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Varkonyi-Sepp J, Freeman A, Ainsworth B, Kadalayil LP, Haitchi HM, Kurukulaaratchy RJ. Multimorbidity in Difficult Asthma: The Need for Personalised and Non-Pharmacological Approaches to Address a Difficult Breathing Syndrome. J Pers Med 2022; 12:jpm12091435. [PMID: 36143220 PMCID: PMC9500722 DOI: 10.3390/jpm12091435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/21/2022] Open
Abstract
Three to ten percent of people living with asthma have difficult-to-treat asthma that remains poorly controlled despite maximum levels of guideline-based pharmacotherapy. This may result from a combination of multiple adverse health issues including aggravating comorbidities, inadequate treatment, suboptimal inhaler technique and/or poor adherence that may individually or collectively contribute to poor asthma control. Many of these are potentially "treatable traits" that can be pulmonary, extrapulmonary, behavioural or environmental factors. Whilst evidence-based guidelines lead clinicians in pharmacological treatment of pulmonary and many extrapulmonary traits, multiple comorbidities increase the burden of polypharmacy for the patient with asthma. Many of the treatable traits can be addressed with non-pharmacological approaches. In the current healthcare model, these are delivered by separate and often disjointed specialist services. This leaves the patients feeling lost in a fragmented healthcare system where clinical outcomes remain suboptimal even with the best current practice applied in each discipline. Our review aims to address this challenge calling for a paradigm change to conceptualise difficult-to-treat asthma as a multimorbid condition of a "Difficult Breathing Syndrome" that consequently needs a holistic personalised care attitude by combining pharmacotherapy with the non-pharmacological approaches. Therefore, we propose a roadmap for an evidence-based multi-disciplinary stepped care model to deliver this.
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Affiliation(s)
- Judit Varkonyi-Sepp
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical Health Psychology Department, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Anna Freeman
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Respiratory Medicine Department, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Ben Ainsworth
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Department of Psychology, University of Bath, Bath BA2 7AY, UK
| | - Latha Perunthadambil Kadalayil
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Hans Michael Haitchi
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Respiratory Medicine Department, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Institute for Life Sciences, University of Southampton, Southampton SO16 6YD, UK
| | - Ramesh J Kurukulaaratchy
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Respiratory Medicine Department, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- The David Hide Asthma & Allergy Research Centre, St Mary's Hospital, Isle of Wight, Newport PO30 5TG, UK
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Dias de Castro E, Leblanc A, Barbosa J, Ribeiro L, Cernadas JR. Psychological profiles of patients with suspected drug allergy. Asia Pac Allergy 2020; 10:e39. [PMID: 33178564 PMCID: PMC7610082 DOI: 10.5415/apallergy.2020.10.e39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/10/2020] [Indexed: 11/13/2022] Open
Abstract
Background Several studies demonstrate an important association between allergic diseases and patients' psychological characteristics. Objective To evaluate any differences in the psychological characteristics of patients studied for suspected drug allergy in comparison with healthy controls. A secondary aim was to assess differences between patients with confirmed versus excluded drug allergy, with respect to the clinical aspects. Methods The psychological characteristics of 115 consecutive patients >16 years-old, studied for suspected drug allergy were assessed. They were compared with healthy controls. Four validated questionnaires were used to evaluate anxiety, depression, alexithymia, and personality type. Results Eighty-eight patients completed the evaluation: 34 had confirmed drug allergy and 33 excluded. Forty-eight healthy subjects filled the 4 questionnaires. Increased neuroticism was associated with increased odds of belonging to the excluded drug allergy group (odds ratio [OR], 1.374; 95% confidence interval [CI], 1.173–1.609). Increased neuroticism (OR, 1.244; 95% CI, 1.065–1.453) and increased anxiety (OR, 1.210; 95% CI, 1.084–1.351) were associated with increased odds of confirmed drug allergy. However, higher extraversion decreased this likelihood (OR, 0.755; 95% CI, 0.643–0.888). The odds of having confirmed drug allergy was reduced by 79.7% (OR, 0.203; 95% CI, 0.060–0.694) for patients with 2 suspected drugs and by 84.6% (OR, 0.154; 95% CI, 0.029–0.809) for those with ≥3 in comparison to those with only one. Patients with moderate to severe reactions were more likely to have confirmed drug allergy (OR, 4.295; 95% CI, 1.105–16.693) than those with milder manifestations. Conclusion Our results highlight that patients with drug allergy have a distinctive psychological profile. Psychological assessment may help to identify patients that would benefit from a targeted intervention.
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Affiliation(s)
- Eunice Dias de Castro
- Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João EPE, Porto, Portugal.,MedInUP- Center for Drug Discover and Innovative Medicines, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Leblanc
- Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João EPE, Porto, Portugal
| | - Joselina Barbosa
- Public Health and Forensic Sciences and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal.,UNIC- Cardiovascular Research and Development Unit, University of Porto, Porto, Portugal
| | - Laura Ribeiro
- Public Health and Forensic Sciences and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal.,Biomedicine Department, Faculty of Medicine, University of Porto, Porto, Portugal.,I3S- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Josefina R Cernadas
- Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João EPE, Porto, Portugal
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Ong ASE, Chan AKW, Sultana R, Koh MS. Impact of psychological impairment on quality of life and work impairment in severe asthma. J Asthma 2020; 58:1544-1553. [PMID: 32777181 DOI: 10.1080/02770903.2020.1808989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Psychological impairment, such as anxiety and depression, is common in severe asthma. However, the impact of psychological impairment on asthma-specific quality of life (ASQOL) and work impairment has not been assessed within Southeast-Asia. Furthermore, previous ASQOL questionnaires contained items overlapping with asthma control, making it challenging to isolate the relationship between psychological impairment with ASQOL and asthma control, respectively. OBJECTIVE To evaluate the relationship between psychological impairment with ASQOL and work impairment in severe asthma. METHODS This is a cross-sectional study of severe asthma at Singapore General Hospital. We assessed ASQOL, psychological impairment, work impairment and asthma control using validated questionnaires. An ASQOL questionnaire not containing items evaluating asthma symptoms was selected to reduce overlap with asthma control. Medical records were used to obtain other asthma characteristics and healthcare utilization patterns. RESULTS Amongst 111 patients, 37% had psychological impairment based on Hospital Anxiety and Depression Scale. Poorer ASQOL was associated with anxiety (p = .013) after controlling for demographic characteristics, asthma control and comorbidities. Anxiety symptoms were associated with greater health concerns while depression symptoms were associated with sleep difficulty and physical limitations. Having depressive symptoms was associated with an additional 16% impairment of total work hours (p = .038). Psychological impairment was not associated with spirometry results or healthcare utilization. Ethnicity significantly predicted both ASQOL and work impairment. CONCLUSIONS In severe asthma, patients with psychological impairment have poorer ASQOL and greater work impairment than those without psychological impairment. There is an urgent need to mitigate this problem.
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Affiliation(s)
| | - Adrian Kwok Wai Chan
- Duke-NUS Medical School, Singapore, Singapore.,Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | | | - Mariko Siyue Koh
- Duke-NUS Medical School, Singapore, Singapore.,Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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Treadmill exercise restores memory and hippocampal synaptic plasticity impairments in ovalbumin-sensitized juvenile rats: Involvement of brain-derived neurotrophic factor (BDNF). Neurochem Int 2020; 135:104691. [PMID: 31982414 DOI: 10.1016/j.neuint.2020.104691] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 01/21/2023]
Abstract
Studies demonstrate that asthma, especially during childhood, affects the functions of the brain including learning and memory. Exercise is well known for its neuroprotective functions and for its beneficial effects on asthma. We aimed to assess the effects of exercise on cognitive function, synaptic plasticity, and hippocampal brain-derived neurotrophic factor (BDNF) levels in ovalbumin (OVA) sensitized juvenile rats. Rats were sensitized by intraperitoneal administration and inhaled OVA. Animals were subjected to treadmill running exercise during the OVA-challenged period. T-helper type 2 (Th2) cytokine [interleukin (IL)-4], Th1 cytokine (INF-γ) levels, and INF-γ/IL-4 (Th1/Th2) ratio in bronchoalveolar lavage fluid (BALF), and tracheal response to methacholine and OVA were measured. Further, memory behaviors and BDNF levels were measured in the hippocampus as well as long-term potentiation (LTP) was assessed by recording field excitatory postsynaptic potentials (fEPSPs) in the hippocampus. The levels of IL-4 and TGF-β were decreased but INF-γ level and INF-γ/IL-4 ratio increased in the BALF due to exercise in the OVA-sensitized animals. In addition, exercise improved OVA-sensitization induced cognitive impairments, increased BDNF levels, and enhanced hippocampal LTP in OVA-sensitized rats. Exercise is not only effective in the alleviation of airway inflammation by restoring Th1/Th2 cytokines balance, but also is a candidate for improvement of memory and synaptic plasticity deficits partially through increasing the levels of hippocampal BDNF in OVA-sensitized rats.
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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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Chronic asthma-induced behavioral and hippocampal neuronal morphological changes are concurrent with BDNF, cofilin1 and Cdc42/RhoA alterations in immature mice. Brain Res Bull 2018; 143:194-206. [PMID: 30227235 DOI: 10.1016/j.brainresbull.2018.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/03/2018] [Accepted: 09/11/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Recent studies have found that persistent hypoxia caused by chronic asthma, especially during childhood, affects the development and function of the brain, but the mechanism is unclear. In the present study, BDNF and its signal pathway was investigated in mediating chronic asthma induced-neuronal changes that lead to behavior alterations. METHODS The chronic asthma model was induced by sensitization with ovalbumin for more than 9 weeks in immature mice. Morris water maze test (MWMT), open field test (OFT) and elevated plus maze test (EPMT) were used to conduct behavioral evaluation. Neuronal morphology in hippocampal CA1, CA3 and DG was assessed using ImageJ's Sholl plugin and RESCONSTRUCT software. BDNF signaling pathway related molecules was determined by Western blotting. RESULTS Chronic asthma does affect the behavioral performances of immature mice evaluated in MWMT, OFT, and EPMT. The analysis by three-dimensional reconstruction software found that following the behavioral alteration of asthmatic mice, dendritic changes also occurred in hippocampal neurons, including shortened dendrite length, significantly reduced number of dendritic branches, decreased density of dendritic spines, and reduced percentage of functional dendritic spine types. At the same time, by immunofluorescence and western blotting, we also found that alterations in dendritic morphology were consistent with activation of cofilin1 and changes in BDNF-Cdc42/RhoA levels. Some of the changes mentioned above can be alleviated by intranasal administration of budesonide. CONCLUSION Our data suggest that response similar to nicotine withdrawal or/and hypoxia induced by childhood chronic asthma enhances the BDNF-Cdc42/RhoA signaling pathway and activates cofilin1, leading to the remodeling of actin, causing the loss of dendritic spines and atrophy of dendrites, eventually resulting in behavioral alterations.
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Pateraki E, Morris PG. Effectiveness of cognitive behavioural therapy in reducing anxiety in adults and children with asthma: A systematic review. J Asthma 2017; 55:532-554. [PMID: 28759284 DOI: 10.1080/02770903.2017.1350967] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Asthma and anxiety are known to interact, leading to exacerbations for both conditions. This systematic review summarised evidence regarding the effectiveness of cognitive behavioural therapy (CBT) in reducing anxiety in individuals with asthma, with results presented separately for adults and children. DATA SOURCES PRISMA and CRD guidance were followed to conduct and report the current review. Three major electronic databases (Ovid Medline, PsycINFO, and EMBASE) and manual searches were used to find relevant published and unpublished research. STUDY SELECTIONS Sixteen trials (12 adult- and four child-focused) met inclusion criteria, and were evaluated with adapted quality criteria. Both controlled trials and repeated-measures designs were eligible. All CBT intervention formats were eligible (group, individual, computerised, and self-help). Nine studies (eight adult and one child) focused upon participants with either an anxiety diagnosis or with above-threshold anxiety scores on a validated measure at baseline. RESULTS The review provides tentative preliminary support for the use of CBT for anxiety in adults with asthma, with the evidence base for interventions with children appearing promising, but under-developed. Studies were more likely to indicate beneficial effects where anxiety-focused (rather than illness-focused) intervention protocols were utilised, asthma-related education was provided and where the trials focused on individuals with likely clinical levels of anxiety at baseline. CONCLUSION Whilst further high-quality research is needed, available evidence is supportive of anxiety-focused CBT interventions tailored to target the particular mechanisms thought to maintain this comorbidity in asthma.
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Affiliation(s)
- Eleni Pateraki
- a Paediatric Psychology, Wishaw General Hospital , NHS Lanarkshire , Wishaw , UK
| | - Paul Graham Morris
- b Clinical and Health Psychology , University of Edinburgh , Edinburgh , UK
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Rajabi S, Keshavarz E, Dehghani Y, Keshavarz M, AliMoradi K. Comparing executive functions between patients with chronic asthma and healthy subjects. J Asthma 2017; 55:452-459. [PMID: 28708949 DOI: 10.1080/02770903.2017.1337786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Allergic diseases have different levels of prevalence all over the world. Among them, asthma is the most common chronic disease. Up to now, little attention has been paid to the impact of this chronic disease on people's executive functions. The present study aimed at comparing the executive functions in patients with chronic asthma and healthy subjects. METHODS The study population was patients with chronic asthma who were referred to Al-Zahra hospital in Isfahan Province and their visitors who were assigned as the control group. Thirty patients with chronic asthma and 30 patient visitors were enrolled in this study, and three software programs (Wisconsin, Stroop, and Continuous Performance Tests) were used. RESULTS The results of multivariate variance analysis showed that there is a significant difference between patients with chronic asthma and healthy subjects in terms of set shifting, inhibition, and attention performance. CONCLUSIONS This study revealed that the executive functions of patients with chronic asthma have significant defects.
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Affiliation(s)
- Soran Rajabi
- a Department of Psychology, Faculty of Literature and Humanities , Persian Gulf University , Bushehr , Iran
| | - Esha'q Keshavarz
- b Emergency Medicine , Isfahan University of Medical Sciences , Isfahan , Iran
| | - Yoosef Dehghani
- a Department of Psychology, Faculty of Literature and Humanities , Persian Gulf University , Bushehr , Iran
| | - Maryam Keshavarz
- a Department of Psychology, Faculty of Literature and Humanities , Persian Gulf University , Bushehr , Iran
| | - Khadije AliMoradi
- a Department of Psychology, Faculty of Literature and Humanities , Persian Gulf University , Bushehr , Iran
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Vazquez K, Sandler J, Interian A, Feldman JM. Emotionally triggered asthma and its relationship to panic disorder, ataques de nervios, and asthma-related death of a loved one in Latino adults. J Psychosom Res 2017; 93:76-82. [PMID: 28107897 PMCID: PMC5260801 DOI: 10.1016/j.jpsychores.2016.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/25/2016] [Accepted: 11/26/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Research has demonstrated high comorbidity between asthma and panic disorder (PD). Less is known about the relationship between asthma and the Latino cultural idiom of distress of ataques de nervios, as well as the role that psychosocial stressors play. The current study tested the hypotheses that Latino asthma patients who experience PD, ataques de nervios, and/or asthma-related death of a loved one endorse greater psychological triggers of asthma, greater perceived impact of asthma triggers, and greater difficulty controlling such triggers than do those without these conditions. METHODS Data originated from an interview conducted prior to a randomized controlled trial in which 292 Latino adults with self-reported asthma were recruited from outpatient clinics in the Bronx, NY. The PRIME-MD Patient Health Questionnaire (PHQ) was used to screen for PD symptoms, while the Structured Clinical Interview for DSM-IV (SCID-I) was used to confirm diagnosis of PD. Lifetime history of ataques de nervios and asthma-related death of a loved one were based upon self-report. Asthma triggers were examined using the Asthma Trigger Inventory (ATI). RESULTS PD, ataques de nervios, and asthma-related death of a loved one each predicted a higher frequency of psychological asthma triggers, controlling for gender and comorbid medical conditions. Participants with PD also reported greater impact of asthma triggers than those without PD, while no significant differences in perceived control were observed. CONCLUSION Providers should screen for PD, ataques de nervios, and asthma-related death of a loved one in Latino asthma patients, given their observed association with emotionally triggered asthma.
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Affiliation(s)
- Karinna Vazquez
- Ferkauf Graduate School of Psychology, Yeshiva University, United States
| | - Jonathan Sandler
- Ferkauf Graduate School of Psychology, Yeshiva University, United States
| | | | - Jonathan M Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, United States; Department of Pediatrics, Albert Einstein College of Medicine, United States.
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Gerald JK, Moreno FA. Asthma and Depression: It's Complicated. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:74-5. [PMID: 26772927 DOI: 10.1016/j.jaip.2015.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Joe K Gerald
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Ariz.
| | - Francisco A Moreno
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, Ariz
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Abstract
We assessed the association between asthma and suicidality in a nationally representative sample of US high school students. Data came from the 2007, 2009, and 2011 Youth Risk Behavioral Surveys. Weighted prevalence estimates and adjusted odds ratios were calculated. Subjects with asthma are more likely to report 2-week sadness (35.2%) compared to those without asthma (26.7%). Teens with asthma are also more likely to report suicide ideation (20.1% vs. 15%), planning (15.7% vs. 12.1%), attempt (10.1% vs. 6.9%), and treatment for attempt (3.5% vs. 2%). Although the unadjusted association between lifetime asthma and suicide attempts is statistically significant (crude odds ratio 1.5 (95% CI 1.3-1.8)), after controlling for confounders, that association is no longer statistically significant (AOR 1.2 (1-1.6)). Thus, this increase in suicidality seems to be due to the increased prevalence of sadness among teens with asthma. Similar patterns were seen in the 2007 and 2009 surveys.
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Gonem S, Natarajan S, Desai D, Corkill S, Singapuri A, Bradding P, Gustafsson P, Costanza R, Kajekar R, Parmar H, Brightling CE, Siddiqui S. Clinical significance of small airway obstruction markers in patients with asthma. Clin Exp Allergy 2014; 44:499-507. [PMID: 24341600 DOI: 10.1111/cea.12257] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/07/2013] [Accepted: 11/19/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The role of small airway obstruction in the clinical expression of asthma is incompletely understood. OBJECTIVE We tested the hypotheses that markers of small airway obstruction are associated with (i) increased asthma severity, (ii) impaired asthma control and quality of life and (iii) frequent exacerbations. METHODS Seventy-four adults with asthma and 18 healthy control subjects underwent impulse oscillometry (IOS), multiple breath inert gas washout (MBW), body plethysmography, single-breath determination of carbon monoxide uptake and spirometry. Patients completed the six-point Asthma Control Questionnaire (ACQ-6) and standardized Asthma Quality of Life Questionnaire [AQLQ(S)]. Asthma severity was classified according to the Global Initiative for Asthma (GINA) treatment steps. RESULTS The putative small airway obstruction markers Sacin , resistance at 5 Hz minus resistance at 20 Hz (R5-R20) and reactance area (AX) were not independently associated with asthma severity, control, quality of life or exacerbations. In contrast, markers of total (R5) and mean airway resistance of large and small airways (R20) were significantly higher in the severe asthma group compared with the mild-moderate group (0.47 vs. 0.37, P < 0.05 for R5; 0.39 vs. 0.31, P < 0.01 for R20). The strongest independent contributors to ACQ-6 score were R20 and forced expiratory volume in one second (% pred.), and the strongest independent contributors to AQLQ(S) score were R20 and forced vital capacity (% pred.). A history of one or more exacerbations within the previous year was independently associated with R20. CONCLUSIONS AND CLINICAL RELEVANCE Previously reported markers of small airway obstruction do not appear to be independently associated with asthma disease expression. In contrast, the IOS parameter R20, a marker of mean airway resistance of both large and small airways, appears to have independent clinical significance. These observations require confirmation in prospective longitudinal studies.
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Affiliation(s)
- S Gonem
- Department of Infection, Immunity and Inflammation, Institute for Lung Health, University of Leicester, Leicester, UK
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Zhang X, Ni X, Chen P. Study About the Effects of Different Fitness Sports on Cognitive Function and Emotion of the Aged. Cell Biochem Biophys 2014; 70:1591-6. [DOI: 10.1007/s12013-014-0100-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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