Asthma Trigger Reports Are Associated with Low Quality of Life, Exacerbations, and Emergency Treatments

Ritz, Thomas; Wittchen, Hans‐Ulrich; Klotsche, Jens; Mühlig, Stephan; Riedel, Oliver

doi:10.1513/annalsats.201506-390oc

Cited by 37 publications

(29 citation statements)

References 34 publications

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“…We were able to confirm these findings in children and adolescents with asthma of varying severity in secondary or tertiary care. The impact of asthma triggers on HRQL may be explained by the fact that asthma triggers are associated with greater severity and frequency of asthma exacerbations, emergency treatments, healthcare visits and hospitalization . In addition, a higher number of asthma triggers may result in an increased perceived burden of asthma.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, it has been shown that allergic disease‐specific HRQL in children was associated with grass pollen exposure and airway inflammation and generic HRQL in children was reduced during pollen season . In adults, previous research has suggested that mainly non‐allergic asthma triggers are associated with reduced asthma‐specific HRQL …”

Section: Introductionmentioning

confidence: 99%

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Perceived triggers of asthma impair quality of life in children with asthma

Kansen

Meijer

et al. 2019

Clin Experimental Allergy

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BackgroundData on the impact of the number and nature of perceived asthma triggers on health‐related quality of life (HRQL) in children are scarce.ObjectiveTo investigate the impact of perceived asthma triggers on both asthma‐specific and generic HRQL in children.MethodsA cross‐sectional study was conducted among children (7‐18 years) with asthma in secondary and tertiary care. Children were screened with electronic questionnaires regarding respiratory and allergic symptoms. Asthma‐specific HRQL was assessed using the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) (score range 1‐7) and generic HRQL using the RAND questionnaire (score range 7‐32). The Kruskal‐Wallis test and one‐way ANOVA were used to test the difference of, respectively, the PAQLQ and RAND scores across the number of perceived asthma triggers (0, 1‐2, 3‐4, or ≥ 5). Univariable and multivariable linear regression analyses were performed to evaluate the association between individual triggers and HRQL.ResultsA total of 527 children with a mean (SD) age of 12.1 (2.9) years were included. Children with a higher number of perceived triggers had significantly lower PAQLQ and RAND scores (ie poorer HRQL). The difference in PAQLQ scores was clinically relevant between children with 0 versus 3‐4 or ≥ 5 triggers and 1‐2 versus ≥ 5 triggers (mean difference 0.66, 1.02 and 0.63, respectively). Especially, non‐allergic triggers (physical exercise, the weather, (cigarette) smoke and emotions) were significantly associated with reduced PAQLQ scores. Emotions and food/drinks were associated with reduced RAND scores.Conclusion and Clinical RelevanceA higher number of perceived triggers of asthma were associated with reduced HRQL in children with asthma. Especially, non‐allergic triggers were associated with reduced HRQL.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perceived triggers of asthma impair quality of life in children with asthma

Kansen

Meijer

et al. 2019

Clin Experimental Allergy

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“…As the information conditions in our experiment mimic aspects of trigger-related information or advice that is given to patients by physicians or in internet-based asthma information, our findings may be of relevance to the management of asthma in daily life, as they suggest that experience-based beliefs about asthma triggers are shaped by prior information about asthma causality, as well as individual differences in symptom perception. The effects of prior information on generalization of trigger beliefs may be especially relevant, as they may help to explain the individual differences in asthma trigger beliefs that have been observed in individuals with asthma (Ritz et al, 2016) and associated differences in trigger avoidance strategies (Vernon et al, 2012). …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, in day-to-day asthma management, individuals with asthma often report being uncertain about their personal triggers and trigger avoidance strategies (Caress et al, 2002; Trollvik and Severinsson, 2004). In addition, individuals show a marked variation in the type and number of asthma triggers they identify, with a higher number of self-identified asthma triggers being associated with worse asthma outcomes, even when controlling for other measures of asthma severity (Ritz et al, 2006, 2016; Janssens and Harver, 2015). Taken together, these findings suggest difficulties and inaccuracies in the process of asthma trigger identification or the detection of trigger-symptom contingencies.…”

Section: Introductionmentioning

confidence: 99%

Learning to Detect Triggers of Airway Symptoms: The Role of Illness Beliefs, Conceptual Categories and Actual Experience with Allergic Symptoms

et al. 2017

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Background: In asthma and allergic rhinitis, beliefs about what triggers allergic reactions often do not match objective allergy tests. This may be due to insensitivity for expectancy violations as a result of holding trigger beliefs based on conceptual relationships among triggers. In this laboratory experiment, we aimed to investigate how pre-existing beliefs and conceptual relationships among triggers interact with actual experience when learning differential symptom expectations.Methods: Healthy participants (N = 48) received information that allergic reactions were a result of specific sensitivities versus general allergic vulnerability. Next, they performed a trigger learning task using a differential conditioning paradigm: brief inhalation of CO2 enriched air was used to induce symptoms, while participants were led to believe that the symptoms came about as a result of inhaled allergens (conditioned stimuli, CS’s; CS+ followed by symptoms, CS- not followed by symptoms). CS+ and CS- stimuli either shared (e.g., birds-mammals) or did not share (e.g. birds-fungi) category membership. During Acquisition, participants reported symptom expectancy and symptom intensity for all triggers. During a Test 1 day later, participants rated symptom expectancies for old CS+/CS- triggers, for novel triggers within categories, and for exemplars of novel trigger categories. Data were analyzed using multilevel models.Findings: Only a subgroup of participants (n = 22) showed differences between CO2 and room air symptoms. In this group of responders, analysis of symptom expectancies during acquisition did not result in significant differential symptom CS+/CS- acquisition. A retention test 1 day later showed differential CS+/CS- symptom expectancies: When CS categories did not share category membership, specific sensitivity beliefs improved retention of CS+/CS- differentiation. However, when CS categories shared category membership, general vulnerability beliefs improved retention of CS+/CS- differentiation. Furthermore, participants showed some selectivity in generalization of symptom expectancies to novel categories, as symptom expectancies did not generalize to novel categories that were unrelated to CS+ or CS- categories. Generalization to novel categories was not affected by information about general vulnerability or specific sensitivities.Discussion: Pre-existing vulnerability beliefs and conceptual relationships between trigger categories influence differential symptom expectancies to allergic triggers.

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“…In some studies, stress has been an even stronger risk factor than environmental exposures for asthma morbidity [65]. Multiple sources of stress, commonplace in the disadvantaged asthma patient, have been associated with increased asthma morbidity.…”

Section: Psychosocial Stress: Increased In the Disadvantaged Patientmentioning

confidence: 99%

Asthma in the Disadvantaged: A Phenotype in Need of a Personalized, Multidisciplinary Approach to Therapy

Harris¹,

Welch²,

Soper³

et al. 2018

Asthma Diagnosis and Management - Approach Based on Phenotype and Endotype

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Most patients with asthma can be managed with standardized, traditional therapies; however, 5-10% of patients suffer from disease that is difficult to control. Uncontrolled asthma disproportionally affects low income and racial minority patients. The disadvantaged asthma phenotype is defined by the presence of overlapping social, economic and environmental factors. These factors, such as environmental exposures in substandard housing or suboptimal adherence to controller therapy due to impaired health literacy are challenging to address in the clinic or inpatient setting. Personalized management of the disadvantaged asthma phenotype must target these interconnected factors through a multidisciplinary approach that includes longitudinal collaboration with communitybased organizations, social workers and legal aid.

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Asthma Trigger Reports Are Associated with Low Quality of Life, Exacerbations, and Emergency Treatments

Abstract: Patients' perceptions of asthma triggers are important determinants of asthma outcomes, which can help identify individuals at risk for suboptimal asthma management.

Cited by 37 publications

References 34 publications

Perceived triggers of asthma impair quality of life in children with asthma

Perceived triggers of asthma impair quality of life in children with asthma

Learning to Detect Triggers of Airway Symptoms: The Role of Illness Beliefs, Conceptual Categories and Actual Experience with Allergic Symptoms

Asthma in the Disadvantaged: A Phenotype in Need of a Personalized, Multidisciplinary Approach to Therapy

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