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Lundberg M, Voutilainen H, Lyly A, Karjalainen J, Huhtala H, Laidlaw TM, Lee SE, Nuutinen M, Toppila-Salmi S. Adult-onset asthma, allergy, and aspirin hypersensitivity associate with self-reported food avoidance. Eur Clin Respir J 2024; 11:2347073. [PMID: 38706510 PMCID: PMC11067555 DOI: 10.1080/20018525.2024.2347073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024] Open
Abstract
Background The adoption of avoidance diets by adult-onset asthmatics has not previously been studied. We hypothesized that avoidance diets would associate with adult-onset asthma, allergy, and aspirin-exacerbated respiratory disease (AERD). Methods A total of 1247 subjects with adult-onset asthma (age range: 31-91) from the Finnish national registry, and age- and sex-matched controls (n = 1970) participated in a questionnaire study in 1997. We estimated the association between asthma/allergy/AERD and avoidance diets, adjusting for potential confounding factors and validated the results in two retrospective cohorts of 5080 rhinitis/rhinosinusitis patients and 167 AERD patients from 2019 to 2020. Results The presence of asthma positively associated with adoption of any avoidance diet (adjusted OR [CI95%] 1.24 [1.02-1.51], p = 0.029) as did allergic disease and self-reported AERD within the asthmatic group (1.79 [1.29-2.48], p = 0.001 and 1.69 [1.15-2.49], p = 0.007, respectively). Asthmatics and allergic asthmatics were more likely to report avoidance of fish, fruits and vegetables, and spices (p ≤ 0.03) compared to controls and non-allergic asthmatics. The adjusted OR for multiple diets among AERD patients was 2.57 [1.34-4.95] p = 0.005. In the validation, 26.2% of the allergic asthmatics and 10.8% of AERD patients had documented avoidance diets. Conclusions Our study shows a positive association between avoidance diets and adult-onset asthma, and with allergic disease or AERD within asthmatic patients. Although we lack information on the reason patients chose to observe a specific diet, our results reinforce the importance of asking patients about their diet and if needed, giving dietary advice for adult asthma patients to help them avoid the adoption of unnecessarily restrictive diets.
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Affiliation(s)
- Marie Lundberg
- Department of Otorhinolaryngology- Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Helena Voutilainen
- Department of Allergy, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Annina Lyly
- Department of Otorhinolaryngology- Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Allergy, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Tanya M. Laidlaw
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Stella E. Lee
- Division of Otolaryngology – Head and Neck Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Mikko Nuutinen
- Department of Allergy, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Haartman Institute, Medicum, University of Helsinki, Helsinki, Finland
| | - Sanna Toppila-Salmi
- Department of Allergy, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Haartman Institute, Medicum, University of Helsinki, Helsinki, Finland
- Department of Otolaryngology, University of Eastern Finland, Kuopio, Finland
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Baggott C, Chan A, Hurford S, Fingleton J, Beasley R, Harwood M, Reddel HK, Levack WMM. Patient preferences for asthma management: a qualitative study. BMJ Open 2020; 10:e037491. [PMID: 32801203 PMCID: PMC7430405 DOI: 10.1136/bmjopen-2020-037491] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/01/2020] [Accepted: 07/02/2020] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Preference for asthma management and the use of medications is motivated by the interplay between lived experiences of asthma and patients' attitudes towards medications. Many previous studies have focused on individual aspects of asthma management, such as the use of preventer and reliever inhalers. The aim of this qualitative study was to explore the preferences of patients with mild-moderate asthma for asthma management as a whole and factors that influenced these preferences. DESIGN A qualitative study employing qualitative descriptive analysis situated within a constructionist epistemology to analyse transcribed audio recordings from focus groups. SETTING Three locations within the greater Wellington area in New Zealand. PARTICIPANTS Twenty-seven adults with self-reported doctor's diagnosis of asthma, taking short-acting beta-agonists alone or inhaled corticosteroids with or without long-acting beta2-agonist, who had used any inhaled asthma medication within the last month. RESULTS Four key areas described preferences for asthma management. Preferences for self-management: participants wanted to be in control of their asthma and developed personal strategies to achieve this. Preferences for the specific medications or treatment regimen: participants preferred regimens that were convenient and reliably relieved symptoms. Preferences for inhaler devices: devices that had dose counters and were easy to use and portable were important. Preferences for asthma services: participants wanted easier access to their inhalers and to be empowered by their healthcare providers. Participant preferences within each of these four areas were influenced by the impact asthma had on their life, their health beliefs, emotional consequences of asthma and perceived barriers to asthma management. CONCLUSIONS This study illustrates the interaction of the lived experience of asthma, factors specific to the individual, and factors relating to asthma treatments in shaping patient preferences for asthma management. This aids our understanding of preferences for asthma management from the patient perspective. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12619000601134).
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Affiliation(s)
| | - Amy Chan
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Sally Hurford
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - James Fingleton
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Matire Harwood
- Te Kupenga Hauora Maori, University of Auckland, Auckland, New Zealand
| | - Helen K Reddel
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
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Cheung MMY, Saini B, Smith L. Patients' drawings of their asthma: adding qualitative specificity to a quantitative measure of illness perceptions. J Asthma 2018; 57:95-104. [PMID: 30507271 DOI: 10.1080/02770903.2018.1541358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Patients' perceptions about their asthma can influence behavior, coping and outcomes. Previous studies have also identified that patients' views can differ significantly to that of healthcare professionals. Enhancing current understanding of patients' perceptions can assist in reducing this mismatch. We aimed to utilize the medium of drawings to add qualitative specificity and depth to a quantitative measure of illness perceptions exploring patients' perspectives of their asthma. Methods: Eighteen adults with asthma completed the Brief Illness Perception Questionnaire (BIPQ) and participated in a drawing activity. Analysis was based on the participants' transcribed descriptions of their drawing. A coding approach was used to map the data according to the BIPQ items. Results: The drawings and subsequent discussions specified the "what," the "how," and the "why" of the experience of living with asthma. Prominent emotional and social elements emerged, with evocative images coupled with expressive and profound language. Use of drawing also revealed additional representations which were outside of the BIPQ scope. Conclusions: Using qualitative methods to analyze a novel approach to understanding illness perceptions provided insight into how asthma affects patients' lives personally.
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Affiliation(s)
- Melissa Mei Yin Cheung
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Bandana Saini
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Lorraine Smith
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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4
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Abstract
INTRODUCTION The global incidence and prevalence of allergic diseases are increasing as is the intensity and duration of excessive psychological stress due to multiple factors associated with living in today's world such as personal, social and political unrest, increased fear and anxiety, and/or depression often leading to hopelessness. Both allergy and chronic psychological stress are characterized by immune imbalances that have similar characteristics. Thus, it is reasonable to posit that the two are interactive and stress may induce as well as complicate at least some allergic diseases. Areas covered: Stress management/reduction has been proposed with various physical, pharmacological, and psychological interventions for both preventive and therapeutic reasons. A useful intervention involves mindfulness techniques, which allow the individual to put their life situation in context for better personal management. Expert commentary: Future studies must be developed that will further examine the role of excess psychological stress in specific allergic diseases and evaluate the effectiveness of various stress intervention protocols, particularly those involving mindfulness, to determine which individual would best respond clinically to which intervention. When this is accomplished, assessment and treatment of psychological stress will become a standard component of clinical care for allergy, asthma, and other immune-based diseases.
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Affiliation(s)
- Gailen D Marshall
- a Laboratory of Behavioral Immunology Research, Division of Clinical Immunology and Allergy, Department of Medicine , The University of Mississippi Medical Center , Jackson , MS , USA
| | - Matthew T Tull
- b Department of Psychology , The University of Toledo , Toledo , OH , USA
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Pickles K, Eassey D, Reddel HK, Locock L, Kirkpatrick S, Smith L. "This illness diminishes me. What it does is like theft": A qualitative meta-synthesis of people's experiences of living with asthma. Health Expect 2018; 21:23-40. [PMID: 28768067 PMCID: PMC5750696 DOI: 10.1111/hex.12605] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND What matters to people in their everyday experiences of living with asthma is influenced by a diverse range of personal, social, medical and environmental factors. Previous reviews of the asthma literature have largely focused on medical aspects of asthma or specific population groups with particular needs. OBJECTIVE To identify, describe and synthesize from the available qualitative literature the views and experiences of adults living with asthma. METHOD We systematically searched for qualitative studies reporting on the personal experience of living with asthma. A meta-synthesis approach was used to analyse and interpret the data. Key themes relating to personal perspectives on asthma were identified and grouped into overarching concepts. RESULTS We identified 26 studies. There was a paucity of literature on the physical burden of asthma symptoms and the role of social support. Our synthesis generated a central concept of the "work" associated with living with asthma: work was of a personal nature, and at times an intensely emotional experience. Individuals tailored their behaviour in response to demands of the physical and social environment, including interactions with health-care professionals. CONCLUSION This is the first systematic review of the qualitative literature reporting on people's own perspectives of living with asthma. Our findings draw attention to the nuances and sensitivities surrounding patient experiences of self-management. Medical care is a central plank of managing chronic conditions, but our health-care systems are now expected to deliver patient-centred care. Considering the broader aspects of asthma management, beyond that of symptoms and treatment, will help to facilitate comprehensive care.
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Affiliation(s)
- Kristen Pickles
- Centre for Values, Ethics & the Law in MedicineUniversity of SydneySydneyNSWAustralia
| | - Daniela Eassey
- Faculty of PharmacyUniversity of SydneySydneyNSWAustralia
| | - Helen K. Reddel
- Woolcock Institute of Medical ResearchUniversity of SydneySydneyNSWAustralia
| | - Louise Locock
- Nuffield Department of Primary Care Health ScienceUniversity of OxfordOxfordUK
| | - Susan Kirkpatrick
- Nuffield Department of Primary Care Health ScienceUniversity of OxfordOxfordUK
| | - Lorraine Smith
- Faculty of PharmacyUniversity of SydneySydneyNSWAustralia
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Finell E, Seppälä T. Indoor air problems and experiences of injustice in the workplace: A quantitative and a qualitative study. INDOOR AIR 2018; 28:125-134. [PMID: 28741743 DOI: 10.1111/ina.12409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/18/2017] [Indexed: 06/07/2023]
Abstract
This study explores subjective injustice experiences of individuals suffering from suspected or observed indoor air problems in their workplaces in two studies. We focus on injustice experiences because they influence how individuals cope with and recover from health problems. The first study reports associations between the perceived harmfulness of the indoor environment (ie, mold/inadequate ventilation) and subjective injustice experiences in workplaces in a representative sample of Finnish working-aged people (N = 4633). Altogether, 37% of the respondents perceived their workplaces' indoor environments to be harmful. Multivariate logistic regression analyses revealed that the risks of reporting subjective injustice experiences (eg, information, attitudes, and remuneration) were significantly higher for those reporting harmful indoor environments compared to those who reported no such problems (OR 1.28-1.95 for different situations). The second study explored injustice experiences more closely by qualitatively analyzing the content of 23 essays. These essays were written by people who suffered from suspected or observed indoor air problems in their workplaces. The respondents reported multidimensional experiences of injustice, which related to conflicts, and moral exclusions. Awareness of these psychosocial effects is important for the prevention of unnecessary escalation of psychosocial problems in workplaces with observed and suspected indoor air problems.
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Affiliation(s)
- E Finell
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - T Seppälä
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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Cheung MMY, Saini B, Smith L. Drawing asthma: An exploration of patients' perceptions and experiences. J Asthma 2017; 55:284-293. [PMID: 28514199 DOI: 10.1080/02770903.2017.1325492] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE As an art form, drawings can facilitate the tangible expression of patients' inner images and feelings in a range of health conditions. However, there are currently no published studies investigating adults' perspectives of asthma using drawings. This study aimed to explore how adults' drawings illustrate their perceptions and experiences of asthma. METHODS Adults with asthma participated in a one-on-one drawing activity. Analysis was grounded in the participants' accounts of their drawing, which were examined alongside the relevant image. A coding approach was used to cluster thematic material and map the data according to the Common-Sense Model of Self-Regulation (CSM). RESULTS Eighteen participants took part. Three themes emerged: (1) asthma is constrictive and restrictive, (2) feeling alone, feeling different, and (3) the life journey of asthma. The drawings aligned with several domains of the CSM, in particular consequences. The images drawn by the participants and their subsequent discussions highlighted the prominence of the emotional burden of asthma. CONCLUSIONS The drawings provided powerful and evocative communication of the experience of asthma. Future research using drawings can further both healthcare professionals' and patients' understanding of the physical, social and emotional demands of living with asthma, and support the development of asthma self-management practices.
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Affiliation(s)
| | - Bandana Saini
- a Faculty of Pharmacy , The University of Sydney , Camperdown , Australia
| | - Lorraine Smith
- a Faculty of Pharmacy , The University of Sydney , Camperdown , Australia
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Abstract
OBJECTIVE To review the pathophysiologic mechanisms underlying asthma exacerbations, the impact of exacerbations, and both current and future treatment strategies to establish asthma control and reduce the risk of future exacerbations. RESEARCH DESIGN AND METHODS Relevant adult data were identified via PubMed, with additional references obtained by reviewing bibliographies from selected articles. RESULTS Asthma exacerbations or 'attacks' are acute episodes of progressive worsening of symptoms which occur in patients with all degrees of asthma severity and are an important cause of morbidity and mortality. For patients, these asthma attacks constitute a considerable part of the disease burden in terms of both personal suffering and economic impact. Exacerbations are characterized in part by decreases in expiratory flow or lung function. The pathophysiologic mechanism underlying these changes is likely to be different depending on the specific asthma phenotype. Asthma exacerbations are commonly initiated by upper respiratory tract infections and/or environmental allergens, although there are other known factors which increase the risk of a patient developing exacerbations, such as cigarette smoking. Establishing asthma control and reducing the risk of future exacerbations is the main goal of asthma treatment. Inhaled corticosteroids alone or in combination with long-acting β2-agonists, in addition to other step-up strategies such as leukotriene receptor antagonists and theophylline, are recommended. The anti-immunoglobulin E monoclonal antibody omalizumab should also be considered in difficult-to-treat allergic asthma. CONCLUSIONS Despite the currently available treatments, many patients with asthma remain symptomatic and experience exacerbations regardless of disease severity. New therapies, including long-acting anticholinergics, anti-cytokines, and chemoattractant receptor-homologous molecules, are under investigation with some promising results. In addition to increased education and use of self-management plans, these novel therapies are essential to help improve asthma control and reduce exacerbation risk.
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Affiliation(s)
- LeRoy M Graham
- Georgia Pediatric Pulmonology Associates, Morehouse School of Medicine , Atlanta, GA , USA
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Gada E, Khan DA, DeFina LF, Brown ES. The relationship between asthma and self-reported anxiety in a predominantly healthy adult population. Ann Allergy Asthma Immunol 2013; 112:329-32. [PMID: 24428963 DOI: 10.1016/j.anai.2013.08.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/28/2013] [Accepted: 08/28/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Numerous studies involving patients with severe asthma have cited a relation between asthma and anxiety; this relation is responsible for decreased quality of life, increased morbidity, and higher health care usage. However, whether a link between milder asthma and anxiety exists remains unclear. OBJECTIVE To determine whether asthma and anxiety share an association in a group of predominantly healthy adults. METHODS Adults seen at the Cooper Clinic in Dallas, Texas from March 2000 through January 2013 for preventive medical examinations that included an extensive medical history, including a questionnaire regarding anxiety history, a physician-based physical examination, and laboratory and spirometric testing were used in the analysis. Multiple logistic regressions were used to determine the relation between asthma and anxiety. RESULTS The sample consisted of 15,675 patients, of whom 1,403 (9%) had an asthma diagnosis. A sizeable majority of patients with asthma rated their health good or excellent, did not use an inhaler, and had a ratio of forced expiration volume in the first second to forced vital capacity greater than 70%. When controlling for covariates, milder asthma was significantly associated with anxiety (odds ratio 1.435, 95% confidence interval 1.238-1.663, P < .001). Smoking, a variable associated with asthma severity, was significantly associated with anxiety (odds ratio 1.432, 95% confidence interval 1.261-1.626, P < .001), although other variables, such as the ratio of forced expiration volume in the first second to forced vital capacity or use of an inhaled corticosteroid or combined inhaled corticosteroid and a long-acting β agonist, were not significantly associated with anxiety. CONCLUSION In this cohort of patients with predominantly mild asthma, there was a 43.5% increased risk of anxiety. All patients with asthma should be considered at a higher risk of anxiety and a target population for anxiety screening.
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Affiliation(s)
- Elan Gada
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - David A Khan
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas.
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Ryan S, Räisänen U. "The brain is such a delicate thing": an exploration of fear and seizures among young people with epilepsy. Chronic Illn 2012; 8:214-24. [PMID: 22615484 DOI: 10.1177/1742395312449666] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Epilepsy is a condition where pathology, diverse manifestations and attached social understandings contribute to an emotional experience unlike many other chronic conditions. The emotional dimension to epilepsy has been little considered in existing research. OBJECTIVES To explore the emotional experience of young people with epilepsy. METHODS A qualitative study involving in-depth interviews with 37 young people diagnosed with epilepsy. RESULTS Fear emerged as the key emotion and this largely related to the experience, or anticipated experience, of seizure activity. Three key features of fear and epilepsy emerged through the analysis; harm, temporality and action. The fear experienced was not only external, relating to immediate injury, but also internal in terms of potential damage to the brain. The embodied nature of epilepsy can, therefore, present a threat to conceptions of the self. Underlying this internal dimension of fear is an understanding of the brain as central to the sense of self. CONCLUSIONS The experience of epilepsy does not only involve fear of physical harm but also fear of a loss of self. We conclude that there are broader (alternative) readings of the experience of epilepsy that are often overlooked.
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Affiliation(s)
- Sara Ryan
- Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
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