Mediators of asthma outcomes

Abstract

Background Patient adherence, the level of asthma self-management skills, exposure to stress, and depression can have considerable influence on a wide range of asthma outcomes, and thus are considered asthma outcome mediators. Objective National Institutes of Health (NIH) institutes and other federal agencies convened an expert group to recommend standardized measures for 7 domains of asthma clinical research outcomes measures. Although the review of mediators of these outcomes was not within the scope of any specific outcome topic, a brief summary is presented so that researchers might consider potential mediators. Methods We prepared a summary of key mediators of asthma outcomes, based on expertise and knowledge of the literature. Results The rationale for including measures of adherence, self-management skills, and exposures to stress in asthma clinical research is presented, along with a brief review of instruments for collecting this information from clinical research participants. Conclusions Appropriate measurement of adherence, self-management skills, and exposures to stress will enhance characterization of study participants and provide information about the potential impact these factors can have on mediating the effects of treatment interventions.

Advances in adult asthma diagnosis and treatment in 2012: Potential therapeutics and gene-environment interactions

“…The March 2012 supplement reports the work of the Asthma Outcomes Workshop convened by the National Institutes of Health and the Agency for Healthcare Research and Quality to accomplish this task. [40][41][42][43][44][45][46][47][48] Seven categories of outcome were considered: biomarkers, symptoms, composite scores of asthma control, exacerbations, quality of life, pulmonary physiology, and health care utilization and costs. Mediators of asthma outcomes were also considered.…”

Psychological distress in asthma and allergy: the Västerbotten Environmental Health Study

“…Relevant aspects of psychological distress in this context are stress, exhaustion (burnout), anxiety, depression, and health worries. The association between stress on the one hand, and atopy in the form of allergic asthma (Rand et al, 2012;Yonas, Lange, & Celedón, 2012), allergic rhinitis (Mösges & Klimek, 2007), and atopic dermatitis (Mitschenko, Lwow, Kupfer, Niemeier, & Gieler, 2008), on the other hand, is well documented. Mechanisms underlying stress as a mediator of atopy have been carefully described (Rand et al, 2012;Wright, 2005;Yonas et al, 2012).…”

Improving patient adherence with asthma self-management practices: what works?

“…Furthermore, an assessment of adherence is often critical in correctly identifying if a patients’ asthma control is due to nonadherence versus treatment-resistant asthma. 11 …”