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Simple and concise measures for health status are desirable in clinical practice. The Asthma Bother Profile (ABP), which consists of 23 items, has been developed to assess how much asthma bothers patients. The Airways Questionnaire 20 (AQ20) is a simple instrument which consists of 20 items. The purpose of this study was to investigate how the ABP and AQ20 evaluate the health status of patients with asthma. A total of 166 patients with chronic asthma (age: 48 +/- 16 yr, 77 males) completed pulmonary function testing, measurement of airway hyperresponsiveness, dyspnea rating, assessments of their anxiety and depression (HADS; Hospital Anxiety and Depression Scale), and assessments of their health status. The health status was assessed using the ABP, AQ20, the short-form 36 health survey questionnaire (SF-36), the Living With Asthma Questionnaire (LWAQ) and the Asthma Quality of Life Questionnaire (AQLQ). The Japanese version of the ABP included only 15 'bother' items out of the original 23 items due to cultural differences. The scores on the ABP were widely distributed, whereas the scores on the AQ20 were skewed towards the milder end of the scale. The ABP had a strong correlation with the Avoidance and Distress constructs on the LWAQ, and Anxiety and Depression on the HADS (Rs = 0.56 to approximately 0.79), and its strongest correlation with the General Health (Rs = -0.64) scale among the 8 subscales on the SF-36. The AQ20 had a less significant correlation with the LWAQ, AQLQ, and SF-36 than the ABP. The ABP and AQ20 were short and simple to complete, and both measures could easily be used in clinical practice. The ABP can evaluate patients more specifically with respect to distress and bother than the AQ20.
J Asthma 2004 Apr
PMID:A comparison of two simple measures to evaluate the health status of asthmatics: the Asthma Bother Profile and the Airways Questionnaire 20. 1511 66

Asthma is a global health problem with up to 15% of children suffering from the disease. It has been shown by various researchers that symptomatic asthmatic patients have increased levels of free serotonin in plasma when compared with asymptomatic patients. Thus, some researchers suggest that reducing the concentration of free serotonin in plasma might be useful in treating patients with asthma. Low levels of serotonin, has however, been linked to various psychological conditions like depression, oppositional defiant disorder, ADHD and even conduct disorder. Research has indicated that products like methylphenidate (also known by the brand names as e.g., Ritalin, Concerta, Metadate and others) and other stimulants used for these conditions, particularly ADHD, exert their paradoxical calming effects by boosting serotonin levels in the brain. Therefore, the hypothesis suggest that some children using asthma medication that lowers serotonin levels, might present with symptoms of depression ADHD, oppositional defiant disorder and even conduct disorder. They may be using asthma medication that lowers serotonin and additionally use methylphenidate that boosts serotonin levels for e.g., ADHD. The hypothesis therefore suggests that asthmatic children presenting with psychological complaints, be treated holistically and serotonin levels measured before coming to conclusions regarding their psychological functioning.
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PMID:Asthma medication may influence the psychological functioning of children. 1528 58

Asthma is a chronic disease that is highly prevalent around the world with increasing societal and economic burden. National Asthma Educational and Preventive Program (NAEPP) and Global Initiative for Asthma (GINA) are evidence-based documents designed to help clinicians make appropriate decisions for their patients and to reduce undesirable variation in the care of asthmatic patients. It is a generally accepted fact that asthma specialists achieved better and improved asthma outcomes for their patients when compared with primary care physicians (PCPs). These outcome differences are somewhat related to PCPs' poor adherence to published NAEPP guidelines. Multi-Colored Simplified Asthma Guideline Reminder (MSAGR) is the first user-friendly single-sheet convenient asthma tool designed for clinicians after barriers to the poor adherence to asthma guidelines in primary care settings were identified. Voluntary acceptance and utilization of MSAGR resulted in fewer emergency room visits and hospitalizations for their patients. General acceptance of MSAGR (more than 1 million copies requested by clinicians globally), and overwhelming positive comments by asthma care providers, strongly advocate a need for real-time, pragmatic clinical tools not only in asthma, but also in other chronic diseases such as chronic obstructive pulmonary disease, diabetes mellitus, hypertension, and depression, etc. In this brief review, we discuss how clinicians, patients, and payers are utilizing these simplified asthma tools to improve asthma care in their community.
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PMID:Multi-colored simplified asthma guideline reminder: why pragmatic asthma tools are needed in real-world practice. 1557 97

Asthma is a chronic, inflammatory disorder of the airways leading to airflow limitation. Its worldwide rise, mainly in developed countries, is a matter of concern. Nocturnal asthma (NA) frequently occurs and concerns two thirds of asthmatics. But, it remains controversial whether NA is a distinct entity or is a manifestation of more severe asthma. Generally, it is considered as an exacerbation of the underlying pathology. The pathological mechanisms most likely involve endogenous circadian rhythms with pathological consequences on both respiratory inflammation and hyperresponsiveness. A decrease in blood and tissue magnesium levels is frequently reported in asthma and often testifies to a true magnesium depletion. The link with magnesium status and chronobiology are well established. The quality of magnesium status directly influences the Biological Clock (BC) function, represented by the suprachiasmatic nuclei and the pineal gland. Conversely, BC dysrythmias influence the magnesium status. Two types of magnesium deficits must be clearly distinguished: deficiency corresponding to an insufficient intake which can be corrected through mere nutritional Mg supplementation and depletion due to a dysregulation of the magnesium status which cannot be corrected through nutritional supplementation only, but requires the more or less specific correction of the dysregulation mechanisms. Both in clinical and in animal experiments, the dysregulation mechanisms of magnesium depletion associate a reduced magnesium intake with various types of stress including biological clock dysrhythmias. The differenciation between Mg depletion forms with hyperfunction of BC (HBC) and forms with hypofunction of BC (hBC) is seminal and the main biological marker is melatonin (MT) production alteration. We hypothesize that magnesium depletion with HBC or hBC may be involved in chronopathological forms of asthma. Nocturnal asthma would be linked to HBC, represented by an increase in MT levels. The corresponding clinical forms associate diverse expressions of nervous hypoexcitability such as depression, cluster headaches, dyssomnia, mainly advanced sleep phase syndrome, some clinical forms of chronic fatigue syndrome and of fibromyalgia. The main comorbidities are depression and/or asthenia. They take place during the night or the "bad" seasons (autumn and winter) when sunshine is at a minimum. The corresponding chronopathological therapy relies on bright light phototherapy sometimes with additional psychoanaleptics. Conversely, asthma forms linked to hBC are less frequently studied as a whole and present a decrease in MT levels. They associate various signs of nervous hyperexcitability such as anxiety, diurnal cephalalgia (mainly migraine), dyssomnia, mainly delayed sleep phase syndrome, and some clinical forms of chronic fatigue syndrome and of fibromyalgia. The treatment relies on diverse forms of "darkness therapy", possibly with the help of some psycholeptics. Finally, the treatment of asthma involves the maintenance of a standard dosing schedule of anti-asthma drugs, a balanced magnesium intake and the appropriate treatment of the chronopathological disorders.
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PMID:Magnesium depletion with hypo- or hyper- function of the biological clock may be involved in chronopathological forms of asthma. 1594 13

The present bibliographic review shows that patients considered to have mild asthma often suffer impairment in quality of life (QoL) and use considerable scheduled and unscheduled health care resources. I found that asthma investigators used no consistent classification scheme for asthma severity, and the level of agreement amongst specialists when categorizing patients with asthma was low. Asthma severity has been classified using a wide range of parameters including medication use, asthma symptoms, lung function, hospitalizations and incidence of exacerbations. Most studies showed a general association between asthma severity and health-related quality of life (HRQoL) such that patients with severe disease suffered greater impairment. However, few patients with mild asthma enjoyed unimpaired HRQoL. Indeed depression and impaired HRQoL were reported as frequently in patients with mild asthma as in those with more severe disease. Although in general severe patients used the most health care resources, even patients with mild asthma used considerable health care resources including emergency room care and hospitalizations. In summary, the term 'mild' when applied to asthma is potentially misleading given the impaired HRQoL and avoidable health care utilization prevalent amongst such patients. The application of disease severity classification in clinical asthma management has not been validated. It may now be appropriate to examine these classifications more critically in order to determine if they have clinical or research usefulness. By contrast, the strategy of treating to achieve disease control has been validated and offers the advantage of simplicity in its application.
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PMID:Impact of 'mild' asthma on health outcomes: findings of a systematic search of the literature. 1621 94

Our objective was to determine the prevalence rate of parent-reported asthma in children with internalizing disorders seeking psychological treatment, and to study the level of internalizing and externalizing problems in these patients compared to patients without asthma. Participants were 367 children (ages 5-18 years) with internalizing disorders seeking psychological treatment. Children's psychiatric diagnosis was established with the Anxiety Disorders Interview Schedule for DSM-IV-Child and Parent versions. Parents reported on their child's asthma diagnosis, medical history, and medication usage. Child psychopathology was assessed with the Child Behavior Checklist and by child self-report with the Multidimensional Anxiety Scale for Children and the Children's Depression Inventory. We assessed internalizing psychopathology of the mothers with the Depression Anxiety and Stress Scale. An additional diagnosis of parent-reported asthma was established for 15% of the children diagnosed with an Axis I internalizing disorder, a prevalence rate markedly higher than reported for current parent-reported childhood asthma in the U.S. population. Patients with asthma showed higher levels of internalizing problems than their nonasthmatic counterparts. Internalizing psychopathology was not higher for mothers of patients with asthma. Asthma is a significant problem within the population of patients with childhood internalizing disorders. It can be accompanied by a greater severity of internalizing problems and may require specific precautions in the treatment protocol. Though parent report of asthma diagnosis is commonly used in surveys of childhood asthma, our findings have to be viewed in the light of its limitations.
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PMID:Prevalence and correlates of asthma in children with internalizing psychopathology. 1684 39

Depression generally begins before Type II diabetes and coronary artery disease; however, no data are available on whether asthma or major depressive disorder (MDD) have an earlier onset. The age at onset of asthma and depression were collected from 85 adult asthma patients with current MDD. The mean ages at onset of asthma and MDD were 21.0 years and 28.8 years, respectively. Asthma preceded MDD in 62% of cases; MDD preceded asthma onset in 24% of cases; and asthma and MDD had a concurrent onset in 14% of the cases. In asthma patients, unlike patients with Type II diabetes and coronary artery disease, depression appears generally to occur after the onset of asthma.
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PMID:Age at onset of major depression in inner-city adults with asthma. 1684 92

It has been recognized that acute and chronic stress has an impact on the immune system. Acute stress may have a stimulating effect on the immune system, while in the case of chronic stress specially depression, the immune system could be down-regulated. However, an association between depression and a higher number of circulating white blood cells with increased activity has been reported. Elevation in immune cell numbers and alteration in cytokine profiles are documented for women suffering sporadic spontaneous abortion with a high stress score. In spite of these contradictory results and to make a new approach in immunological (NK activity) as well as psychological parameters (stress/depression) in women suffering from recurrent spontaneous abortion (RSA) the present study was planned. Forty-five women with a history of RSA and a matched control group were participated in this study. A questionnaire for life events known as life change units (LCU) and the Beck Depression Inventory (BDI) outlines were used and the socio-psychological events were recorded after visiting and interview. Fresh peripheral blood lymphocytes were taken as a source of NK activity and K562 cell line were used as NK sensitive target. The experiments were performed and the cells were analyzed with a flow-cytometer. The stress and the depression scores were determined 245+/-83.6 and 27.6+/-8.8 for women with RSA and 224+/-79.6 and 19.4+/-7.1 for non-RSA group respectively. There was an association between life stress scores and depression scores with r=0.65 and P=0.000 for RSA women. A correlation with r =-0.34 and P = 0.02 was found between depression scores and NK cytotoxicity. The Pearson correlation test showed a lack of relationship between high stress score and NK activity with the r=0.011 and P=0.95, but r=-0.30 and P=0.072 was obtained for high depression scores and NK cytotoxicity. Therefore, it could be suggested that in the case of women with a history of recurrent spontaneous abortion, modulation for immunological parameters (i.e immunotherapy) concurrently with managing psychological aspects (stress/depression) could be modified for the benefit of the patients.
Iran J Allergy Asthma Immunol 2006 Mar
PMID:A study on stress, depression and NK cytotoxic potential in women with recurrent spontaneous abortion. 1724 98

Although formerly regarded as a nuisance disease, allergic rhinitis (AR) has a considerable effect on quality of life and can have significant consequences if left untreated. The total burden of this disease lies not only in impaired physical and social functioning but also in a financial burden made greater when considering evidence that AR is a possible causal factor in comorbid diseases such as asthma or sinusitis. Compared with matched controls, patients with AR have an approximate twofold increase in medication costs and 1.8-fold the number of visits to health practitioners. Hidden direct costs include the treatment of comorbid asthma, chronic sinusitis, otitis media, upper respiratory infection, and nasal polyposis. Nasal congestion, the most prominent symptom in AR, is associated with sleep-disordered breathing, a condition that can have a profound effect on mental health, including increased psychiatric disorders, depression, anxiety, and alcohol abuse. Furthermore, sleep-disordered breathing in childhood and adolescence is associated with increased disorders of learning performance, behavior, and attention. In the United States, AR results in 3.5 million lost workdays and 2 million lost schooldays annually. Patients struggle to alleviate their misery, frequently self-adjusting their treatment regimen of over-the-counter and prescription medications because of lack of efficacy, deterioration of efficacy, lack of 24-hour relief, and bothersome side effects. Ironically, health care providers overestimate patient satisfaction with therapy. Therefore, improvement in patient-practitioner communication may enhance patient adherence with prescribed regimens.
Allergy Asthma Proc
PMID:The burden of allergic rhinitis. 1739 Jul 49

We studied the relationship between the intensity of dyspnea and psychopathological and personality dimensions in 74 women and 38 men (mean age 49.7 years) with asthma. The women had higher values for the following variables: depression, anxiety-trait, and neuroticism, and they proved to have a greater external control location than the men. After checking the spirometry results, body mass index (BMI) and gender, it was found that dyspnea correlated with anxiety-trait and anxiety-state, neuroticism, and depression. In the men, anxiety-trait modified the relationship between dyspnea and the duration of the disease. This effect was not found in the women. A high level of anxiety-trait seems to be responsible for the escalation of dyspnea during the progression of the disease in men, whereas low anxiety may protect them against the increase of dyspnea. FEV(1), BMI, and anxiety-trait were predictors of dyspnea.
J Asthma 2007 Apr
PMID:Psychopathology and personality factors modify the perception of dyspnea in asthmatics. 1745 39


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