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

Background-Studies of asthma death and severe life threatening asthma (SLTA) include reports of patients who had rapid onset asthma. A study was undertaken to determine the relative frequency of rapid (<6 hours duration) and slow (>6 hours) onset attacks in patients admitted to hospital with acute severe asthma, and to establish whether those with rapid onset asthma diVer in terms of risk factors for asthma morbidity and mortality such as indices of asthma severity/control, socioeconomic factors, health care, and psychological factors. Methods-A cross sectional study was performed on 316 patients aged 15-49 years admitted with acute severe asthma and interviewed within 24-48 hours of admission. Results-Patients underestimated the duration of the index attack. Only 27 (8.5%) were classified as rapid onset. There were more men in the rapid onset group than in the slow onset group (52% versus 26%), and there was evidence of socioeconomic advantage in the patients with rapid onset attacks. The rapid onset group had more previous episodes of SLTA and were more likely to present with SLTA, but there was no diVerence in length of stay in hospital. The rapid onset group were less likely to have presented to a GP during the index attack and were more likely to have used ambulance services. There was no diVerence between the groups in any psychological or health care measure. Conclusions-Rapid onset attacks are an important but uncommon manifestation of asthma that are more likely to present with SLTA in patients who are more likely to have had previous SLTA. Male subjects are at increased risk of rapid onset attacks, and socioeconomic disadvantage, deficiencies in health care (ongoing and acute), and psychological factors are no more common in these patients than in those with attacks of slow onset. These data are consistent with the hypothesis that there is a small proportion of patients with rapid onset severe asthma who do not have the usual risk factors associated with asthma morbidity or mortality, and thus require diVerent management strategies. (Thorax 1998;53:241-247)

Section: Discussionmentioning

confidence: 79%

Rapid onset asthma: a severe but uncommon manifestation

Kolbe

Fergusson

Garrett

1998

“…This is consistent with the results of previous cross sectional studies. 15 16 34 In an epidemiological study using the same instrument (HAD scale), Janson et al 35 found an association between reported respiratory symptoms and psychological status but no evidence that patients with diagnosed asthma had more anxiety and depression than those without asthma. However, the majority of asthmatics identified by Janson et al were likely to be classified as mild.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16][17][18][19] However, few studies have used validated instruments to carefully assess these factors; most factors have been crudely defined 5 9 11 13 14 18 and based on data obtained from relatives. 5 9 11 14 18 the deceased patient's own doctor, 5 9 11 13 14 18 or a medical record which did not necessarily pertain to the event itself.…”

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confidence: 99%

Case-control study of severe life threatening asthma (SLTA) in adults: psychological factors

Kolbe

Fergusson²,

Vamos³

et al. 2002

Background: Severe life threatening asthma (SLTA) is important in its own right and as a proxy for asthma death. In order to target hospital based intervention strategies to those most likely to benefit, risk factors for SLTA among those admitted to hospital need to be identified. Adverse psychological factors are purported risk factors for asthma death and SLTA /near fatal asthma. A study was undertaken to determine whether, in comparison with patients admitted to hospital with acute asthma, those with SLTA have specific adverse psychological factors. Methods: A case-control study was undertaken. Cases (n=77) were admitted to the intensive care unit with SLTA (mean (SD) pH 7.17 (0.15), PaCO 2 10.7 (5.0) kPa). Controls (n=239) were admitted to general wards with acute asthma and were matched only by date of index attack. An interviewer administered questionnaire was undertaken 24-48 hours after admission. A random sample of community based asthmatics was recruited to provide normative data on asthmatics for comparison with cases and hospital controls. Results: The risk of SLTA increased with age (OR 1.04/year, 95% CI 1.01 to 1.07) and was less for women (OR 0.36, 95% CI 0.20 to 0.68). These variables were controlled for in all further analyses. There was a high prevalence of psychological disorder in both cases and matched controls, but there was no difference in prevalence of caseness for anxiety or depression, total (or individual) life events in last 12 months, availability of general or disease specific social support, nor in any of the domains of the Attitudes and Beliefs about Asthma Questionnaire (emotional (mal) adjustment, doctor-patient relationship, stigma, self-efficacy). Cases (SLTA) were less likely to have had previous emotional counselling (25% v 35%, p<0.05). However, when comparison was made with a community based group of asthmatic patients, those admitted to hospital with acute asthma (SLTA and hospital controls) had a higher prevalence of anxiety and depression, higher total life events, and higher prevalence of certain specific life events. Conclusions: There was considerable psychological morbidity generally (and anxiety specifically) in those admitted with acute asthma. Specific adverse psychological factors were not risk factors for SLTA, when comparison was made with those admitted to hospital with acute asthma, but adverse psychological factors were a risk factor for hospitalisation for acute asthma (including SLTA). Psychological risk factors for adverse events in asthma are dependent both on the type of event under study and the comparison group used.

“…Not at all/only with active sport/walking up stairs/hurrying on the flat/walking on the flat/when dressing 9. Did X have sleep disturbance due to asthma?…”

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confidence: 99%

Near fatal asthma attacks: the reliability of descriptive information collected from close acquaintances.

Campbell

McLennan

Coates

et al. 1993

Background-The reliability of information collected from close acquaintances of the deceased in studies on mortality from asthma has not been assessed. As part of a South Australian asthma mortality study, levels of agreement for information obtained directly from cases-that is, cases who had experienced near fatal asthma attacks-were compared with corresponding information concerning these cases obtained independently from close acquaintances. Methods-The first 51 subjects presenting from the outset of the main study to hospital accident and emergency departments with near fatal asthma attacks were included to gain an early assessment of the reliability of responses. The level of agreement between self reported information and that obtained from close acquaintances was compared by means of a kappa statistic or intraclass correlation coefficient, depending on the measurement scale. Both score one for complete agreement and zero when there is no agreement.Results-High levels of agreement were found for questions relating to use of hospital services, with agreement levels ranging from 0-92 for visits in the past month to accident and emergency departments, to 086 for prior hospital admissions and 0-78 for prior need for assisted ventilation. Levels of agreement for drug treatment ranged from 1-00 for use of,B agonists to 0-64 for corticosteroid use, and to a low 0-24 for use of sodium cromoglycate. There was moderate agreement for histories of regular use of over the counter medications without a medical consultation (0.57).Psychiatric characteristics showed moderate levels of agreement, with values of 0-44 for personal history of psychiatric consultations and 0.50 for denial score.Agreement scores were 0-66 for doctor visits in the past month, 0-66 for limitations in daily activities, 0-76 for loss of work days in the past month, 0-59 for severity of asthma, and 0 55 for frequency of asthma attacks in the past month. Poorer agreement scores were found for trends in asthma symptoms (0.21) and frequency of symptoms during the past three years (0.12). Sleep disturbance was also associated with a low agreement score (0.25). Conclusions-The more visible the asthma manifestation, and the more recent the period to which it applies, the more reliable is the information provided by close acquaintances. These factors need to be taken into account when using information from close acquaintances in asthma mortality studies.