Obervations on Subjective Symptomatology, Coping Behavior, and Medical Decisions in Asthma

Abstract

The Asthma Symptom Checklist (ASC), describing the subjective symptoms reported to occur during asthmatic attacks, has been developed previously. In the present study, the ASC key cluster solution was replicated and refined within a sample of 374 asthmatic inpatients. All of the original symptom categories were reporduced, including two mood categories, Panic-Fear and Irritability, a Fatigue category, and two somatic categories. Hyperventilation-Hypocapnia and Airway Obstruction. Two refinements were notable: (1) The Airway Obstruction category was empirically divided into two conceptually clear components, Dyspnea anc Congestion, and (2) three secondary mood categories, Worry, Loneliness, and Anger, were identified, which describe a continuum of mood between the polar extremes of panic and irritability. Of the symptom categories, only Panic-Fear was related to the intensity of the discharge drug regimens recommended 2 to 6 mouths after ASC administration. Panic-Fear scores were independent of pulmonary function measurements. A combined index based on pulmonary functions and panic-fear yielded the best prediction of discharge steroid regiments. Finally, those physicians rated highest in "sensitivity" to their patients by their supervisors prescribed less steroids overall, but most frequently prescribed discharge steriod regimens in relation to their patients' Panic-Fear scores. In contrast, physicians rated lower on sensitivity prescribed higher steroid regimens overall, but based these drug recommendations more cleary on objective pulmonary functioning, and not in relation to their patients' Panic-Fear scores. The results strongly suggest that the ASC Panic-Fear scale is associated with coping behaviors that importantly affect the patient's overall clinical picture by increasing the apparent severity of the asthma, thereby leading to intensified treatment. The findings stress the need to evaluate independently the objective medical condition and subjective symptomatology with its related coping behavior, in order to direct appropriate modes of therapy to each.

Heterogeneity of Bronchial Asthma

“…patient. Even the physician's attitude may play Some late obstructive reactions following BPT an important role as to this (30). may even be due to the portion of the inhaled alDistinction should also be made between emolergen extract-aerosol that has been swallowed tional factors that cause asthma, and neurovegeby the patient (39).…”

“…For example, those with a distinct so-called panic-fear reaction pattern predictably had more severe asthma than the others (30). The patient with severe bronchial asthma can hardly be looked on as detached from his environment and life situation.…”

Effects of psychotherapy in moderately severe COPD: a pilot study

“…Further studies of more prolonged, intensive psychotherapy would establish whether better symptom and quality of life scores accompany more dramatic increases in exercise tolerance in "pink puffers". Eur Respir J 1997; 10: 1581-1584 In patients with chronic obstructive pulmonary disease (COPD), dyspnoea often correlates poorly with physiological impairment [1][2][3]. Anxiety is closely associated with dyspnoea, and may be one of the most important factors determining quality of life in patients with severe COPD [4,5].…”

“…In patients with chronic obstructive pulmonary disease (COPD), dyspnoea often correlates poorly with physiological impairment [1][2][3]. Anxiety is closely associated with dyspnoea, and may be one of the most important factors determining quality of life in patients with severe COPD [4,5].…”

Influência das variáveis biopsicossociais na qualidade de vida em asmáticos

“…O papel das variáveis psicológicas na percepção de bem-estar tem sido igualmente salientado por outros autores. Nos conhecidos estudos de Denver (Dahlem, Kinsman & Horton, 1977;Dirks, 1978;Dirks, Kinsman, Horton,, Fross & Jones, 1978;Kinsman, Dahlem, Spector & Staudenmayer, 1977) verificou-se uma clara relação entre a ansiedade (demasiado alta ou baixa) e o uso dos recursos médicos (tipo do tratamento e taxas de re-hospitalização).…”