Perceived stress, severity of asthma, and quality of life in young adults with asthma

A mixed-methods analysis of younger adults' perceptions of asthma, self-management, and preventive care: "This isn't helping me none"

BACKGROUND

Young adults (ages 18-44) have increased emergency department use for asthma and poor adherence to medications. The objective of this mixed-methods study was to understand experiences with and approaches to managing asthma, of which little is known in this age group.

METHODS

Surveys (Asthma Control Questionnaire, Asthma Quality of Life Questionnaire) and 1:1 semi-structured interviews were used to explore experiences with asthma, symptoms, self-management behaviours, and relationship to asthma control and quality of life. Qualitative data were analysed using content analysis techniques. Descriptive statistics and bivariate correlations were used to examine distributive characteristics and associations between variables.

RESULTS

Forty urban adults participated (mean age 32.7 ± 6.2, 1σ). Coughing was reported nearly 46% more often than wheezing, with 42.5% (17/40) coughing until the point of vomiting most days. Most participants delayed using medication for symptoms due to misperceptions about inhalers. Higher symptom frequency and worse asthma control were associated with greater use of non-pharmacologic symptom management strategies (r = 0.645, P < .001; r = 0.360, P = .022, respectively). Five themes were identified regarding young adults experiences with asthma: (1) having asthma means being limited and missing out on life; (2) health care for asthma is burdensome, and other things are more important; (3) there is not enough personal benefit in medical interactions to make preventive care worthwhile; (4) there are insufficient support and education about asthma for adults; and (5) people normalize chronic symptoms over time and find ways of coping that fit with their lifestyle.

CONCLUSIONS AND CLINICAL RELEVANCE

Young adults may tolerate symptoms without using quick-relief medication or seeking preventive care. Increasing engagement with preventive services will require decreasing perceived burdens and increasing the personal benefits of care. Evaluating for non-pharmacologic approaches to managing symptoms and asthma-related coughing may identify uncontrolled asthma. Enhanced training for clinicians in patient-centric asthma care may be needed.

The Patient Needs in Asthma Treatment (NEAT) questionnaire: Further evidence on its psychometric properties

BACKGROUND

Building on previous psychometric work, we sought to assess the Patient Needs in Asthma Treatment (NEAT) questionnaire's validity, responsiveness to change, and the minimal important change (MIC) over a 3-year period (Study 1) and its reliability and the smallest detectable change (SDC) in a test-retest study (Study 2) among patients self-reporting physician-diagnosed asthma.

METHODS

In Study 1, a total of 207 patients completed a survey which included the NEAT, the Asthma Control Test (ACT), the Asthma Quality of Life Questionnaire-Sydney (AQLQ-S), and a question on treatment satisfaction in 2014 and 2017. In Study 2, a total of 78 patients completed NEAT twice on average four weeks apart in 2018.

RESULTS

Concurrent validity: In linear regressions, unmet patient needs were cross-sectionally associated with poorer asthma control (β = -0.21; P = 0.01), asthma-related quality of life (QoL) (β = 0.31; P < 0.01), and treatment satisfaction (β = -0.59; P < 0.01). Predictive Validity: Higher unmet needs at baseline predicted worse treatment satisfaction at follow-up (β = -0.28; P < 0.01), but neither asthma control nor asthma-related QoL. Responsiveness to change was demonstrated by linear regressions of changes in the total NEAT score and changes in AQLQ-S (β = 0.21; P < 0.01) and treatment satisfaction (β = -0.36; P < 0.01). MIC: Patients whose NEAT score increased between baseline and follow-up by the identified MIC (0.301) reported lower treatment satisfaction at follow-up (β = -0.17; P = 0.01). Test-retest reliability was demonstrated by correlations between NEAT baseline and follow-up scores (eg, intra-class correlation coefficients for total score = 0.78). The SDC (0.384) was slightly larger than MIC.

CONCLUSION

NEAT is a promising tool for assessing asthma treatment needs.

The role of self-efficacy and locus of control in asthma-related needs and outcomes: a cross-sectional study

Objective: This study sought to identify psychological resources, which are associated with improved asthma outcomes. Methods: A total of 205 patients who reported physician-diagnosed asthma were surveyed between September 2017 and March 2018. Psychological resources included self-efficacy (i.e. the belief in one's capabilities to organize and execute required behavior [SE]; assessed by the Short Scale for Measuring General Self-Efficacy Beliefs), and internal and external locus of control (i.e. one's beliefs about whether a given event is the result of one's behavior or of forces outside one's control [LoC]; Scale for Internal External Locus of Control-4). Outcome variables included asthma control (Asthma Control Test), asthma-related quality of life (QoL; Asthma Quality of Life Questionnaire-Sydney) and patient needs (Patient Needs in Asthma Treatment Questionnaire). Associations were estimated by linear regressions. Results: We observed that higher self-efficacy and internal LoC scores, but lower scores on the external LoC subscale were associated with improved asthma control (SE: β = 0.19, p = 0.01; internal LoC: β = 0.17, p = 0.02; external LoC: β = -0.18, p = 0.01), better asthma-related QoL (SE: β = -0.38, p < 0.01; internal LoC: β = -0.40, p < 0.01; external LoC: β = 0.46, p < 0.01) and less unmet needs (SE: β = -0.16, p = 0.02; internal LoC: β = -0.18, p < .01; external LoC: β = 0.32, p < 0.01). Conclusions: Our study provides novel evidence on psychological resources among patients with asthma, which are associated with improved asthma outcomes.

Cross-sectional study of cognitive stress appraisal and related factors among workers in metropolitan areas of Japan

OBJECTIVE

Stress has major socioeconomic implications for all spheres of employment. It is a trigger for depression, and affects absenteeism, turnover, productivity, morale and suicide. Positive or negative cognitive stress appraisal can be a self-care strategy that affects workers' ability to cope with stress. This study examined cognitive stress appraisal among workers and identified related individual and environmental factors.

DESIGN

Cross-sectional study using self-administered postal questionnaires.

SETTING

Companies located in two metropolitan areas of Japan (Tokyo and Kanagawa prefectures).

PARTICIPANTS

2311 employees of 48 companies in metropolitan areas in Japan. In total, 341 questionnaires were returned (response rate: 14.8%), 337 of which were suitable for analysis (effective response rate: 98.8%).

PRIMARY MEASURES

Cognitive stress appraisal was assessed using the Japanese version of the Perceived Stress Scale (PSS). Potential variables related to stress appraisal included demographic, individual and environmental factors. Multiple regression analysis was used to identify factors related to cognitive stress appraisal.

RESULTS

Participants' mean±SD age was 42.8±11.7 years, and two-thirds were male. The mean±SD PSS score was 25.8±6.2. The multiple regression analysis controlled for age, sex and depression showed that those with poorer economic status (β=0.171, p<0.001), lower electronic health (eHealth) literacy (β=-0.113, p=0.012), higher traditional organisational climate (β=0.131, p=0.004) and lower perceived social support (β=-0.205, p<0.001) experienced significantly higher levels of negatively perceived stress.

CONCLUSIONS

The results show individual and environmental factors related to cognitive stress appraisal among workers. An effective strategy to improve mental health among workers may involve an interprofessional approach by public health nurses and health practitioners that includes enhanced self-coping skills using individual workers' eHealth literacy, improvement of organisational climates in workplaces and community-based social support.

Work stress, asthma control and asthma-specific quality of life: Initial evidence from a cross-sectional study

OBJECTIVE

Research has suggested that psychological stress is positively associated with asthma morbidity. One major source of stress in adulthood is one's occupation. However, to date, potential links of work stress with asthma control or asthma-specific quality of life have not been examined. We aimed to address this knowledge gap.

METHODS

In 2014/2015, we conducted a cross-sectional study among adults with asthma in Germany (n = 362). For the current analyses that sample was restricted to participants in employment and reporting to have never been diagnosed with chronic obstructive pulmonary disease (n = 94). Work stress was operationalized by the 16-item effort-reward-imbalance (ERI) questionnaire, which measures the subcomponents "effort", "reward" and "overcommitment." Participants further completed the Asthma Control Test and the Asthma Quality of Life Questionnaire-Sydney. Multivariable associations were quantified by linear regression and logistic regression.

RESULTS

Effort, reward and their ratio (i.e. ERI ratio) did not show meaningful associations with asthma morbidity. By contrast, increasing levels of overcommitment were associated with poorer asthma control and worse quality of life in both linear regression (ß = -0.26, p = 0.01 and ß = 0.44, p < 0.01, respectively) and logistic regression (odds ratio [OR] = 1.87, 95% confidence interval [CI] = 1.14-3.07 and OR = 2.34, 95% CI = 1.32-4.15, respectively).

CONCLUSIONS

The present study provides initial evidence of a positive relationship of work-related overcommitment with asthma control and asthma-specific quality of life. Longitudinal studies with larger samples are needed to confirm our findings and to disentangle the potential causality of associations.

Health-related quality of life in children with objectively diagnosed staple food allergy assessed with a disease-specific questionnaire

AIM

Among Swedish children of 0-12 years old, we investigated various food allergy-related exposures associated with health-related quality of life using a food allergy-specific questionnaire among children allergic to the staple foods cow's milk, hen's egg and/or wheat, and contextualised worse food allergy-associated health-related quality of life using a generic questionnaire versus controls.

METHODS

In total, 85 children with objectively diagnosed allergy to the staple foods were included as cases, and 94 children matched for age and sex were included as controls. We administered a food allergy-specific parent-completed questionnaire originally developed by EuroPrevall to cases only, and a generic health-related quality of life questionnaire (EuroQol Health Questionnaire, 5 Dimensions; EQ 5-D); to both cases and controls.

RESULTS

Hen's egg was the most common offending staple food, affecting 76% of cases. Approximately 7% of cases were allergic to all three staple foods. Parent-reported respiratory and cardiovascular symptoms were associated with worse health-related quality of life. Elements of disease severity [previous anaphylaxis (p < 0.001); epinephrine autoinjector prescription (p < 0.003)] were negatively associated with health-related quality of life. Cases had worse health-related quality of life measured by the EQ-5D compared to controls (p < 0.01).

CONCLUSION

The use of a disease-specific questionnaire revealed that disease severity in children with objectively diagnosed allergy to the staple foods cow's milk, hen's egg and/or wheat is associated with worse health-related quality of life. The use of a generic questionnaire confirmed that cases have worse health-related quality of life than controls.

Longitudinal HRQoL shows divergent trends and identifies constant decliners in asthma and COPD

BACKGROUND/AIM

Monitoring of lung function alone does not adequately identify the high-risk patients among elderly asthma and COPD cohorts. The additional value of Health-Related Quality of Life (HRQoL) development in the detection of patients with a disabling disease in clinical practice is unclear. The aim of this study was to statistically examine the individual development of HRQoL measured using respiratory-specific AQ20 and generic 15D questionnaires.

MATERIALS AND METHODS

The HRQoL of COPD (N = 739) and asthma (N = 1329) patients was evaluated at 0, 1, 2, and 4 years after recruitment. To determine a five-year HRQoL change for each patient we used mixed-effects modelling for linear trend.

RESULTS

In COPD, the majority (60-80%) of the individuals showed declining trend, whereas in asthma, the majority (46-71%) showed no attenuation in HRQoL. The proportion of constant decliners was estimated higher with the 15D both in asthma (6.3%) and COPD (6.3%) than with AQ20 (3.5 and 4.5%, respectively). The first measurement of HRQoL was found to predict future development of HRQoL. In asthma, obesity-related diseases such as hypertension, diabetes and gastro-esophageal reflux disease best explained the decline, whereas in COPD, age and the level of bronchial obstruction were the main determinants.

CONCLUSION

Based on the five-year follow-up, the HRQoL trends significantly diverging from each other could be identified both among the asthma and COPD patients. Compared to cross-sectional HRQoL, the HRQoL trend over a clinically relevant period of time allows us to ignore, to a great extent, the random error of self-assessed HRQoL and thus, it may offer a more accurate measure to describe the disease process.

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.

Asthma outcomes: quality of life

BACKGROUND

"Asthma-related quality of life" (QOL) refers to the perceived impact that asthma has on the patient's QOL.

OBJECTIVE

National Institutes of Health institutes and other federal agencies convened an expert group to recommend standardized measures of the impact of asthma on QOL for use in future asthma clinical research.

METHODS

We reviewed published documentation regarding the development and psychometric evaluation; clinical research use since 2000; and extent to which the content of each existing QOL instrument provides a unique, reliable, and valid assessment of the intended construct. We classified instruments as core (required in future studies), supplemental (used according to the study's aims and standardized), or emerging (requiring validation and standardization). This work was discussed at an National Institutes of Health-organized workshop convened in March 2010 and finalized in September 2011.

RESULTS

Eleven instruments for adults and 6 for children were identified for review. None qualified as core instruments because they predominantly measured indicators of asthma control (symptoms and/or functional status); failed to provide a distinct, reliable score measuring all key dimensions of the intended construct; and/or lacked adequate psychometric data.

CONCLUSIONS

In the absence of existing instruments that meet the stated criteria, currently available instruments are classified as either supplemental or emerging. Research is strongly recommended to develop and evaluate instruments that provide a distinct, reliable measure of the patient's perception of the impact of asthma on all of the key dimensions of QOL, an important outcome that is not captured in other outcome measures.

Corticotropin-releasing hormone receptor-1 and 2 activity produces divergent resistance against stress-induced pulmonary Streptococcus pneumoniae infection

Utilizing a murine model of S. pneumoniae infection and restraint stress, we determined how corticotropin releasing hormone (CRH-R) receptors impacts disease. CRH-R1 (antalarmin) and CRH-R2 (astressin2B) antagonists were administered intraperitoneally prior to restraint stress followed by pulmonary S. pneumoniae infection. CRH-R1 inhibition is not protective against pneumococcal disease induced by stress. Conversely, CRH-R2 inhibition attenuates stress-induced bacterial growth and significantly prevented severe sepsis. Neutrophillic responses were associated with CRH receptor-specific disease outcome providing a potential cellular target for stress-induced susceptibility to the development of severe pneumococcal disease. CRH receptor-mediated effects on immune responses could prove valuable for novel therapeutics.

Epinephrine-primed murine bone marrow-derived dendritic cells facilitate production of IL-17A and IL-4 but not IFN-γ by CD4+ T cells

Sympathetic activation leading to the release of epinephrine and norepinephrine, is known as an important regulatory circuit related to immune-mediated diseases. However, questions still remain on the behavior of antigen presenting cells (APC) dictated by stress-induced sympathetic neurotransmitters. The purpose of this study was to examine the fate of bone marrow-derived dendritic cell (BMDC)-associated influences on resting CD4(+) T cell activation. We hypothesize that pre-exposure of dendritic cells (DCs) can modify the intensity of cytokine production, leading to preference in resting CD4(+) T cell activation. BMDCs were pre-treated with epinephrine for 2h followed by subsequent treatment of lipopolysaccharide (LPS). Subsequently, BMDCs were cocultured with purified CD4(+) T cells from mouse spleen in the absence or presence of anti-CD3 stimulation in epinephrine-free media. Epinephrine pre-treatment enhanced surface expression of MHCII, CD80 and CD86. Quantitative RT-PCR showed that epinephrine pre-treatment induced a significant transcriptional decrease of IL-12p40 and a significant increase of IL-12p35 and IL-23p19. In addition, β2-adrenergic-blockade was shown to reverse these effects. Epinephrine pre-treatment also induced a significant decrease of IL-12p70 and a significant increase of IL-23 and IL-10 cytokine production. Importantly, these changes corresponded with increased IL-4 and IL-17A, but not IFN-g cytokine production by CD4(+) T cells in a b2-adrenergic receptor-dependent manner. These results suggest that exposure to stress-derived epinephrine dictates dendritic cells to generate a dominant Th2/Th17 phenotype in the context of subsequent exposure to a pathogenic stimulus.

Factors associated with furry pet ownership among patients with asthma

BACKGROUND

Exposure to indoor allergens is an established risk factor for poor asthma control. Current guidelines recommend removing pets from the home of patients with asthma.

OBJECTIVES

This cross-sectional study was conducted to determine the prevalence of furry pet ownership in asthmatics compared to non-asthmatics and to identify factors associated with furry pet ownership among those with asthma. Secondary analysis assessed characteristics among asthmatics that might be associated with allowing a furry pet into the bedroom.

METHODS

Using data from The National Asthma Survey collected from 2003 to 2004, we carried out univariate and multiple regression analyses, in 2009, to identify independent predictors of furry pet ownership in asthma sufferers after controlling for potential confounders.

RESULTS

Overall, asthmatics were more likely to own a furry pet than nonasthmatic individuals in the general population (49.9% versus 44.8%, p < .001). Multivariate analysis showed that female sex, older age, white race, and high income were independent predictors of furry pet ownership among asthmatics. Additionally, 68.7% of patients with asthma who own a furry pet allowed them into their bedroom. Higher income and carrying out < or =2 environmental control practices in the home were associated with increased likelihood of allowing a furry pet into the bedroom.

CONCLUSIONS

Furry pet ownership is equally or more common among asthmatics compared to those without asthma. The majority of asthmatics with furry pets allow them into the bedroom. Recognizing and addressing these problems may help decrease asthma morbidity.

Association between clinical diagnostic tests and health-related quality of life surveys in patients with dry eye syndrome

PURPOSE

This study was performed to assess the impact of dry eye on patients' quality of life (QOL) and to analyze the association between subjective symptoms and ocular surface findings of dry eye.

METHODS

The study population consisted of 158 patients with dry eye aged 20 years or older who visited any of the 15 medical care facilities enrolled in the study. The backgrounds and ocular findings of the patients were investigated, and their QOL was evaluated with the Japanese version of the 25-item National Eye Institute Visual Functioning Questionnaire (VFQ-25) and of the Medical Outcomes Study (MOS) 8-item Short-Form Health Survey (SF-8) to examine the association between subjective symptoms and ocular surface findings.

RESULTS

Of the patients enrolled, 15 were men and 143 were women, and their average age was 62.5 +/- 12.6 years. Sixty patients (38.0%) had comorbid Sjögren syndrome (SS). The results of Schirmer testing, fluorescein staining, and rose bengal staining for SS patients were significantly worse than those for the non-SS patients, but the VFQ-25 and SF-8 scores were not significantly different between the SS and non-SS patients. In the ocular surface findings, a weak association between the fluorescein staining scores and general vision scores, a subscale of the VFQ-25, was found. However, the ocular surface findings and VFQ-25/SF-8 results in the simple correlation analysis as well as in the multiple linear regression analysis showed no significant associations.

CONCLUSIONS

Ocular surface findings and QOL scores of patients with dry eye appear to disagree. Therefore, it is necessary to address subjective symptoms and QOL scores in addition to examination findings when evaluating dry eye.

Health-related quality of life in young adults with asthma

BACKGROUND

The aim was to study health-related quality of life, five years after an intervention study among young adults with asthma.

METHOD

The design was a follow-up study of a cohort of young adults with asthma (n=64) and 248 general population controls. Both groups were investigated at follow-up with a respiratory questionnaire and one generic quality-of-life instrument, and the asthma cohort also completed one-asthma-specific questionnaire. The material was analyzed with multivariate models.

RESULTS

Female gender and low FEV1 at baseline predicted both a decline during follow-up and a low quality of life at follow-up. The asthma cohort and controls scored similarly regarding generic quality of life. However, in the asthma cohort, females scored significantly lower in the physical dimension of the generic instrument, especially in the domain of general health.

CONCLUSIONS

There is an association between low FEV1 and a decline in quality of life among young adults with asthma, i.e. low FEV1 predicts a decline in quality of life during a five-year period. Young females with asthma seem to have lower quality of life compared with young males with asthma.