Category Archives: Asthma education

Few strategies to improve adherence in asthma have been subjected to adequate trial. Such strategies have been summarized by Milgram and Bender as educate, communicate, negotiate treatment goals, streamline, remove barriers and individualize. Education alone is insufficient to ensure high levels of adherence, and such initiatives have been shown to have limited influence on patient behaviour. (more…)

However, self-management of asthma is considerably more difficult for the patient than the mere taking of medications. The patient is expected to avoid precipitants, monitor the course of the disease, detect changes, assess them accurately and alter treatment accordingly, at times having to shift rapidly from regular treatment into emergency mode. As already stated, serious errors of self-management are frequent and influenced by a variety of social, economic and psychological factors . (more…)

In chronic disease, it is generally accepted that compliance is independent of age (excluding adolescence), sex, level of education, socioeconomic grouping and experience of symptoms and treatment side effects. Factors shown to be associated with nonadherence are a variety of psychopathologies (particularly depression ) and cognitive impairment. (more…)

A detailed discussion of adherence in asthma is beyond the scope of this article. It is intuitively obvious that adherence (defined as the extent to which a patient’s behaviour coincides with medical advice) is of paramount importance to the effectiveness of any form of intervention. Evidence suggests that nonadherence with asthma medication is endemic, with approximately 50% of subjects being nonadherent , and that physicians are poor and biased at predicting adherence. (more…)

Psychological factors may have a significant impact on attitudes to disease and medications, on the ability to work with health professionals and to comply with management regimens . Psychological status is also associated with reported respiratory symptoms, independent of pulmonary function . (more…)

Psychological factors may affect the course of a chronic illness in a number of ways. First, there may be psychoneuro-immunological or psychophysiological (parasympathetic or alpha-adrenergic) mechanisms, including the effects of psychological factors on lung function . Psychological variables may affect the patient’s awareness of symptoms, either exaggerating or repressing the symptom’s intensity and significance, while stress may be one of a number of factors triggering a relapse in vulnerable subjects. (more…)

On the other hand, clinically significant depression is not a prevalent problem in adult patients with asthma , although this may not be the case in children . Good family support may be protective particularly against the adverse effects of life events , while poor family support and abnormal family function have been suggested as risk factors for morbidity and mortality. Forty per cent of patients with asthma with SLTA or hospital admission had inadequate disease-specific social support despite otherwise adequate support for more general matters (in more than 90% of cases) . (more…)

Breathing is threatened in asthma. It is, therefore, not surprising that the most common form of psychological morbidity was anxiety ; anxiety at the level of psychiatric diagnosis was found in up to one-third of hospitalized patients and 25% in the community. Post-traumatic stress disorder may follow an acute severe attack; the intensity and severity of anxiety may not disappear readily. (more…)

Previous studies have shown high levels of psychological morbidity in patients who had SLTA or who died of asthma ; these findings have now been extended to include those admitted with acute asthma . However, in a case control study, no differences were found in any specific psychological parameters between those with SLTA and those admitted to hospital with acute asthma , similar to the results of Boulet et al . (more…)

On the other hand, an objective measure of airflow obstrucion is crucial if there is concern that the deterioration in symptoms is due to conditions other than asthma, such as disordered breathing or hyperventilation. Some physicians may be more comfortable basing decisions regtarding use of oral steroids on a quantitative measure rather than on symptoms alone. (more…)