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Daily Psychosocial Factors Predict Levels and Diurnal Cycles of Asthma Symptomatology and Peak Flow
Abstract
This study examines the relationship among psychosocial factors, asthma symptoms, and peak expiratory flow rate (PEFR) in the natural environment. Twenty adult asthmatics wore preprogrammed wristwatches that prompted them to assess PEFR, asthma symptoms, and psychosocial factors five times a day for 10 days. Psychosocial variables (activities, locations, social contacts, mood, and stressors) were strongly related to PEFR and asthma symptoms, suggesting that they may play a more important role in disease expression than has been previously thought. Diurnal cycles of asthma symptoms and PEFR were observed. However, statistically controlling for psychosocial factors eliminated diurnal cycles for PEFR or asthma symptoms, indicating that psychosocial factors are a major contributor to the observed diurnal cycle in PEFR and symptoms. These relationships underscore the need to include psychosocial factors in future asthma research.
... Whereas the roles of physical factors in determining PEF performance are well known (Quanjer, Lebowitz, Gregg, Miller, & Pedersen, 1997), attention to the potential influence of psychosocial factors has been relatively lacking. One notable exception was the study by Smyth, Soefer, Hurewitz, Kliment, and Stone (1999). With ecological momentary assessments conducted in adults with asthma over 3 weeks, Smyth and colleagues studied the effects of mood, stressors, daily activities (not only physical activities), social contacts, and geographical location on PEF and asthma symptoms. ...
... However, judging from the standardized regression coefficients in Tables 2 and 3, it appeared that socializing activity had main effects on PEF and percent predicted PEFs that were comparable with those of exercise, but its role in PEF has been relatively ignored in the literature (cf. Smyth et al., 1999). Contrary to expectation, housework, social contacts, and positive and negative mood were not independently related to PEF. ...
... In addition, no relationship was found between mood and peak flow. Previous studies that found a relationship (Smyth et al., 1999) had not controlled for the range of biological and health measures (some of which being related to mood) as the present study, which might account for the difference in finding. Compared with older adults with restricted networks, those with diverse, friend-focused, and distant family networks had superior PEF values, with those having diverse networks doing best. ...
Objective:
This study examined the associations between social network types and peak expiratory flow (PEF), and whether these associations were mediated by social and physical activities and mood.
Method:
Nine hundred twenty-four community-dwelling Chinese older adults, who were classified into five network types (diverse, friend-focused, family-focused, distant family, and restricted), provided data on demographics, social and physical activities, mood, smoking, chronic diseases, and instrumental activities of daily living. PEF and biological covariates, including blood lipids and glucose, blood pressure, and height and weight, were assessed. Two measures of PEF were analyzed: the raw reading in L/min and the reading expressed as percentage of predicted normal value on the basis of age, sex, and height. Diverse, friend-focused, and distant family networks were hypothesized to have better PEF values compared with restricted networks, through higher physical and/or social activities. No relative advantage was predicted for family-focused networks because such networks tend to be associated with lower physical activity.
Results:
Older adults with diverse, friend-focused, and distant family networks had significantly better PEF measures than those with restricted networks. The associations between diverse network and PEF measures were partially mediated by physical exercise and socializing activity. The associations between friend-focused network and PEF measures were partially mediated by socializing activity. No significant PEF differences between family-focused and restricted networks were found.
Conclusions:
Findings suggest that social network types are associated with PEF in older adults, and that network-type differences in physical and socializing activity is partly responsible for this relationship.
... There is also evidence that social occurrences that are entrained to time of day are determinants of mood and/or physiological patterns (e.g., meals; Smyth et al., 1998; Stone et al., 1996). It is also the case that solitary activities, events, or settings that individuals experience can be potent predictors of mood, behavior, symptoms, and physiological parameters (e.g., driving in the car; Smyth et al., 1999a; Stone et al., 1996). Accordingly, it may be necessary in behavioral medicine research to examine not only naturally occurring fluctuations in activities, location, behavior, etc., but the influence of time of day as well. ...
... A new data assessment protocol, typically referred to as Ecological Momentary Assessment (EMA; Stone and Shiffman, 1994 ) allows the study of behavior, psychological states, and physiological reactions in their natural context. EMA-like research approaches have been used to overcome the limitations of cross-sectional and panel designs in studies examining, although not limited to, stress and coping (Bolger and Zuckerman, 1995 ), personality traits and negative affect (Bolger, 1990), depression (Stader and Hokanson, 1998), substance abuse (Litt, 1998), cardiovascular disease (Kamarck, et al., 2002), mental illness (deVries, 1992), cigarette smoking (Shiffman et al., 1996), chronic pain (Stone et al., 1997), and asthma (Smyth et al., 1999a). Such a methodology allows the delineation of antecedent stress conditions (e.g., interpersonal events), moderating or mediating variables (e.g., coping responses), and outcome measures (e.g., blood pressure) much more effectively than panel or retrospective designs, in which the time between assessments can be lengthy (i.e., weeks, months, or even years). ...
... We have also examined the relation of the natural environment to variability in chronic diseases, such as asthma. One study (Smyth et al., 1999a ) examined diurnal cycles of both lung function and asthma symptoms in their natural environment, and additionally examined the contribution of the environment to the observed diurnal variability of asthma symptoms. The relationship between psychosocial factors such as activities , locations, social contact, stressors, and mood and lung function (peak expiratory flow rate, PEFR) and asthma symptoms was investigated . ...
Behavioral medicine research often seeks to examine relatively complex theoretical models and clinical processes. Traditional designs, based on retrospective self-report in the natural environment or laboratory-based studies, cannot assess complex and temporally dynamic psychological, behavioral, and physiological processes in the natural environment. An alternate research approach, Ecological Momentary Assessment (EMA), provides a method to collect such data. This research approach and these data allow investigation of a number of research questions not amenable to other data collection methods. Examples of research questions uniquely suited for EMA data include, but are not limited to: (1) the comparison of retrospective data to momentary data; (2) evaluation of physiological and psychosocial processes in the natural environment; (3) the relation of symptoms and other disease processes to characteristics of the natural environment; and (4) examination of dynamic changes in psychosocial variables that may mediate improvement following treatment. Despite the strengths of EMA data, a number of challenges exist – including logistic, analytic, and interpretation problems – to the easy implementation of EMA approaches in behavioral medicine.
... Prolonged exposure to high levels of stress can lead to illnesses if it is not dealt with effectively. Several researchers explained its adverse impacts on the physical, and psychological health by demonstrating its relationship with cardiovascular diseases (Lloyd, Wing & Orchard, 1996), asthma (Smyth, Soefer, Hurewitz, Kliment, & Stone, 1999), chronic headache (De Benedittis & Lorenzetti, 1992), irritable bowel syndrome (Dancey, Taghavi & Fox, 1998), alcohol consumption (Cooper, Russell, Skinner, Frone & Mudar, 1992;Largo-Wight, Peterson, & Chen, 2005), anxiety (Lundberg, 1996), and depression (Miner, & Dowd, 1996;Ravindran, Griffiths, Merali, & Anisman, 1996;Stader & Hokanson, 1998). As a result, it proves to be a crucial duty for researchers, and practitioners to define stress, to explain stress-related factors, and to develop an intervention model regarding the effects of personal, and environmental factors on the individual's wellbeing. ...
... These factors should be studied in the future researches. (Lloyd, Wing & Orchard, 1996), astım (Smyth, Soefer, Hurewitz, Kliment & Stone, 1999), kronik baş ağrısı (De Benedittis & Lorenzetti, 1992) ve irritabl kolon sendromu (Dancey, Taghavi & Fox, 1998) gibi fiziksel sağlık problemlerin yanı sıra kaygı bozuklukları (Lundberg, 1996), depresyon (Miner, & Dowd, 1996;Ravindran, Griffiths, Merali, & Anisman, 1996;Stader & Hokanson, 1998) Bilişsel değerlendirme kavramını ele alan araştırmacılar "birincil değerlendirme" ve "ikincil değerlendirme" kavramlarını öne sürmektedir (Lazarus & Folkman, 1984). Birincil değerlendirme, bireyin stres uyaranını kişilik gelişimi için fırsat (challenge) olarak algılaması ya da bu uyarını çok önemli bir olay olarak görmesi (centrality) ve kayba neden olacak tehdit edici (threat) bir olay şeklinde önemli bir stres türüdür. ...
Coping is an important concept to explain stress-related factors because it is a process that is mediated by both primary, and secondary appraisal (Lazarus & Folkman, 1984). The present study aims to examine the extent to which correctional officers' cognitive appraisal associated with stress, and to develop, and test models including work stress, cognitive appraisal of stress, affect-related variables, coping strategies, psychological distress, and psychological adjustment. For this aim, a total of 268 correctional officers from seven different prisons in Turkey participated in the present study. The subjects were given Stress Appraisal Measure (SAM), Work Stress Scale for Correctional Officers (WSSCO), Positive, and Negative Affect
Schedule (PANAS), Beck Depression Inventory (BDI), Emotional Approach Coping Scale (EACS), State-Trait Anxiety Inventory-Trait Form (STAI-T), Satisfaction with Life Scale (SWLS), Job Satisfaction Scale (JSS), and The Ways of Coping Inventory (WCI) in addition to Demographic Information Form. A variety of hierarchical multiple regression analyses were conducted to reveal the significant associates of psychological distress and adjustment. According to the results of regression analyses, four models were developed, and tested by structural equation modeling. The results of the present study demonstrated that different cognitive appraisals, different affect-related variables, different coping strategies combined to influence psychological distress, and psychological adjustment measures in addition to the direct effects of work stress. Following discussion of the results in terms of theoretical, and methodological perspectives, the limitations of the present study, and the suggestions for future research were also handled.
Key Words: Work Stress, Cognitive Appraisal, Affect, Coping Strategies, Distress, Correctional Officers
... Psychosocial stress affects the nervous, endocrine, and immunological systems, which are involved in the onset and exacerbation of various diseases. Many studies have reported psychosocial influences on the onset and progression of allergic diseases such as bronchial asthma and atopic dermatitis [1][2][3][4][5][6][7][8][9][10][11] with psychosomatic pathology, which is defined as "pathophysiological states of somatic disorders that have been closely affected by psychosocial factors in their occurrence and progression and in which organic and/or dysfunctional lesions are found" [12]. It is important to first assess these psychosocial factors and to customize a treatment strategy by clarifying the psychosocial problems of each patient. ...
... Psychosocial stressors have been reported as inciting, continuing, or precipitating factors for asthma [4][5][6][7][8][9][10][11]. Many of them are related to major life events (entering school, being employed, having a child, divorce, moving, changing jobs, and a close relative's sickness or death) or to minor stressors in everyday life (problems with interpersonal relationships in family, at school, or at workplace and a heavy burden of study or work). ...
Many reports have been published concerning how psychosocial stress influences the occurrence and progression of allergic diseases such as bronchial asthma and atopic dermatitis. As for asthma, a typical allergic disease often accompanied by psychosomatic related problems, the Global Initiative for Asthma (GINA), international medical guidelines for asthma, describes psychosocial problems as causative factors of poor asthma control and as risk factors for asthma exacerbation, even if symptoms are well controlled. However, because there is little high quality evidence for effective treatments for asthma patients with psychosocial problems, concrete assessments and treatments for such problems is scarcely described in GINA. Therefore, psychosomatic intervention for asthma patients is not effectively conducted on a worldwide scale. In contrast, the "Japanese Guidelines for the Diagnosis and Treatment of Psychosomatic Diseases" describe the assessment and treatment of psychosomatic disorders in detail. In the guidelines, psychosocial factors are classified into five categories; 1) Relation between stress and asthma occurrence or progression, 2) Relation between emotion and asthma symptoms, 3) Problems related to a patient's character and behaviors, 4) Problems of daily life and Quality of Life (QOL), and 5) Problems related to family relationships and life history. The employment of a self-administered questionnaire, the "Psychosomatic Questionnaire related to Asthmatic Occurrence and Progression", is useful for clarifying psychosocial factors and for setting up treatment strategies according to the problems identified. The Japanese guidelines have been proven to be useful, but empirical evidence for their effectiveness is still relatively limited. It will be necessary in the future to accumulate high-quality evidence and to revise the psychosomatic approaches in the guidelines that are universally valid.
... The PEFR mainly reflects the caliber of large airways [55] and is determined by the dimensions of large intra and extra-thoracic airways, the force generated by the expiratory muscles; primarily abdominals, and the elastic properties of the lung [56]. It has also been found that psychosocial variables (PA, stress, mood) are strongly related to PEFR, with stress showing a negative correlation [57,58]. ...
Purpose:
Respiratory function is thought to improve with long-term meditation. This study aimed to assess respiratory function in a cohort of healthy long-term meditators and non-meditators in Sri Lanka.
Methods:
Respiratory function of healthy, skilled long-term meditators (n = 20) practicing Buddhist meditation consistently >3 years, and age-sex matched non-meditators (n = 20) were assessed by assessing resting respiratory rate, spirometry, breath-holding time and six-minute-walk distance. Data were analyzed with SPSS-23 statistical software.
Results:
The long-term meditators; 45% male, mean (SD) total lifetime meditation experience 12.8 (6.5) years, aged 45.8 (8.74) years, BMI 23.68 (2.23) kgm-2, and non-meditators; 45% male, mean (SD) age 45.3 (8.05) years, BMI 23.68 (3.28) kgm-2, were comparable. Long-term meditators had slower resting respiratory rates [mean (SD); 13.35 (1.9) vs. 18.37 (2.31) breaths/minute; p < 0.001], higher peak expiratory flow rates [mean (SD); 9.89 (2.5) vs. 8.22 (2.3) L/s; p = 0.03], and higher inspiratory breath-holding times [mean (SD); 74 (29.84) vs. 53.61 (26.83) seconds, p = 0.038] compared to non-meditators. There was no significant difference in the six-minute-walk distance and estimated maximal oxygen consumption between the two groups.Resting respiratory rate of long-term meditators, showed a significant negative correlation with total lifetime meditation practice in years (r = -0.444, p = 0.049), and the average length of a meditation session per day (r = -0.65, p = 0.002). The long-term meditators with longer duration of retreat participation demonstrated lower resting respiratory rate (r = -0.522, p = 0.018) and higher tidal volumes (r = 0.474, p = 0.04).
Conclusions:
Long-term meditators had significantly slower resting respiratory rates and longer breath-holding times, with better spirometry parameters than non-meditators. Greater practice duration and retreat experience appear to be associated with improved resting respiratory function in long-term meditators.
... 79 Although naturalistic clinical assessments are not as common, in a small sample of adult asthmatics, it has been shown that everyday stressors, assessed across 10 consecutive days using preprogrammed watches, linked to peak expiratory flow rate values and symptoms. 80 Ciprandi et al showed in a diverse Italian outpatient population, using a questionnaire quantifying levels of anxiety and depression, that a significant inverse correlation exists between anxiety scores and asthma control levels as reflected by subjective and objective measures like FEV 1 , fractional exhaled NO levels, Asthma Control Test scores, and physical findings. 81 The widely accepted complexity of stress-related effects on asthma is further augmented by the fact that throughout childhood and adolescence, several changes occur in the neuroendocrine function, with a dramatic change in reactivity exhibited by the HPA axis in response to stressors. ...
The complicated interaction between the central and the autonomic (sympathetic, parasympathetic, and enteric) nervous systems on the one hand and the immune system and its components, on the other hand, seems to substantially contribute to allergy pathophysiology, uncovering an under-recognized association that could have diagnostic and therapeutic potentials. Neurons connect directly with and regulate the function of many immune cells, including mast cells, the cells that have a leading role in allergic disorders. Proinflammatory mediators such as cytokines, neurotrophins, chemokines, and neuropeptides are released by immune cells, which stimulate sensory neurons. The release of neurotransmitters and neuropeptides caused by the activation of these neurons directly impacts the functional activity of immune cells and vice versa, playing a decisive role in this communication. Successful application of Pavlovian conditioning in allergic disorders supports the existence of a psychoneuroimmunological interplay in classical allergic hypersensitivity reactions. Activation of neuronal homeostatic reflexes, like sneezing in allergic rhinitis, coughing in allergic asthma, and vomiting in food allergy, offers additional evidence of a neuroimmunological interaction that aims to maintain homeostasis. Dysregulation of this interaction may cause overstimulation of the immune system that will produce profound symptoms and exaggerated hemodynamic responses that will lead to severe allergic pathophysiological events, including anaphylaxis. In this article, we have systematically reviewed and discussed the evidence regarding the role of the neuro-immune interactions in common allergic clinical modalities like allergic rhinitis, chronic rhinosinusitis, allergic asthma, food allergy, atopic dermatitis, and urticaria. It is essential to understand unknown – to most of the immunology and allergy experts – neurological networks that not only physiologically cooperate with the immune system to regulate homeostasis but also pathogenetically interact with more or less known immunological pathways, contribute to what is known as neuroimmunological inflammation, and shift homeostasis to instability and disease clinical expression. This understanding will provide recognition of new allergic phenotypes/endotypes and directions to focus on specialized treatments, as the era of personalized patient-centered medicine, is hastening apace.
... For example, the most severe symptoms of asthma occur around 4 a.m. (3) and myocardial infarction and angina most commonly occur in the early morning hours (4). In addition, the circadian clock affects hormonal homeostasis with several hormones exhibiting daily oscillations. ...
Diurnal variation in enzymes, hormones, and other biological mediators has long been recognized in mammalian physiology. Developments in pharmacobiology over the past few decades have shown that timing drug delivery can enhance drug efficacy. Here, we report the development of a battery-free, refillable, subcutaneous, and trocar-compatible implantable system that facilitates chronotherapy by enabling tight control over the timing of drug administration in response to external mechanical actuation. The external wearable system is coupled to a mobile app to facilitate control over dosing time. Using this system, we show the efficacy of bromocriptine on glycemic control in a diabetic rat model. We also demonstrate that antihypertensives can be delivered through this device, which could have clinical applications given the recognized diurnal variation of hypertension-related complications. We anticipate that implants capable of chronotherapy will have a substantial impact on our capacity to enhance treatment effectiveness for a broad range of chronic conditions.
... In the present study it is observed that there is considerable fall in PEFR value in exam stressed students when compared to normal students. Similarly in the previous research [45] that as there is an increase in stress level there is significant fall in the PEFR value. The psychosocial variables are strongly related to PEFR, thus suggesting that they play more important roles in bronchial constriction. ...
Background: Professional degrees are daunting to the learning group because of a modern curriculum that is dramatically different from high school curricula and other educational courses. It is more pronounced among first year students in educational institutions because of rivalry and demands from institution managers, academic staff and parents. Stress causes many detrimental effects in the body. Aim: The present study planned to evaluate the effect of examination stress on the changes in lung functions among dental college students. Materials and Methods: 20 normal students were selected and categorised into normal and stressed students. They were assessed for a lung function test using RMS helios 702 Spirometer. The parameters such as FVC, FEV1, FEV1/FVC, PEFR, FEF25-75 were assessed. Results: It is observed that there was a decrease in the values of FVC, FEV1, FEV1/FVC, PEFR, FEF25-75 in exam stressed students when compared to normal students. The values of FEV1/FVC and FEF25-75 were statistically significant. Conclusion: Thus, the study concluded an innovative finding that there was an inverse association with depressive symptoms in the pulmonary function test of exam stressed students which was shown by a statistically significant decrease in FEV1/FVC and FEF25-75. Exam is really a stressful experience and affects both male and female students. Awareness should be conducted among students about ill effects of stress. Decreased stress, increased lung function results in increased academic performance.
... life have been associated with increased risk for new onset respiratory disorders including 2 episodic wheeze and asthma. These findings are not limited to early life, with major negative 3 stressful events in childhood and adolescence prospectively associated with new active asthma 4 diagnosed in adulthood. 1 Additionally, while these findings highlight incidence of new asthma, 5 stressors, both acute and chronic, are also implicated in exacerbations among patients with 6 asthma. ...
... These symptoms can be triggered or made worse by emotions, stress, and other psychosocial factors. [3][4][5] Chronic asthma can lead to chronic inflammation and loss of lung tissue elasticity. ...
This article reviews relevant research on the possible benefits of Yoga interventions for individuals with asthma. Research suggests that Yoga, especially when practiced with inclusion of the whole of its traditional techniques (including âsana, prânâyâma,meditation, and relaxation) provides benefit for asthma sufferers. The article then offers suggestions for Yoga teachers and Yoga therapists who would like to develop a Yoga practice for students with asthma. Specific prânâyâma and âsana practices are described. The recommended practices will help students with asthma develop a new awareness of how physical posture and breathing techniques can minimize the frequency and severity of asthma episodes.
... Ambulatory assessments are needed to test these pathways as they occur naturalistically, free of recall bias and with high ecological validity and reliability (Myin-Germeys et al., 2009;Shiffman, Stone, & Hufford, 2008;Torous, Onnela, & Keshavan, 2017;Trull & Ebner-Priemer, 2013). Ambulatory approach is particularly important for studying respiratory symptoms, as they vary from day to day (Smyth, Soefer, Hurewitz, Kliment, & Stone, 1999). Another important consideration when studying respiratory illness is that self-reported symptoms and objectively-assessed pulmonary function are only modestly related (Curtis & Patrick, 2003;Tsiligianni, Kocks, Tzanakis, Siafakas, & van der Molen, 2011), a finding replicated in the WTC population (Kotov et al., 2015;Luft et al., 2012). ...
Background:
Posttraumatic stress disorder (PTSD) increases risk of future respiratory illness. However, mechanisms that underpin the association between these common and debilitating conditions remain unknown. The aim of this study was to identify modifiable, health-related behaviors they may explain the link between PTSD and respiratory problems.
Methods:
World Trade Center responders (N = 452, 89% male, mean age = 55 years) completed baseline PTSD and sleep questionnaires, followed by 2-weeks of daily diaries, actigraphy and ambulatory spirometry to monitor lower respiratory symptoms, pulmonary function, activity levels, stressors, and sleep. Lipid levels were obtained from electronic medical records.
Results:
Cross-sectional mediation analyses revealed that the association between PTSD and self-reported respiratory symptoms was explained by poor sleep, low activity, and daily stressors. The association between PTSD symptoms and pulmonary function was explained by insomnia and low activity.
Conclusions:
A range of health-related daily behaviors and experiences, especially sleep disturbances and inactivity, may explain excess respiratory illness morbidity in PTSD. The findings were generally consistent across daily self-report and spirometry measures of respiratory problems. Targeting these behaviors might enhance prevention of and intervention in respiratory problems in traumatized populations.
... This technology presents an opportunity for drastic reductions in preventative care costs; if patients are exposed to triggers that exacerbate their asthma, oftentimes their clinician won't be able to provide immediate recommendations. As a result, novel mobile-based techniques such as Ecological Momentary Assessment (EMA) have been developed to determine asthma exposures within the community 6 . Clinical techniques and mediums for administering EMA have been shown to be reliable and accurate, as EMA has a much better correlation between the actual event and what was recalled by the patient 7 . ...
Pediatric asthma is a prevalent chronic disease condition that can benefit from wireless health systems through constant symptom management. In this paper, we propose a smart watch based wireless health system that incorporates wireless sensing and ecological momentary assessment (EMA) to determine an individual's asthma symptoms. Since asthma is a multifaceted disease, this approach provides individualized symptom assessments through various physiological and environmental wireless sensor based EMA triggers specific to common asthma exacerbations. Furthermore, the approach described here improves compliance to use of the system through insightful EMA scheduling related to sensor detected environmental and physiological changes, as well as the patient's own schedule. After testing under several real world conditions, it was found that the system is sensitive to both physiological and environmental conditions that would cause asthma symptoms. Furthermore, the EMA questionnaires that were triggered based on these changes were specific to the asthma trigger itself, allowing for invaluable context behind the data to be collected.
... This study used EMA to assess daily experiences living with asthma and to tailor the intervention based on recent medication use and symptom frequency. EMA has been used successfully to assess variability of asthma symptoms [37], but it has not been extensively utilized as a tool for individualizing an intervention. EMA may have advantages over more traditional assessment methods, as it avoids issues of recall bias often encountered when using methods that rely on retrospective reporting. ...
Purpose:
To conduct a randomized controlled pilot of a multicomponent, technology-based intervention promoting adherence to controller medication in African-American emerging adults with asthma. The intervention consisted of two computer-delivered sessions based on motivational interviewing combined with text messaged reminders between sessions.
Methods:
Participants (N = 48) were 18-29 years old, African-American, with persistent asthma requiring controller medication. Participants had to report poor medication adherence and asthma control. Youth were randomized to receive the intervention or an attention control. Data were collected through computer-delivered self-report questionnaires at baseline, 1, and 3 months. Ecological Momentary Assessment via two-way text messaging was also used to collect "real-time" data on medication use and asthma control.
Results:
The intervention was feasible and acceptable to the target population, as evidenced by high retention rates and satisfaction scores. Changes in study outcomes from pre- to postintervention favored the intervention, particularly for decrease in asthma symptoms, t (42) = 2.22, p < .05 (Cohen's d = .071).
Conclusions:
Results suggest that the intervention is feasible and effective. However, findings are preliminary and should be replicated with a larger sample and more sophisticated data analyses.
... While the impact of health status on labor market participation and macroeconomic losses has been explored in many recent studies [e.g., Cai and Kalb (2006), WHO (2005), Bound et al. (1999), Kahn (1998), Stern (1989)] 2 , the association between chronic disease and food poverty is unclear. 1 Chronic diseases may lead to reduced worker productivity, unemployment, premature retirement, disability and death. 2 The role of specific diseases in impairing labor productivity and efficiency has mostly been studied in the perspective of developed countries. For studies on diabetes, see Brown et al. (2005), Bastida and Pagan (2002)]; for asthma, see Smyth et al. (1999); for cardiovascular disease, see Zhang et al. (2009); for arthritis, see Gorin et al. (1999), Lerner et al. (2004); and for mental illnesses, see Adler et al. (2006), Butterworth et al. (2006) and Zhang et al. (2009). This paper investigates the connection between chronic disease and food poverty. ...
While poverty and its causes have long been studied by economists, the link between chronic disease and food poverty has been a neglected area of research. This article investigates the impact of chronic disease on food poverty by using two rounds of panel data of Pakistan and linear probability regression framework. Chronic disease is defined to include diabetes, arthritis, heart disease, AIDS, cancer and asthma. The regression results show that on average the effect of chronic disease on food poverty is statistically equal to zero, but this effect significantly varies by income groups categorized by three non-income based classifications. We note that the incidence of chronic disease is significantly higher among non-poor when permanent income of the household is incorporated in to the model, most notably among individuals coming from low- and middle-income backgrounds. Thus public health policies that seek awareness, prevention and treatment of chronic diseases have the potential of poverty alleviation in a high poverty environment.
... Societal activity elevates all types of combustion emissions, hence ambient air pollution levels, including PM 2.5 . The intensity of societal activity also correlates with stress, which is associated with mortality (Juth et al. 2008;Phillips et al. 1999Phillips et al. , 2001Phillips et al. , 2004Smyth et al. 1999). In an analysis of correlations between heart attack risk and subjects' daily activities, Peters et al. (2004) reported a role for Bexposure-to-traffic^stress in heart attack risk but not for pollutant concentrations per se. ...
During July 2002, forest fires in Quebec, Canada, blanketed the US East Coast with a plume of wood smoke. This “natural experiment” exposed large populations in northeastern US cities to significantly elevated concentrations of fine particulate matter (PM2.5), providing a unique opportunity to test the association between daily mortality and ambient PM2.5 levels that are uncorrelated with societal activity rhythms. We obtained PM2.5 measurement data and mortality data for a 4-week period in July 2002 for the Greater Boston metropolitan area (which has a population of over 1.7 million people) and New York City (which has a population of over 8 million people). Daily average PM2.5 concentrations were markedly increased for 3 days over this period, reaching as high as 63 μg/m³ for Greater Boston and 86 μg/m³ for New York City from background ambient levels of 4–48 μg/m³ in the non-smoke days. We examined temporal patterns of natural-cause deaths and 24-h ambient PM2.5 concentrations in July 2002 and did not observe any discernible increase in daily mortality subsequent to the dramatic elevation in ambient PM2.5 levels. Comparison to mortality rates over the same time periods in 2001 and 2003 showed no evidence of impact. Results from Poisson regression analyses suggest that 24-h ambient PM2.5 concentrations were not associated with daily mortality. In conclusion, substantial short-term elevation in PM2.5 concentrations from forest fire smoke were not followed by increased daily mortality in Greater Boston or New York City.
Electronic supplementary material
The online version of this article (doi:10.1007/s11869-015-0332-9) contains supplementary material, which is available to authorized users.
... smoking, alcohol use, exercise) in healthy populations [13][14][15][16][17] and symptoms in disease populations (e.g. asthma, heart disease, inflammatory bowel disease, rheumatoid arthritis) [18][19][20][21]. Comparatively, there are few reports of EDD device use in cancer patients, and no studies of cancer patients on clinical trials [7,22]. ...
For cancer patients on Phase I trials, one of the most important physician decisions is whether or not patients are deriving benefit from therapy. With an increasing number of cytostatic treatment agents, the criteria to determine patient response to Phase I treatment has become harder to define. Physicians are increasingly looking to patient-reported outcomes (PROs) such as quality of life (QOL) to help evaluate treatment response. Electronic daily diary (EDD) devices can be used by patients to report their QOL over extended periods of time, thereby providing a more accurate picture of how patients are affected by treatment on a daily basis. However, questions remain about how to integrate this patient-reported information into decisions about Phase I treatment. This study investigated how physicians use patients' daily QOL reports to evaluate patient response to Phase I treatment. Data were collected over a 4-month period from Phase I patients (N = 30) and physicians (N = 3) in an NCI-designated comprehensive cancer center. Patients completed daily QOL reports using EDD devices and physicians were provided with a summary of patients' QOL before each visit. After the visit, doctors recorded their treatment decision and also rated the importance of four biomedical factors (Toxicity, Imaging, Labs, and Performance Status) and QOL in their treatment decision for that visit. Although physicians rated QOL as being very important in evaluating treatment response, in practice, when predictors of their decisions were analyzed, results showed they relied exclusively on biomedical data (Toxicity, Imaging) to make Phase I treatment decisions. Questions remain about the utility and effective integration of QOL and biomedical data in clinical decision-making processes in Phase I clinical trials.
... Second, Russell and Ridgeway (1983) validated opposing two-dimension affect scales (e.g., a continuum between happy and unhappy), but positive and negative affect scales have demonstrated poor correlation and to operate differently (Watson, Weber, Assenheimer, & Clark, 1995). Third, Stone has frequently used modifications of the positive and negative affect scales developed by Deiner and Larsen (1984) in EMA studies (le Grange, Gorin, Dymek, & Stone, 2002;Marco et al., 1999;Smyth, Soefer, Hurewitz, Kliment, & Stone, 1999). and pressure ratings every 10 minutes to assess whether the participant was currently wearing his or her brace and whether enough pressure was being applied to the apex points of the brace to be effective. ...
An important challenge physicians encounter when treating adolescent patients with moderate scoliotic curves is that the adolescents may not wear the brace as prescribed or long enough for the brace to be effective. The present investigation used electronic monitoring and temperature probes to investigate whether the adolescents were wearing their brace during events identified using a modified Daily Reconstruction Method for six randomly selected days over a 14-day period. It was hypothesized that environmental, interpersonal, and intrapersonal variables during the events would be predictive of objective brace-wear across and within participants, and patterns of significant variables would differ from subjective reports of brace-wearing. Participants were nine ethnically diverse adolescents (two male, seven females) with a mean age of 13.25 years, who provided 47 – 81 events each for a total of 567 observations. When analyzing whether the adolescents were wearing their braces during events, the results of a logistic regression across participants suggests adolescents did not wear their braces when participating in physical activities, when with parents and non-related adults, during hygiene activities, and when in a more negative mood. As a group, the adolescents in this study were more likely to wear their brace when they were studying at school and when they feel competent. For individuals, other variables, such as riding in vehicles, eating, shopping, and comfort were associated with not wearing their brace. The main discrepancies in objective and subjective measures of whether they were wearing their brace-wearing were intrapersonal situations. The adolescents were less likely to not report not wearing their brace when they were in a more negative mood, and but were more likely to when they were uncomfortable. Importantly, this investigation was successful at pioneering a replicated single-case design to assess both objectively measured brace-wearing and environmental, interpersonal, and intrapersonal psychosocial variables within and across participants. This innovative use of DRM methodology is generalizable to research investigating a wide array of adherence behaviors and measuring their predictors proximally in time but without reactivity typically caused by interrupting ongoing activities.
... In our study, as the stress increased, there is a significant fall in the PEFR, as was already shown by Smyth JM et al., [6]. The psychosocial variables (physical activities, social contacts, mood, and stressors) were strongly related to the PEFR, thus suggesting that they may play more important roles in the bronchial constriction than was previously thought. ...
... CPD: cigarettes per day; FTND: Fagerström Test for Nicotine Dependence (Heatherton et al.,1991); RFQ-HC: Reasons for Quitting Questionnaire–Health Concerns subscale (Curry et al., 1990); RFQ-IR: Reasons for Quitting Questionnaire–Immediate Reinforcement subscale (Curry et al., 1990); RFQ-SC: Reasons for Quitting Questionnaire–Self-Control subscale (Curry et al., 1990); RFQ-SI: Reasons for Quitting Questionnaire–Social Influence subscale (Curry et al., 1990)(Sandberg et al., 2000; Smyth et al., 1999). As a result, these individuals may begin smoking cigarettes at an earlier age in an attempt to cope with increased stress and negative affect. ...
Despite the negative effects of smoking on lung functioning and overall health, smoking is more prevalent among individuals with asthma compared to those without asthma. The purpose of this study was to examine the predictive ability of asthma diagnosis in terms of smoking behavior and reasons for quitting. Participants were 251 regular daily smokers: 125 smokers with self-reported, physician-diagnosed asthma and 126 smokers without asthma. Asthma diagnosis significantly predicted age of regular smoking onset, number of quit attempts, and reasons for quitting related to self-control suggesting that smokers with asthma may have more difficulty quitting and unique reasons for quitting.
... Durbin-Watson Stat.: 2.04Brosig, Leweke, Milch, Eckhard, & Reimer, 2001; King et al., 1991; Kosarz, Hrabal, & Traue, 1997). Asthma bronchiale wurde auch in anderen Studien untersucht (Priel, Heimer, Rabinowitz, & Hendler, 1994; Vogt & Schandry, 1995 (Schmaling et al., 2002; Smyth et al., 1999) ...
Asthma bronchiale ist eine weit verbreitete Erkrankung, die offensichtlich durch psychische wie auch durch somatische Stressoren beeinflusst wird. Bei psychisch auffälligen Patienten zeigt sich daher auch oft ein besonders schwerer Asthmaverlauf ("Brittle Asthma").
Ziel der vorliegenden Untersuchung war es, psychosomatische Prädiktoren der Atemwegsinstabilität am exemplarischen Einzelfall einer 25-jährigen Patientin in stationärer Psychotherapie empirisch darzustellen, und die so gewonnenen Erkenntnisse an einem ausgewählten Patientenkollektiv (Pool) zu überprüfen. Dazu wurden neben täglichen Messungen des Peak-Expiratory-Flow (PEF) Stimmungen (Aggression, Aktivierung und Depression als die drei zentralen Dimensionen) und Körperbeschwerden sowie Aspekte des therapeutischen Settings mittels standardisierter Tagebucherhebung registriert. Die Auswertung der so erhaltenen Zeitreihen erfolgte multivariat mittels einer kombinierten Längsschnitt-Querschnitt-Analysemethode (pooled time-series cross-section data analysis). Die oben genannten Variablen erwiesen sich an verschiedenen Zeitpunkten und in unterschiedlicher Stärke als signifikante Prädiktoren für die täglichen Schwankungen der PEF-Werte, dem Maß der Atemwegsinstabilität (p jeweils < 0,05). Des weiteren konnte der besondere Einfluss von unbewussten Emotionen auf das Asthmageschehen gezeigt werden, wodurch auch eine Objektivierung des Zusammenhangs von Depressivität und Körperbeschwerden gelang. Jeweils zwischen 14 und 30 Prozent der Gesamtvarianz des Parameters "PEF-Variabilität" ließen sich so mittels verschiedener Modelle erklären (p < 0,01). Außerdem wurde eine Funktion gefunden, mit deren Hilfe der Verlauf dieses Parameters über den Zeitraum der Therapie hinweg beschrieben bzw. vorhergesagt werden konnte.
Die Ergebnisse zeigen neue Möglichkeiten zur empirischen Erfassung der Psychodynamik von Psychosomatosen und zur objektiven Darstellung von Therapieverläufen auf. Diskutiert werden weiterhin die Chancen der multivariaten Zeitreihenanalyse und der Einzelfallaggregation für die Erforschung komplexer psychosomatischer Zusammenhänge. Bronchial asthma is a common bio-psycho-social disease, influenced by psychic as well as by somatic stressors. It was the aim of the present study to demonstrate empirically how psychosomatic parameters interact with airway-instability in a paradigmatic case of a 25-year-old women during ward-based psychotherapy and to compare the findings with pooled data, stemming from 6 unselected patients with brittle ashtma in the same setting. By means of a structured diary type study, peak expiratory flow (PEF), moods (aggression, activation, and depression) and somatic complaints were registered together with crucial aspects of the therapeutic setting. Furthermore, daily variance of PEF was determined as dependent variable. The resulting time series were examinated in a multivariate approach by pooled time-series cross-section data analysis.
The findings showed that all psychosocial variables could be used as significant predictors of daily PEF-variance, but to a different extend (each p < 0.05) and partly with time-lag. Furthermore, the correlation between somatic complaints and depression could be objectified. The different models accounted for almost 14 to 30 per cent of the total variance of PEF-Variability (p < 0.01). Moreover, a function was found which could be used to describe (and even predict) the course of airway-instability over the therapeutic process. Our findings show new strategies to investigate the psychodynamic process in psychosomatoses empirically and to describe the course of psychotherapy objectively. Furthermore, the potential of multivariate time-series analysis and single-case-aggregation as a mean to demonstrate psychosomatic interrelations is discussed.
... Increased respiratory resistance, airway reactivity, shortness of breath, and decreased peak expiratory flow rate have been reported after an emotional challenge. [97][98][99] ...
A chronic inflammatory disorder of the respiratory airways, asthma is characterized by bronchial airway inflammation resulting in increased mucus production and airway hyper-responsiveness. The resultant symptomatology includes episodes of wheezing, coughing, and shortness of breath. Asthma is a multifactorial disease process with genetic, allergic, environmental, infectious, emotional, and nutritional components. The underlying pathophysiology of asthma is airway inflammation. The underlying process driving and maintaining the asthmatic inflammatory process appears to be an abnormal or inadequately regulated CD4+ T-cell immune response. The T-helper 2 (Th2) subset produces cytokines including interleukin-4 (IL-4), IL-5, IL-6, IL-9, IL-10, and IL-13, which stimulate the growth, differentiation, and recruitment of mast cells, basophils, eosinophils, and B-cells, all of which are involved in humoral immunity, inflammation, and the allergic response. In asthma, this arm of the immune response is overactive, while Th1 activity, generally corresponding more to cell-mediated immunity, is dampened. It is not yet known why asthmatics have this out-of-balance immune activity, but genetics, viruses, fungi, heavy metals, nutrition, and pollution all can be contributors. A plant lipid preparation containing sterols and sterolins has been shown to dampen Th2 activity. Antioxidant nutrients, especially vitamins C and E, selenium, and zinc appear to be necessary in asthma treatment. Vitamins B6 and B12 also may be helpful. Omega-3 fatty acids from fish, the flavonoid quercetin, and botanicals Tylophora asthmatica, Boswellia serrata and Petasites hybridus address the inflammatory component. Physical modalities, including yoga, massage, biofeedback, acupuncture, and chiropractic can also be of help.
... In addition, psychosocial stress has been reported to be a significant modulator of chronic manifestation of atopy. There are numerous reports suggesting that in atopic patients, disease onset and severeness of atopic symptomatology are closely related to stressful life events and increased levels of emotional stress in everyday life (Smyth et al., 1999; BuskeKirschbaum et al., 2000) The relevance of stress in the maintenance and exacerbation of chronic atopy is further emphasised by the effectiveness of psychotherapeutic interventions, including stress management or relaxation training, which have been demonstrated to lead to a significant improvement of AD and AA symptomatology (Ehlers et al., 1995; Hajjar, 1999). However, although there is increasing acceptance that stress may be a significant factor in triggering atopic symptoms, the underlying psychobiological mechanisms of stress-induced exacerbation of atopy are not fully understood. ...
In previous studies, atopic patients showed attenuated cortisol responses to psychosocial stress which is suggestive of a hyporeactive hypothalamus-pituitary-adrenal (HPA) axis in this patient group. Regarding the anti-inflammatory role of glucocorticoids, reduced responsiveness of the HPA axis under stress may be one potential explanation of stress-induced exacerbation of atopic symptoms. The present study evaluated whether hyporeactivity of the HPA axis is a feature related to the disposition of atopy rather than a consequence of an ongoing chronic allergic inflammatory process. Newborns with an atopic disposition (parental atopy; n=31) and without atopic disposition (no parental atopy; n=20) were recruited. To further assess atopic disposition, total IgE levels were determined in the cord blood of the neonates. Three days after birth, a blood sample was obtained by a heel prick which is part of a standard pediatric examination. Blood sampling by heel prick is well known to be a significant stressor resulting in activation of the HPA axis in newborns. Analysis of salivary cortisol indicated a significant increase of cortisol levels in the newborns after the stressor with a trend towards an elevated cortisol response in babies with a family history of atopy or with elevated levels of cord IgE (> or = 0.5 kU/l). Neonates with a positive parental atopic heritage and elevated cord IgE were found to show significantly elevated cortisol responses to the heel prick stress when compared to newborns without a parental atopic history and normal cord IgE values. Moreover, cord IgE levels were significantly correlated with basal cortisol levels and the cortisol response to the stressor. These findings suggest that atopic disposition in neonates is associated with altered responsiveness of the HPA axis to stress which may increase the vulnerability to develop manifestation of atopy in later life.
... Daily diary studies of patients with asthma show that life stressors have been associated with lower same-day peak expiratory flow rate and greater self-report of asthma symptoms. Psychosocial variables, such as activities, location, social contacts, mood, and stressors, are strongly related to peak expiratory flow rate (PEFR) and asthma symptoms and are a major contributor to the observed diurnal cycle in PEFR and symptoms [54]. Sandberg [55] used continuous monitoring by diaries and daily peak flow measurements in a prospective study of children with moderate to severe asthma, all receiving inhaled corticosteroid medication. ...
The psychologic influence on childhood asthma has long been a subject of investigation and controversy. This article illustrates the evidence that psychologic stress is related to children with asthma. Individual experience, the impact of family and neighborhood, the effect of caregiver mental status, and the presence of negative psychologic events affect symptoms and management. The pathways through which these factors influence asthma are mediated through cognitive and biologic mechanisms, with evidence indicating changes in behavior and alteration in immune response as underlying mechanisms. Psychologic issues are important in the patient with severe asthma. The mind-body paradigm that links psychologic stress to disease is necessary when considering the global evaluation of childhood asthma.
... A nalysis of ambulatory daytime salivary collections has become an important tool for elucidation of issues related to stress and health. [1][2][3] There is growing evidence that alterations in the diurnal vari-ation of cortisol have health implications for problems ranging from stress, 4 to depression, [5][6][7][8][9] posttraumatic stress disorder, 10 and cancer progression. [11][12][13] In most of these studies, the slope (the regression coefficient of the natural logarithm of the cortisol level on time) 11 seems particularly important. ...
The daytime log-cortisol slope appears to be of growing importance in studying the relationship between stress and health. How best to estimate that slope with minimal burden to the participants and the cost of the study is a decision often made without empiric foundation.
In 50 older participants, the authors examined cortisol assay comparability across laboratories, assay reliability, test-retest reliability of slopes, and comparability of slope estimates for two, three, and four samples per day.
The authors demonstrate in an older sample that 1) assay reliability is a relatively minor issue, that one assay per saliva sample suffices; 2) the use of a sample obtained at wake time for each participant appears to be a preferred anchor for the slope estimate in comparison to a sample 30 minutes postwake time; 3) self-reported times appear preferable to automatic time recording; and 4) test-retest reliability of slopes, however, is not sufficiently high to base a slope estimate on one day; minimally two days and preferably three should be required.
Whether these conclusions apply to other populations, or using other protocols, is not assured, but the study itself provides a model that can be used to check research decisions. Unnecessarily imposing a burdensome protocol has both ethical and scientific ramifications and should be carefully avoided.
The effect of psychosomatic treatment (PST) plus internal medical treatment (IMT) on bronchial asthma was compared with the effect of IMT alone in 13 pairs of young asthmatic patients (5 men and 8 women) aged 16 to 29. The IMT included the simple explanation of the pathology of bronchial asthma and allergic mechanisms, the coping methods in case of asthmatic attacks, avoiding methods from allergens, and pharmacological treatment of bronchial asthma with detail explanation especially about beclomethasone diproprionate inhalation therapy. The PST consisted of frequent explanation of the influence of psychosocial stress on asthma, of several advices to change patient's behavior, and of solution-focused approach (SPA) to the patients. In SPA, patients were sympathized in their sufferings, asked what would their lives be like when they were in good condition, were asked how they had managed to conquer difficulties so far and were helped to recover self-confidence. Each of the patients treated in PST was paired with another asthmatic patient who was the same in sex, age and severity in asthma, according to the patient's visiting list in October 1997 on its order. These patients were treated in IMT alone. The change of asthmatic symptoms and the change of dose of medicine in each patient was scored as -2, -1, 0,1 or 2 based on the Table 1 and the Table 2 according to patient's records, both in 6 months and in 1〜1.5 years later from the beginning of the treatment. For example, such a patient was scored 2 that had suffered from frequent asthmatic attacks at the beginning but that improved in 6 months later so much as had seldom attacks. Then total score was calculated from the sum of the both scores. The effect of PST plus IMT and IMT alone was compared in each pair of patients. In the result, the symptom score and the total score were significantly better in PST group than in IMT group in 6 months later (Fig.1), and the symptom scores were apt to improve more in PST group than in IMT group in 1〜1.5 years later (Fig.2). In conclusion, PST were effective in the treatment of bronchial asthma in adolescence.
Background:
Psychosocial stress and negative affect have been linked to asthma exacerbations, but longitudinal studies demonstrating a daily life association between negative affect and airway nitric oxide are missing.
Objective:
The longitudinal association between negative mood fluctuations, exhaled nitric oxide, and lung function in asthma was examined.
Methods:
Self-assessments of the fraction of exhaled nitric oxide (FeNO), spirometry (forced expiratory volume in the first second, FEV1), negative mood, and daily activities were obtained from 20 patients with asthma for 2 months, resulting in 1108 assessments for the analyses (approximately 55 per patient). Concurrent and prospective associations between FeNO, FEV1, and negative mood were analyzed using mixed effects regression models for longitudinal data.
Results:
Negative mood was positively associated with changes in FeNO during the same day, and to a stronger extent when prior day negative mood was included in the prediction. FeNO and negative mood were positively associated with same-day FEV1, with the latter relation being partially mediated by changes in FeNO. Associations between FeNO and FEV1 were stronger in younger patients, with earlier onset of asthma, or with lower asthma control. Findings were not changed when controlling for physical activity, medication, cold symptoms, air pollution, and hours spent outside.
Conclusion:
Daily life changes of negative mood in asthma are positively associated with FeNO changes and FeNO increases are associated with a mild bronchodilation. These findings indicate that psychological influences need to be considered when using FeNO as indicator of airway inflammation and guide for treatment decisions.
Psychological factors as triggers of asthma: the causal connection remains to be made.
Major impediments to the effective treatment of asthma are:
the nature of the disease itself, especially its intermittency and reversibility;
the nature of the treatments including problems with monitoring, medicating,
avoiding triggers, and following other specific precautionary measures;
the nature of the care provider, notably changes in the manner of health care delivery, the dubious quality of care, and resort to care by unqualified practitioners; and
the nature of the patient, including age, flawed assessment of symptoms, inappropriate coping styles, and mental illness.
The psychology of effective management of asthma:
conveying information in a user-friendly manner;
employing a team approach;
crafting a simple, negotiated treatment plan;
identifying the markers of treatment nonadherence and intervening when they occur;
providing for positive reinforcement and regular feedback to patient and care providers.
Patient-defined behaviors desired in health professionals.
This article has as purpose to show how a group of undergraduate students of the Faculty of Medicine perceived the working conditions in which they carried out their social service in the year 2009. The authors carried out a scouting study based on a on-line research in which they consulted 814 undergraduate MD; they selected a sample of 262 and 52 of the 262 initial questions about working conditions. Amongst the results they show that the undergraduate MD, since they are scholarship holders, were not considered strictly as workers of the healthcare centers, although they worked taking on all the duties and responsibilities of general practitioners. The working conditions were scarce.
Over the past three decades, an array of legislation with attendant regulations has been implemented to enhance the quality of the environment and thereby improve the public's health. Despite the many beneficial changes that have followed, there remains a disproportionately higher prevalence of harmful environmental exposures, particularly air pollution, for certain populations. These populations most often reside in urban settings, have low socioeconomic status, and include a large proportion of ethnic minorities. The disparities between racial/ethnic minority and/or low-income populations in cities and the general population in terms of environmental exposures and related health risks have prompted the "environmental justice" or "environmental equity" movement, which strives to create cleaner environments for the most polluted communities. Achieving cleaner environments will require interventions based on scientific data specific to the populations at risk; however, research in this area has been relatively limited. To assess the current scientific information on urban air pollution and its health impacts and to help set the agenda for immediate intervention and future research, the American Lung Association organized an invited workshop on Urban Air Pollution and Health Inequities held 22-24 October 1999 in Washington, DC. This report builds on literature reviews and summarizes the discussions of working groups charged with addressing key areas relevant to air pollution and health effects in urban environments. An overview was provided of the state of the science for health impacts of air pollution and technologies available for air quality monitoring and exposure assessment. The working groups then prioritized research needs to address the knowledge gaps and developed recommendations for community interventions and public policy to begin to remedy the exposure and health inequities.
The University is currently training as a driver and guide of the new social and technological change, forcing teachers to conduct activities related to teaching, research and university management. The new role of teachers is based on the ability to meet the challenges of a new education that is necessary to combine technological advances, new pedagogical approaches and new methodologies that involve a high level of requirements for teachers, which added to the conditions work, salary, interpersonal relations, the continuing signs of competence and evaluations suffered this group are important aspects that exert great influence on psychological well-being and directly affect physical health. The objective of our study is an assessment of psychosocial factors in a group of university professors in the Degree in Nursing, through the vehicle ISTAS21 a tool for risk assessment of psychosocial work that supports a methodology for prevention half version. The problems encountered are exhibitions including the double presence, quantity and cognitive psychological demands, requiring all early interventions to prevent health problems.
Global asthma prevalence has increased dramatically in recent decades, despite advances in our understanding of the complexities that characterize this illness and in our treatment of it. The goals of asthma treatment are control and reduced impairment; achieving these goals is hindered by lack of provider adherence to evaluation and treatment standards and by patient perceptions, beliefs, comorbid psychiatric disorders, and self-management behaviors. Psychosocial interventions can help patients with asthma achieve asthma control and experience few functional limitations.Keywords:asthma;adherence;perception;stress;treatment
La Universidad se constituye, actualmente, como motor de formación y guía de los nuevos cambios sociales y tecnológicos, lo que obliga al profesorado a realizar actividades relacionadas con la docencia, investigación y gestión del ámbito universitario. El nuevo rol docente se basa en la capacidad para asumir los retos de una nueva educación en la que es necesario conjugar los avances tecnológicos, los nuevos enfoques pedagógicos y las nuevas metodologías que implican un alto nivel de exigencias para los docentes que, sumado a las condiciones de trabajo, salario, relaciones interpersonales, las continuas muestras de competencias y las evaluaciones que padece este colectivo, son aspectos importantes que ejercen gran influencia sobre el bienestar psicológico e inciden directamente sobre la salud física. El objetivo general de nuestro estudio es la realización de una evaluación de los factores psicosociales en un colectivo de profesores Universitarios de la Titulación de Enfermería, mediante el instrumento ISTAS21, herramienta de evaluación de riesgos laborales de naturaleza psicosocial que fundamenta una metodología para la prevención en su versión media. Las exposiciones más problemáticas encontradas son, entre otras, la doble presencia, las exigencias psicológicas, cuantitativas y cognitivas, requiriendo todas ellas intervenciones tempranas para evitar problemas de salud.
Objective: Social support has been linked to beneficial effects on health directly (main effect) and as a buffer to stress. Most research, however, has examined these relationships using global and retrospective assessments of health and stress, which may be subject to recall biases. This study used ambulatory ecological momentary assessment (EMA) methods to test the main and stress-buffering effects of social support on the daily health and well-being of asthma and rheumatoid arthritis (RA) patients. Design: Community volunteers with asthma (n = 97) or RA (n = 31) responded to EMA prompts five times daily for one week. Main outcomes: Baseline perceived social support was obtained, and then, participants reported mood, stress and symptoms using EMA. Multilevel mixed-modelling examined whether social support predicted mood and symptoms directly or via stress-reducing effects. Results: Supporting a main effect, more perceived social support predicted decreased negative mood and stress severity. Supporting a stress-buffering effect, more perceived social support resulted in fewer reported symptoms when stress was present. Conclusion: Results suggest perceived social support directly relates to better ambulatory status and dynamically buffers individuals against the negative effects of stressors, and highlight the importance of studying social support across different temporal and contextual levels.
The aim of the study was to characterize patients at risk for exacerbations of their asthma as a result of the Tottori-Ken Seibu earthquake and to identify factors that predict exacerbation of asthma after an earthquake. A retrospective cohort study-analysis was conducted of 156 asthmatic patients, aged 18 to 89 years, who were out-patients of Tottori University Hospital and who had completely recorded their asthmatic symptoms and measured their peak expiratory flow (PEF) rates for more than one year prior to the earthquake. Seventeen (11%) patients who experienced the earthquake were identified as having an exacerbation within one month after the earthquake. Diurnal variability of PEF during the month after the earthquake was compared to values during a matched month one year previously. When factors associated with exacerbation were identified by a review of the medical case notes and the contribution of these factors to the exacerbation was determined using multivariate analysis, airflow limitation was shown to be independently associated with exacerbation after the earthquake. Acute asthma attacks are more likely to occur within the first week after the earthquake event without diurnal PEF variability. Asthma is likely to worsen after an earthquake.
The effect of problem-focused and avoidant coping on social withdrawal was investigated among a sample of 31 urban children with asthma experiencing varied levels of illness-related stress. Two main and two moderating effects were examined. Neither problem-focused nor avoidant coping was significantly associated with withdrawal when the child's asthma symptoms and stressors were controlled. However, a pattern emerged in analyses of the interaction between coping and stress level. Higher levels of both problem-focused and avoidant coping were associated with lower levels of social withdrawal, but only for children with low levels of asthma-related stress.
Asthma is a common and costly condition in the United States; 7.5% of the population reports having asthma. Asthma prevalence and mortality rates have been increasing in recent decades; purely biological mechanisms are insufficient to explain asthma onset, exacerbation, or its rising prevalence. This chapter reviews the application of psychological theories to the understanding of asthma; the effects of stress and mood states on asthma; and the prevalence and effects of comorbid psychiatric disorders among persons with asthma. We also provide an overview of medical treatments for asthma, and discuss challenges related to adherence with those treatments. Behavioral and other psychological interventions are reviewed that directly or indirectly affect asthma. Suggestions for future research needs and directions conclude the chapter.
Research estimating the comorbidity of asthma and anxiety disorders has produced highly disparate findings and little consensus.
This study is a meta-analytic review of data from 15 independent studies of the co-occurrence of adult asthma and anxiety
disorders and was conducted to provide more precise comorbidity estimates. Aggregating across studies, the average prevalence
of any anxiety disorder among adults with asthma was 34%, indicating a strong relationship between the two conditions in general.
More specifically, the prevalence of panic attacks (25%), panic disorder (12%), agoraphobia (12%), and generalized anxiety
disorder (9%) were considerably higher among adults with asthma than in the general population. However, additional analyses
yielded prevalence estimates for specific phobia (10%), social phobia (7%) and posttraumatic stress disorder (6%) comparable
to or lower than rates observed in the population at large. Attention to psychiatric symptoms should be a crucial component
of asthma management, as anxiety disorders appear to be highly prevalent among persons with asthma and may be associated with
increased asthma morbidity.
It is well established that the course of asthma can be affected by the psychological stress an individual experiences. This article reviews literature assessing the effects of psychological stress on asthma outcomes and discusses the benefits and disadvantages of different measures for assessing stress, including subjective questionnaires, event checklists, and interview-based approaches. We discuss the importance of taking into account the timing and chronicity of stress, as well as individuals' subjective appraisals of stress. We suggest that, although questionnaire and checklist approaches are easier to administer, interview-based stress assessments are preferable, where feasible, because they generate richer and more in-depth information regarding the stressors that people experience. In addition, this kind of information seems to be more robustly linked to pediatric asthma outcomes of interest.
Previous asthma diary studies have yielded equivocal findings on concurrent associations between lung function and mood, and prospective associations have rarely been explored. We therefore examined concurrent and prospective associations between daily mood, shortness of breath, and lung function, and studied between-individual variability and stability of concurrent associations across different times of the day.
Twenty asthma patients and 20 healthy controls recorded their positive and negative mood, shortness of breath, physical activity, peak expiratory flow (PEF) and forced expiratory volume in the first second (FEV(1)) using an electronic pocket spirometer with diary functions three times per day for about 21 days.
For both groups, PEF showed positive concurrent associations with ratings of various mood states, whereas FEV(1) was only associated with positive mood. Both indices correlated negatively with shortness of breath. Within-individual concurrent associations varied significantly in both groups and their stability varied across time of the day, with overall higher stability for associations with shortness of breath in asthma and PEF for both groups. Prospectively, higher shortness of breath consistently predicted lower lung function later during the day and on the subsequent day.
The relationship between normal mood variations and lung function is highly variable across individuals and times of the day, limiting the predictive value of average group associations. Shortness of breath is predictive of future lung function decline in asthma. Future longitudinal research should focus on extreme emotional states, effort-independent measures of lung function, and additional indicators of asthma control.
Numerous studies of populations living in areas with good air quality have reported correlations between daily average levels of ambient particulate matter (PM) and daily mortality rates. These associations persist at PM levels below current air quality standards and are difficult to reconcile with the toxicology of PM chemical constituents. The unusual level of lethality per unit PM mass predicted by these associations may result from confounding by unmeasured societal, behavioral, or stress factors. Daily average ambient PM levels may be expected to correlate with societal activity level, because a working population increases PM emissions through increased manufacture, power utilization, construction, demolition, farming, and travel. Also, people's perceived and actual health depend on societal and psychological factors. A stress such as anger strongly increases the risk of death due to heart attack. Societal factors modify mortality as shown by calendar-related changes in mortality that are unrelated to air quality. Cardiovascular and respiratory mortality are correlated to day of the week, end of the month, and to the first week of the year. There is likely a role of such nontoxicologic variables in the PM associations, and without vigorously testing if other variables correlate as well as PM, we may erroneously conclude that reducing already low levels of PM will yield real public health benefits.
Asthma is characterized by airway hyper-responsiveness, inflammation, and reversible obstruction. Respiratory tract infection, allergies, air pollution, and psychosocial factors impact the severity and frequency of asthma symptoms. Pharmacotherapy and self-care are the major components in the management of asthma, but behavioral interventions also have the potential to affect asthma morbidity. We conducted a small, randomized controlled study, examining the effects of biofeedback-assisted relaxation in 16 nonsmokers with nonsteroid-dependent mild asthma. Data were collected on asthma symptoms, pulmonary function, indicators of arousal, and cellular immune factors. The trained group evidenced a decrease in forehead muscle tension in comparison to the controls, but no changes in peripheral skin temperature. Decreases in asthma severity and bronchodilator medication usage for the experimental group were observed. Pulmonary function testing revealed a significant difference between groups in FEV1/FVC at posttest, with the E group having a higher ratio than the controls. The cellular immune data showed no significant group differences in total white blood cell or lymphocyte counts, but decreases over time were observed. Significant differences were observed in the numbers of neutrophils and basophils in the trained group compared to controls, which supports the concept of decreased inflammation. Results of delayed-type hypersensitivity skin testing suggested enhanced function, but they were not conclusive. These findings, though limited by size of population, suggest a positive effect of biofeedback-assisted relaxation in young, nonsteroid-dependent asthmatics. The mechanisms underlying linkages between psychological, behavioral, and immune responses in asthma require further study.
We investigated the modulation of pulmonary function by mood states in the daily life of asthmatic patients and nonasthmatic control subjects and its relationship to the airway effects of laboratory induction of emotion using films.
Twenty asthmatic patients and 20 nonasthmatic control subjects participated in a laboratory session in which various emotions (ie, anxiety, anger, depression, happiness, elation, contentment, and neutrality) were induced by films. Respiratory resistance (Ros) was measured by forced oscillation. After this session, participants kept mood diaries, including regular spirometric self-assessments, for at least 3 weeks. Episodes of strong negative or positive mood were selected from these diaries and compared with conditions of relative affective neutrality.
In asthmatic patients, negative mood states, and to a lesser degree positive mood states, were associated with a reduction in forced expiratory volume in the first second (FEV1) compared with neutral states. These effects were not observed in nonasthmatic control subjects. Self-reports of arousal varied in a reciprocal manner with FEV1, whereas physical activity did not vary systematically between mood episodes. A moderate negative relationship between changes in FEV1 during negative mood episodes and changes in Ros during viewing of the depressing film was also observed in asthmatic patients.
Pulmonary function of asthmatic patients is negatively affected by strong mood states in daily life. Airway effects of negative emotion induction, particularly depression, can predict changes in pulmonary function in response to negative mood in the field.
We sought to examine whether there were gender differences in the relationship of depressive, anxiety-related, and somatic symptomatology to the presence, severity, and duration of asthma.
A total of 54 adult asthma patients (24 women, 30 men) and 31 healthy subjects (19 women, 12 men) were studied. Within each gender group, patients' psychological distress levels were compared as a function of severity (mild vs. moderate) and duration of disease (<5 vs. 5+ years), to each other and with healthy subjects. Data were collected in Ukraine utilizing the Minnesota Multiphasic Personality Inventory (MMPI), the best-validated psychological assessment instrument in Eastern European populations.
Relative to healthy women, women with both mild and moderate asthma showed elevated distress in multiple domains reflecting somatic and psychological complaints. In contrast, only men with relatively more severe disease of longer duration showed elevated symptomatology relative to healthy men, with depressive symptoms predominating.
To the extent that distress in response to asthma takes a more diffuse form and may be expressed at milder and earlier stages of the disease in women than men, the findings suggest the need to tailor asthma education and behavioral interventions to the unique psychological needs of women and men in order to be maximally effective.
Previous research has demonstrated links between low socioeconomic status (SES) and clinical asthma outcomes, as well as links between stress and asthma. The objective of this study was to test whether adolescents with asthma from different SES backgrounds differed in biological profiles relevant to asthma, including immune and cortisol measures. The second objective was to test whether psychological stress and control beliefs could explain these differences.
Adolescents with persistent asthma from either low (N= 18) or high (N= 12) SES neighborhoods were interviewed about their stress experiences (chronic stress, acute life events, interpretations of ambiguous life events) and control beliefs. Blood was drawn to assess immune (cytokines, eosinophils, IgE) and neuroendocrine (cortisol) markers associated with asthma.
Adolescents in the low SES group had significantly higher levels of a stimulated cytokine associated with a Th-2 immune response (IL-5), higher levels of a stimulated cytokine associated with a Th-1 immune response (IFN-gamma), and marginally lower morning cortisol values compared with the high SES group. Low SES adolescents also had greater stress experiences and lower beliefs about control over their health. Statistical mediational analyses revealed that stress and control beliefs partially explained the relationship between SES and IL-5/IFN-gamma.
Our finding that low SES was associated with elevations in certain immune responses (IL-5/IFN-gamma) in adolescents with asthma suggests the importance of further exploration into relationships between SES and Th-2/Th-1 responses in asthma. Our findings also suggest that psychological stress and control beliefs may provide one explanation for links between SES and immune responses in childhood asthma.
Although major depression is thought to have substantial negative effects on work performance, the possibility of recall bias limits self-report studies of these effects. The authors used the experience sampling method to address this problem by collecting comparative data on moment-in-time work performance among service workers who were depressed and those who were not depressed.
The group studied included 105 airline reservation agents and 181 telephone customer service representatives selected from a larger baseline sample; depressed workers were deliberately oversampled. Respondents were given pagers and experience sampling method diaries for each day of the study. A computerized autodialer paged respondents at random time points. When paged, respondents reported on their work performance in the diary. Moment-in-time work performance was assessed at five random times each day over a 7-day data collection period (35 data points for each respondent).
Seven conditions (allergies, arthritis, back pain, headaches, high blood pressure, asthma, and major depression) occurred often enough in this group of respondents to be studied. Major depression was the only condition significantly related to decrements in both of the dimensions of work performance assessed in the diaries: task focus and productivity. These effects were equivalent to approximately 2.3 days absent because of sickness per depressed worker per month of being depressed.
Previous studies based on days missed from work significantly underestimate the adverse economic effects associated with depression. Productivity losses related to depression appear to exceed the costs of effective treatment.
Although stress and anxiety have long been assumed to play an exacerbatory role in asthma, no study has systematically documented that daily exacerbations of asthma symptoms are related to stress and/or anxiety. In this study, 24 airways obstruction patients (12 asthmatics and 12 chronic obstructive pulmonary disease patients) were instructed to monitor the severity of daily respiratory symptoms. In addition, subjects recorded their daily anxiety level and the number and perceived impact of daily stressors. The results showed that although there were differences between high- and low-stress days for both groups, there were no differences between groups on symptom severity or between high- and low-anxiety days, as measured by the State-Trait Anxiety Inventory (STAI). Thus, although the number and impact of daily stressors were found to be directly associated with the severity of asthma symptoms, anxiety does not appear to have a direct role in the exacerbation of asthma. The findings failed to support the anxiety theory of asthma but provided an explanation for the poor results obtained in previous treatment studies which employed anxiety management with asthmatics.
Studies incorporating repeated observations of momentary phenomena are becoming more common in behavioral and medical science. Analysis of such data requires the use of statistical techniques that are unfamiliar to many investigators. Some common ways of analyzing momentary data are reviewed--aggregation strategies, repeated measures analysis of variance, pooled within-person regression, and two-stage estimation procedures for multilevel models--and are found to be usually suboptimal, possibly leading to incorrect inferences. A broad class of statistical models for multilevel data that can address many research questions typically asked of momentary data are then described. Analytic issues that merit careful consideration include the scaling of momentary variables, allowance for serial autocorrelation of residuals, and the treatment of coefficients that vary across individuals as fixed versus random effects.
Approaches to the analysis of behavioral medicine data with few individuals but many repeated observations are discussed. Difficulties with common analytic strategies are noted and applications from econometrics using cross-sectional pooled time series designs are recommended. Additional complications due to outliers, missing data, measurement error, and aggregation bias are discussed.
Evidence indicates that psychological stress plays a role in precipitating and exacerbating asthma symptoms and suggests that relaxation techniques aimed at reducing stress and autonomic arousal leads to symptom reduction. This study explored the effect of a tape-recorded relaxation intervention on well-being (mood and stresson). asthma symptoms, and a measure of pulmonary function (PEFR). Twenty adult asthmatics were studied for 21 days in their natural environment using a multiple baseline design. Self-administered relaxation training (including both breathing exercises and muscle relaxation) led to decreased negative mood and stressor report. Reporting of asthma symptoms decreased over time, and PEFR was increased by relaxation training. Asthma medication use was unchanged. Results suggest that tape–recorded relaxation training positively impacts well-being, asthma symptoms. and PEFR in a naturalistic setting. Further study of the potential use of inexpensive tape-recorded interventions in chronic illness is warranted.
Used the repeated-measures ANOVA approach to analyze the relationship between position, location, and mood and individual ambulatory blood pressure (ABP) and heart rate (HR) in 246 Ss (aged 30–60 yrs at baseline). Position and location had sizeable effects on systolic and diastolic ABP as well as HR, but a large amount of interpersonal variability was seen in these effects. Of the 12 moods studied, anger was associated with the largest increase in both systolic and diastolic ABP followed by excitement; feeling happy, rushed, and anxious were also associated with small, but statistically significant ABP increases. Feeling tired was associated with a modest decrease in ABP. Although several of the mood effects were significant, overall mood was found not to account for much of the variance in ABP or HR. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discusses ecological momentary assessments (EMAs), recently developed approaches for assessing behavioral and cognitive processes in their natural settings. Four qualities define EMA methods: 1) phenomena are assessed as they occur, 2) assessments are dependent upon careful timing, 3) assessments usually involve a substantial number of repeated observations, and 4) assessments are usually made in the environment that the S typically inhabits. Phenomena for which EMAs are relevant are reviewed, particularly rapidly fluctuating processes such as affect, pain perception, and coping efforts. Issues relevant to the application of EMAs are addressed, including choice of sampling scheme. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Mood and affect are often assessed in psychological research without regard for the potential influence of time of day or other environmental factors. This study examined the determinants of daily mood variability. Ninety-four subjects completed a diary every 15 min for 1 day, and subjects' moods, activities, and locations were assessed. Diurnal cycles were found for several moods (e.g., happy, tired), activities (e.g., discourse, thinking), and locations (e.g., home, work). Diurnal cycles in most moods were strongly associated with activities and location, yet diurnal cycles of some moods (rushed, sad, and tired) were not dependent on these factors. These findings have implications for mood assessment: Mood assessment performed only at particular times of day, or those relying on point assessment, may be influenced by time of day and by the activities and location of the subject.
This paper reviews the empirical literature on the relation between asthma, suggestion, and emotion, and proposes the hypothesis that these effects are mediated parasympathetically. The literature indicates that, among asthmatics, suggestion can produce both bronchoconstriction and bronchodilation, and that stress can produce bronchoconstriction. The proportion of asthmatic subjects showing bronchoconstriction to both suggestion and stress averages 35%-40% across studies, but, because of methodological considerations, might be conservatively estimated as closer to 20%. The effect is smaller for suggestion of bronchodilation, and is very short-lived among nonasthmatics. No clear connection has been found between these responses and such subject variables as age, gender, asthma severity, atopy, or method of pulmonary assessment, although some nonsignificant tendencies appear. Most studies in this literature used small n's and did not systematically examine various somatic, environmental, and demographic factors that could influence results. A hypothesis is presented regarding vagal mediation of psychological effects on the airways, as well as possible alternative mechanisms, and recommendations for future research to evaluate these hypotheses.
The relationship between mood and peak flow (PEF) was examined in 10 adult asthmatics by taking twice daily readings over 15 days. Three subjects showed a clear overall mood-PEF relationship but this effect was attributable to recordings taken in the evening and not those taken in the morning. The size of the mood-PEF relationship correlated significantly with the percentage difference between morning and evening PEF. The results are discussed in terms of the direction of causality between mood and PEF and the need to examine individual differences in the mood-PEF relationship.
The relationship between mood and fluctuations in peak expiratory flow rate (PEF) was studied in seven mildly asthmatic adult men and seven non-asthmatic controls. Participants completed visual analogue mood scales and measured PEF four times per day for 24 days, and the Profile of Mood States was also filled in at the end of each day. Significant correlations between mood and PEF were found in six of the asthmatics. No specific asthma-related profile was identified, since each person showed idiosyncratic associations between mood and pulmonary function. The non-asthmatics did not show consistent correlations above a level expected by chance. Possible explanations of these results and their relevance to the management of asthma are discussed.
Atopy is not the most common factor causing asthma in adults. Recent elucidations of pathophysiologic mechanisms involving the autonomic nervous system, cyclic nucleotide metabolism, and arachnoidonic biochemistry give us a better understanding of the similarities and unique differences among asthma events related to exercise, aspirin, emotions, occupational environments, atmospheric conditions, and respiratory tract infections. The ultimate value of this information is no greater than its potential to aid the physician in decreasing the interference of asthma in the daily lives of patients.
Diurnal variation of peak expiratory flow was assessed over 10 days in 40 asthmatic outpatients judged clinically to be stable. Thirty patients showed a morning dip in their peak expiratory flow and the frequency with which this occurred appeared to be linked with the amplitude of the dip. The percentages showing large, moderate and insignificant dips were similar to those described in asthmatics hospitalised with an exacerbation. Ten patients were admitted with an exacerbation of their asthma in the preceding 2 years. Two of the three non-dippers assumed a dipping pattern during this admission. Without a continuous peak expiratory flow record it would not have been thought that many of our apparently stable patients were showing high amplitude dips such as have been associated with sudden unexpected death. The place of a continuous diurnal peak expiratory flow record in relation to asthma mortality is discussed.
Our object was to describe demographic data from a population of adult asthmatics admitted to a regional tertiary medical center to identify risk factors for intubation. We performed a retrospective cohort study of all asthma admissions (International Classification of Diseases, Ninth Revision, Code 493.9) excluding cases with chronic obstructive pulmonary disease. This included all patients with asthma 20 years and above admitted to the University of California Davis Medical Center, Sacramento, from January 1, 1990 to June 30, 1993. A total of 375 asthma admissions were reviewed. There were 244 women (29 intubated) and 131 men (13 intubated) with a mean age of 40.7 (range 20-72) years. Of this group, 131 people were white, 140 black, 56 Hispanic, 42 Asian, and 6 American Indian. By National Heart, Lung, and Blood Institute Guidelines, there were 101 mild, 181 moderate, and 93 severe cases. Significant risk parameters identified for intubation were psychosocial problems [odds ratio (O.R.) 9.3; 95% confidence interval (C.I.) 6.8, 12.7], low socioeconomic group (O.R. 2.9; 95% C.I. 1.5, 5.8), little formal education (O.R. 5.4; 95% C.I. 2.8, 10.2), atopic allergy (O.R. 11.7; 95% C.I. 5.7, 23.7), duration of asthma > or = 15 years (O.R. 2.6; 95% C.I. 1.3, 5.3), previous intubation (O.R. 14.0; 95% C.I. 7.6, 25.6), upper respiratory infection (O.R. 4.0; 95% C.I. 2.2, 7.5), hospital admission for asthma within the last year (O.R. 5.3; 95% C.I. 2.7, 10.4), emergency room visit within the last year (O.R. 8.8; 95% C.I. 3.9, 20.1), and steroid dependency (O.R. 5.5; 95% C.I. 3.0, 10.2).(ABSTRACT TRUNCATED AT 250 WORDS)
There is a fascinating and exceedingly important area of medicine that most of us have not been exposed to at any level of our medical training. This relatively new area is termed chronobiology; that is, how time-related events shape our daily biologic responses and apply to any aspect of medicine with regard to altering pathophysiology and treatment response. For example, normally occurring circadian (daily cycles, approximately 24 hours) events, such as nadirs in epinephrine and cortisol levels that occur in the body around 10 pm to 4 am and elevated histamine and other mediator levels that occur between midnight and 4 am, play a major role in the worsening of asthma during the night. In fact, this nocturnal exacerbation occurs in the majority of asthmatic patients. Because all biologic functions, including those of cells, organs, and the entire body, have circadian, ultradian (less than 22 hours), or infradian (greater than 26 hours) rhythms, understanding the pathophysiology and treatment of disease needs to be viewed with these changes in mind.
Asthma is a significant public health problem in many communities. Symptoms of asthma occur as a direct or indirect result of many contributing factors, including influences from the natural and built environments, human behavior, and the adequacy of techniques used in its management. A model is presented to integrate many of these contributing factors, highlighting the characteristics of the atmosphere, i.e., climate, irritants, and allergens. The model stresses the need for investigators to heed the many contributing triggers and influences, including possible synergistic mechanisms, in this disease.
Progressive changes in American housing and life styles have been associated with increased prevalence of allergen sensitization and asthma. Not only have there been large increases in the proportion of time spent indoors, but many of the changes made in houses are likely to increase exposure to indoor allergens. Thus, higher mean indoor temperatures, reduced ventilation, cool wash detergents, and the widespread use of carpeting are all changes that could have increased the levels of allergens in American homes. Over the past 15 years, dust mites, cockroaches, and cats have been identified as major sources of indoor allergens. The combination of exposure and sensitization to one of these allergens is significantly associated with acute asthma. Furthermore, clinical studies have shown a direct quantitative correlation between dust mite allergen exposure and the prevalence of both sensitization and asthma. New evidence suggests that reductions in allergen exposure may improve asthma symptoms, leading to decreased inflammation and bronchial hyperreactivity. Furthermore, as understanding of sources of allergens increases, the protocols for decreasing exposure become better defined and relatively easy to implement.
While high doses of caffeine may affect pulmonary function and bronchial challenge tests in patients with mild asthma, the effects of lower doses (< or = 5 mg/kg) are less well documented. Specific recommendations exist for withholding theophylline, but not caffeine, before bronchoprovocation and pulmonary function testing.
To assess the effect of a single oral dose of caffeine (5 mg/kg) on FEV1 and bronchial responsiveness to histamine a double blind, placebo controlled study was performed in eight patients with mild stable asthma.
While caffeine had no effect on FEV1, mean (95% confidence interval) log PC20 histamine was significantly higher 150 minutes [caffeine = 0.99 (0.2) mg/ml, placebo = 0.53 (0.29)] and 240 minutes [caffeine = 0.89 (0.24), placebo = 0.44 (0.26)] after administration of caffeine than after placebo.
Caffeine should be excluded from the diet for a period of more than four hours before bronchial provocation testing. The exact length of time for which it must be excluded requires further study.
Nocturnal symptoms are common in asthma, even when patients are regularly seen at an outpatient clinic. Inflammation is generally accepted as a general feature of asthma and the severity of this basic inflammatory process can be increased by exogenous triggers such as exposure to allergens and nonallergic stimuli. Superimposed endogenous circadian rhythms may play a more important and intricate role in the circadian modulation of the inflammatory process by changing the number of cells, their release of mediators and/or the susceptibility of airway smooth muscle and vasculature. For instance, an increase in vagal tone may induce nocturnal bronchoconstriction which is further enhanced by falling catecholamine levels. Together, the reduced nocturnal catecholamine levels and the diminished bronchodilating capacity of the NANC system and the low cortisol levels oppose possible protection against inflammatory processes leading to nocturnal airflow obstruction.
We present a review of specific health status measures, including symptoms, physical examination, and laboratory tests (exclusive of lung function tests), in terms of their suitability for assessing the presence and severity of asthma in epidemiologic and clinical research. We focus on the validity, reliability, and responsiveness to clinical intervention of these measures. Several adult questionnaires designed for epidemiologic research include questions on asthma and wheezing that have demonstrated repeatability and validity against concurrent measurements of nonspecific airway responsiveness. The International Union Against Tuberculosis Bronchial Symptoms Questionnaire was designed specifically to detect asthma and airway hyperresponsiveness in adult populations, and its reliability and validity have been well documented. A childhood questionnaire developed by Australian investigators has been demonstrated to provide information on asthma and wheezing that is reliable and valid against the criterion of concurrently measured nonspecific airway responsiveness. Although suitable for epidemiologic research, these questionnaires do not provide sufficient data on the severity of current asthma symptoms (aspects of which include intensity, duration, and frequency of symptoms) to be useful for clinical research involving subjects with established asthma. Many different methods of obtaining and analyzing symptom data have been used in clinical trials, but these have not received the methodologic scrutiny that allow the recommendation of a "best" approach for evaluating symptoms in clinical trials of interventions for asthma. The use of daily symptom diaries in short-term drug trials is common, but the optimal symptom-reporting interval for such studies has not been established. Similarly, a particular approach to integrating different symptoms (wheeze, dyspnea, cough, sputum) and the different aspects of these symptoms (intensity, duration, frequency) cannot be recommended on the basis of available data. Physical examination findings have little utility as asthma outcome measures because they may be normal between symptom episodes, they have relatively poor interobserver reliability, and they are relatively poor predictors of the outcome of emergency room visits for asthma. The finding of an elevated arterial PCO2 has utility as an indicator of a severe asthma attack, but arterial blood gas measurements have little other utility as asthma outcome measures. The chest radiograph is generally normal in patients with asthma and therefore not useful as an asthma outcome measure.(ABSTRACT TRUNCATED AT 400 WORDS)
The association of health behaviour, indicators of social adjustment, and psychosomatic symptoms with diagnosed asthma was assessed in a community-based sample of 4550 adolescents in South Western Sydney, Australia. The results of this survey found an asthma prevalence among 11-15-year-olds of 17.5%, being consistent with previous studies. Tobacco use and alcohol consumption were higher among asthmatic compared with nonasthmatic adolescents. Asthmatics reported feeling lonely more often, having a number of negative social perceptions and feelings, and having more frequent psychosomatic symptoms. The findings of the study suggest that adolescents with asthma represent an important vulnerable group of school children. Asthma education may need a greater life-style change focus, besides asthma self-management training.
To assess endocrinological and immunological correlates of marital conflict and marital satisfaction, 31 older couples (mean age 67 years) who had been married an average of 42 years were studied.
Couples were admitted to the Clinical Research Center and a catheter was placed in each subject's arm. Blood was drawn on entry for immunological assays; for hormone analyses, five blood samples were drawn during a 30-minute conflict discussion and a 15-minute recovery session. The conflict session was recorded on videotapes that were later coded for problem-solving behaviors using the Marital Interaction Coding System (MICS).
Among wives, escalation of negative behavior during conflict and marital satisfaction showed strong relationships to endocrine changes, accounting for 16% to 21% of the variance in the rates of change of cortisol, adrenocorticotropic hormone (ACTH), and norepinephrine (but not epinephrine). In contrast, husbands' endocrine data did not show significant relationships with negative behavior or marital quality. Both men and women who showed relatively poorer immunological responses across three functional assays (the blastogenic response to two T-cell mitogens and antibody titers to latent Epstein-Barr virus) displayed more negative behavior during conflict; they also characterized their usual marital disagreements as more negative than individuals who showed better immune responses across assays.
Abrasive marital interactions may have physiological consequences even among older adults in long-term marriages.
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Daily mood variability: From of diurnal patterns and determinants of diurnal patterns Epidemiology and the concept of underlying mechanisms of nocturnal asthma
- A A Stone
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The effects of stress, negative emotions, and psychosocial support on immune responses and symptom expression in asthmatic adolescents
- D.-H Kang
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