decades in Westernized countries. Despite increased understanding of the pathogenesis of asthma and allergic diseases, control of severe asthma is still difficult. Asthma is also associated with a high prevalence of anxiety, particularly in adolescents. There is no effective treatment for food allergy. Food allergy is often associated with severe and recalcitrant eczema. Novel approaches for treatment of asthma and food allergy and comorbid conditions are urgently needed. Traditional Chinese medicine, used in Asia for centuries, is beginning to play a role in Western healthcare. There is increasing scientific evidence supporting the use of traditional Chinese medicine for asthma treatment. Since 2005, several controlled clinical studies of "antiasthma" herbal remedies have been published. Among the herbal medicines, antiasthma herbal medicine intervention is the only antiasthma traditional Chinese medicine product that is a Food and Drug Administration investigational new drug that has entered clinical trials in the United States. Research into the effects and mechanisms of action of antiasthma herbal medicine intervention in animal models is actively being pursued. Research on traditional Chinese medicine herbal medicines for treating food allergy is rare. The herbal intervention Food Allergy Herbal Formula-2 is the only Food and Drug Administration botanical investigational new drug under investigation as a multiple food allergy therapy. This review article discusses promising traditional Chinese medicine interventions for asthma, food allergy, and comorbid conditions, and explores their possible mechanisms of action.