Similar psychological characteristics in mild and severe asthma

doi:10.1016/S0022-3999(00)00203-8

Journal of Psychosomatic Research

Volume 50, Issue 1, January 2001, Pages 7-10

https://doi.org/10.1016/S0022-3999(00)00203-8 Get rights and content

Abstract

Objective: Psychological factors have been implicated as potentially contributing to asthma severity. In the present study, we investigated whether patients with mild and severe asthma differ with regard to several psychological characteristics. Methods: Ninety outpatients with severe asthma (74% female, mean [S.D.] age: 46.5 [13.7] years) and 37 outpatients with mild asthma (73% female, age: 39.4 [13.9] years) were compared with respect to general psychological health, anxiety sensitivity, hyperventilation symptoms, personality, and locus-of-control orientation, all measured by well-validated self-report questionnaires. Analysis of (co)variance (ANCOVA) was used to assess between-groups differences. Results: No significant differences in psychological characteristics were found between patients with mild and severe asthma. Only on the subscale for external locus-of-control orientation, severe asthmatic patients differed from those with mild disease (P=.005) in showing less trust in physicians and medication with regard to influencing their asthma. Conclusion: The results suggest that mild and severe asthmatic patients cannot be differentiated on the basis of psychopathology or personality. Whether or not the observed lack of confidence in the influence of physicians or medication on asthma course is cause or consequence of disease severity, remains to be established.

Introduction

Asthma is a chronic inflammatory disease of the airways characterised by variable airway obstruction and bronchial hyperresponsiveness, varying from a very mild disorder to a disabling and life-threatening disease. Only a small minority of asthmatic patients has severe disease, which, nevertheless, has a profound impact on health status [1] and accounts for more than 50% of costs of asthma [2], [3]. Therefore, all factors possibly contributing to asthma severity are of particular interest.

Several psychosocial variables have been implicated as potential factors contributing to asthma severity [4], [5], [6], including level of general psychological health [7], [8], [9], [10], anxiety and hyperventilation [11], [12], [13], [14], personality [8], [15], [16], [17], and health locus-of-control orientation [18], [19]. However, studies into these characteristics in patients with asthma have produced unequivocal results, and the question remains whether patients with severe asthma exhibit different psychological features as compared to patients with only mild disease.

Therefore, the aim of the present study was to investigate whether or not patients with mild and severe asthma differ with regard to psychological characteristics (i.e. general health, anxiety sensitivity, hyperventilation, personality, and locus-of-control orientation).

Section snippets

Sample

Thirty-nine patients with mild asthma and 94 patients with severe asthma were recruited from the outpatient departments of 10 different teaching and nonteaching hospitals. The diagnosis of asthma was based on recommendations by the Global Initiative for Asthma [20], and asthma severity was defined according to the proposal by the European Respiratory Society Task Force on difficult/therapy-resistant asthma [21]: Patients with severe asthma had to use high doses of inhaled corticosteroids (≥1600

Patient characteristics

Of the 133 included asthmatic subjects, six patients (four severe, two mild) had to be excluded from the analysis, due to inadequate completing of the questionnaires. These six patients showed no significant differences in biographic characteristics as compared to the remaining 127 patients.

A significantly older age (mean: 46 vs. 39 years), longer asthma duration (median: 25 vs. 12 years), and increased level of airways obstruction (mean forced expiratory volume in 1 s (FEV₁): 77 vs. 92% pred)

Discussion

The present study shows that patients with severe asthma cannot be distinguished from those with mild asthma with regard to the investigated psychological characteristics. The only exception appeared to be the external locus-of-control orientation, showing that severe asthma patients have less trust in physicians and medication with regard to influencing their asthma. Since this has been shown to be related to noncompliance with medical treatment [18], the identification and management of such

Acknowledgements

The authors would like to thank Mrs. M.C. Timmers for technical assistance, and the chest physicians of the participating hospitals for their cooperation (Slotervaart Hospital, Amsterdam; Rode Kruis Hospital, Beverwijk; Reinier de Graaf Gasthuis, Delft; Bronovo Hospital, Den Haag; Leyenburg Hospital, Den Haag; Spaarne Hospital, Heemstede; Diaconessenhuis, Leiden; St. Antoniushove, Leidschendam and St. Franciscus Gasthuis, Rotterdam). This study was supported by a grant from the Netherlands

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U-BIOPRED was conducted by a European Union consortium of 16 academic institutions in 11 European countries. A subset dataset from subjects with valid anxiety and depression measures and a large blood biomarker dataset were analysed, including 198 non-smoking patients with severe asthma (SAn), 65 smoking patients with severe asthma (SAs), 61 non-smoking patients with mild-to-moderate asthma (MMA), and 20 healthy non-smokers (HC). The Hospital Anxiety and Depression Scale was used to measure anxiety and depression and a series of inflammatory markers were analysed by the SomaScan v3 platform (SomaLogic, Boulder, Colo). ANOVA and the Kruskal-Wallis test were used for multiple-group comparisons as appropriate.
There were significant group effects on anxiety and depression among the four cohort groups (p < 0.05). Anxiety and depression of SAn and SAs groups were significantly higher than that of MMA and HC groups (p < 0.05. There were significant differences in serum IL6, MCP1, CCL18, CCL17, IL8, and Eotaxin among the four groups (p < 0.05). Depression was significantly associated with IL6, MCP1, CCL18 level, and CCL17; whereas anxiety was associated with CCL17 only (p < 0.05).
The current study suggests that severe asthma patients are associated with higher levels of anxiety and depression, and inflammatory responses may underlie this comorbid condition.
Depressive and anxiety symptomatology among people with asthma or atopic dermatitis: A population-based investigation using the UK Biobank data
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Dalgard et al., 2015, Lu et al., 2018, ten Brinke et al., 2001, Walters et al., 2011) The risk of depression and anxiety was suggested to increase with the severity of asthma or AD, yet the exact mechanisms are unclear. ( Papi et al., 2018, ten Brinke et al., 2001, Yaghmaie et al., 2013) Several studies assessed the hypothesis that low grade chronic inflammation underpins the association between asthma or AD with DAS, with mixed results depending on the biomarker assessed (IL-6 has a more consistent association, while C-reactive protein (CRP) less so) (Matsunaga and Yamauchi, 2016; Hayes et al., 2017; Trikojat et al., 2017). Recently, neutrophil-to-lymphocyte ratio (NLR) was proposed as a more stable biomarker for inflammation severity compared to CRP (Gibson et al., 2010; Uslu et al., 2018).
The present study investigated the association of depression and anxiety symptomatology (DAS) with asthma and atopic dermatitis (AD) diagnosis during mid-adult years. The study employed data from 502,641 participants in the UK Biobank. Neutrophils to Lymphocytes Ratios (NLRs) of patients with asthma and AD were calculated and evaluated in relation to DAS, measured via the Patient Health Questionnaire-4 (PHQ-4). Age of asthma or AD onset association with DAS were also estimated. Multivariable regression analyses were implemented among participants with asthma or AD, compared to those without these disorders.
Out of 58,833 participants with asthma and 13,462 with AD, the prevalence of DAS was 11.7% and 2.7%, respectively. DAS increased among participants with either asthma or AD, being highest within patients having both (β = 0.41, 95% confidence interval (95%CI), 0.34,0.49). NLR showed a linear increase with PHQ scores in asthma patients, (tertile 1, β = 0.30, 95% CI, 0.27,0.34; tertile 2, β = 0.36, 95%CI, 0.32,0.39, and tertile 3, β = 0.43, 95%CI, 0.39,0.46). An inverted U-shaped association was seen between age of asthma onset and PHQ, with the 40–59 age group (β = 0.54, 95%CI, 0.48,0.59) showing the highest risk followed by the 60+ (β = 0.43, 95%CI, 0.34,0.51 and 20–39 groups (β = 0.32, 95%CI, 0.27,0.38). Similar patterns emerged within AD. Asthma and AD were associated with increased DAS during mid-adult years, being strongest among participants reporting both disorders. A dose–response relationship between NLR and DAS was observed. Asthma or AD onset during mid-adult years (40–59) were associated with the highest increment in DAS.
Emotionally triggered asthma and its relationship to panic disorder, ataques de nervios, and asthma-related death of a loved one in Latino adults
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Research has demonstrated high comorbidity between asthma and panic disorder (PD). Less is known about the relationship between asthma and the Latino cultural idiom of distress of ataques de nervios, as well as the role that psychosocial stressors play. The current study tested the hypotheses that Latino asthma patients who experience PD, ataques de nervios, and/or asthma-related death of a loved one endorse greater psychological triggers of asthma, greater perceived impact of asthma triggers, and greater difficulty controlling such triggers than do those without these conditions.
Data originated from an interview conducted prior to a randomized controlled trial in which 292 Latino adults with self-reported asthma were recruited from outpatient clinics in the Bronx, NY. The PRIME-MD Patient Health Questionnaire (PHQ) was used to screen for PD symptoms, while the Structured Clinical Interview for DSM-IV (SCID-I) was used to confirm diagnosis of PD. Lifetime history of ataques de nervios and asthma-related death of a loved one were based upon self-report. Asthma triggers were examined using the Asthma Trigger Inventory (ATI).
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Anxiety disorders are highly prevalent in children with asthma yet very little is known about the cognitive and parent factors that may underpin this relationship. The present study investigated interpretation biases in children with asthma and anxiety and their parents, and whether parent-child discussions influenced children's interpretations. Eighty-nine parent-child dyads were included across four groups: children with asthma and anxiety, children with anxiety only, children with asthma only and healthy children (aged between 8 and 13 years old). Interpretation bias was assessed using ambiguous scenarios. Children with anxiety showed an interpretation bias in the general threat scenarios, whereas children with asthma showed an interpretation bias in the asthma threat scenarios. Parental predictions of their child's responses showed similar results. Parent-child discussions increased avoidance for children with anxiety and no asthma across all scenarios, but only for children with asthma and anxiety in the asthma threat scenarios. The results provide partial support for a cognitive theory of asthma and anxiety in children and suggest that parents play a role in influencing children's thinking styles. Treatment programs could thus aim to target and modify interpretation biases in children with anxiety, and include parents as part of treatment.
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Les facteurs favorisants et les comorbidités sont fréquemment rencontrés chez les asthmatiques et, en particulier, les asthmatiques sévères. Ils interférent avec le contrôle de l’asthme et certains facteurs favorisants comme l’exposition allergénique sont à l’origine de perte de contrôle et d’exacerbations. Les comorbidités rhumatologiques, cardiovasculaires et métaboliques sont souvent présentes et leur rôle doit être apprécié. Elles doivent être traitées selon l’état de l’art et le bénéfice sur les critères du contrôle de l’asthme objectivement appréciés. Actuellement, leur rôle et leur physiopathologie dans l’asthme sévère sont souvent encore à découvrir mais une analyse minutieuse de leurs importances relatives et un suivi longitudinal dans des cohortes nationales est très souhaitable.
Triggers and precipitating factors as well as comorbid conditions are associated with asthma and severe asthma. They interfere with the potential to control the disease and represent an additional burden for the patients. Allergen exposure is well known to induce loss of control and exacerbations. Comorbid conditions belong to various fields of medicines including cardiovascular diseases, osteoporosis, obesity and sleep apneas and GERD. They should be diagnosed and treated for themselves according to the best state of the art. Their precise role et their contribution to severe asthma pathophysiology is largely unknown and longitudinal cohort studies are needed to better understand and treat the patients with severe asthma.
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Indeed, the association between anxiety (and/or various depressive disorders) and poorly controlled asthma has been repeatedly confirmed in several clinical studies, irrespective of methodologies employed [11,13,16,69,72,76,80,87]. Data on the association between higher levels of asthma severity (evaluated through GINA or other methods) and a more elevated probability of psychiatric disorders appear to be more heterogeneous, with positive results reported in some studies [61,72,77,79,84,86], negative results in others [16,75,78,81,85,87,88], whilst other studies show positive results, but only limited to subjective self-evaluation of anxiety and/or depression [83,84]. Confirmation of a significant association between asthmatic disorders and anxiety takes us back to the problem regarding the specificity of the link between asthma and anxiety disorders and of the nature of such an association [103].
The literature reports a significant association between various mental disorders and asthma, in particular depression and/or anxiety, with some more robust data regarding anxiety disorders. However, the nature of this association remains largely unclear.
(1) To test the hypothesis of a specific association of anxiety and depressive disorder (according to the DSM-IV) with asthma and (2) to test the bidirectional hypothesis of causality between asthma and psychiatric disorders.
Ninety-six adults were compared with 96 control subjects matched according to main socio-demographic variables (i.e., gender, age, marital status, cohabiting/non-cohabiting, and BMI). Subjects with asthma were divided according to GINA and ACT classifications. All subjects underwent Structured Clinical Interviews for DSM-IV Axis I (SCID-I) diagnosis.
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Similar psychological characteristics in mild and severe asthma

Abstract

Introduction

Section snippets

Sample

Patient characteristics

Discussion

Acknowledgements

Chest

Behav Res Ther

Behav Res Ther

J Psychosom Res

Behav Res Ther

Respir Med

Behav Res Ther

Near-fatal asthma

Eur Respir J

The costs of asthma

Eur Respir J

A national estimate of the economic costs of asthma

Am J Respir Crit Care Med

Difficult asthma

Eur Respir J

The social impact of asthma

Fam Pract

Bronchial asthma: lack of relationships between allergic factors, illness severity and psychosocial variables in adult patients attending an asthma clinic

Psychol Med

Psychiatric and medical features of near fatal asthma

Thorax

Personality profiles and breathlessness perception in outpatients with different gradings of asthma

Am J Respir Crit Care Med

Psychiatric morbidity in patients with life-threatening asthma: initial report of a controlled study

Med J Aust