lifestyle and respiratory disease

Question 1

what is the epidemiology of illness/mortality of respiratory disease

Answer 1

20%

Onset and progression strongly linked to lifestyle and other health related behaviour

Question 2

what is the common cold

Answer 2

Upper respiratory tract infections eg colds and influenza
Account for 50% acute illness
A major cause for morbidity and mortality worldwide

Question 3

how is the cold the most common illness

Answer 3

Caused by over 200 viruses

Rhinoviruses account for 30-50% adult colds

Question 4

what is the incidence of colds

Answer 4

Children – 6 colds per year

Adults 2-3 colds per year

Question 5

does exposure mean a cold will develop

Answer 5

Exposure to virus doesn’t necessarily means development of clinical symptoms and illness (1 in 3 exposed to cold get symptoms)
Iceberg analogy

Question 6

can being cold cause a cold

Answer 6

Present scientific opinion dismisses a simple-cause effect link between acute cooling of the body surface and the common cold

Question 7

how could acute chilling of the feet be linked to the onset of cold symptoms

Answer 7

Acute cooling of body surface causes reflex vasoconstriction of nose and upper airways which inhibits respiratory defence
Onset of cold symptoms caused by a conversion of asymptomatic sub clinical infection into a symptomatic infection

Question 8

how does sleep link to colds

Answer 8

A possible explanatory host factor
Sleep quality is an important predictor of immunity
Graded link between sleep duration and efficiency to development of cold

Question 9

can vitamin c effect colds

Answer 9

placebo-controlled trials of vitamin c mega dose
>200mg where RDI 40 mg
Prophylaxis and cold incidence
No sig reduction RR= 0.97
subgroup of marathon runners, skiers and arctic soldiers
Sig reduction RR 0.48 (halved risk of cold, only works in extremes)
Prophylaxis and cold duration
Sig reduction in adults RR 0.92 and children 0.86
Therapy and cold duration
No sig difference from placebo

Question 10

can echinacea effect colds

Answer 10

placebo controlled trials of it
Prophylaxis and cold incidence
no individual trials revealed a significant effect, pooled results showed a 10-20% reduction in risk

Question 11

can echinacea effect cold duration

Answer 11

no sig effect
although prevention trial drop out rates are higher for echinacea than placebo
Available echinacea products differ greatly (majority not tested in clinical trials)

Question 12

can stress affect colds

Answer 12

Chronic stress increases risk of common cold
Assessment of duration and type of stressors
Current infection
Followed by introduction of cold virus
Developing cold not predicted by acute stress but is by chronic

Question 13

what is risk of developing a cold also related to

Answer 13

Smoking
Lack of exercise
Poor sleep efficiency 
Drinking more alcohol
Plus sig associated between smoking and chronic stress

Question 14

how are social factors effecting colds studied

Answer 14

Pre exposure measures and follow up to detect disease

Sociability assessed twice pre-exposure extraversion

Question 15

how do social factors effect colds

Answer 15

Increased subjective SES associated wit decreased risk of colds
Associated independent of objective SES
Cog, affective and social factors
Poorer sleep and health behaviours among lower SES may mediate associated between subjective SES and colds

Question 16

what is a major behaviour linked to colds

Answer 16

Systematic review of impact of hand washing
8 studies, risk reduction 6-44%
Pooled results indicate that cuts risk of resp infection by 16%

Question 17

how can psychosocial intervention for hand washing reduce risk of respiratory disease

Answer 17

430 students in 4 halls of residence
2 control 
Intervention
Alcohol gel dispensers 
Sig increase in hand hygiene behaviour
Sig reduction in symptoms

Question 18

what is asthma

Answer 18

One of most common chronic diseases in the world
Most common chronic disease among children in developed countries
WHO estimate 300 million have it (prevalence increasing)
Asthma episodes incur large economic costs (treatment, lost productivity and social security costs)
Once considered purely psychosomatic

Question 19

how do psychosocial factors affect asthma

Answer 19

Symptoms exacerbated by stress
induces changes in immunity contributing to exacerbation of symptoms/triggering attacks
Dysregulation of cortisol response may be important in chronic asthma
chronic stress leading to infection leading to acute stress on asthma

Question 20

how do anxiety disorders effect asthma

Answer 20

In NYC immediately post 9/11
Mod to sev asthma symptoms rose from 14 to 24 %
More primary care and a and e visits
Increase risk irrespective of pre 9/11 symptoms
Demographic characteristics
About physical exposure to attacks

Question 21

what exacerbates asthma in children and adolescents

Answer 21

inter personal conflicts

Question 22

what are people with asthma expected to do

Answer 22

People with asthma are expected to monitor symptoms and use inhaler appropriately
Majority are unable to detect changes in lung function
No match between peak flow and self rated asthma

Question 23

are psychological interventions for asthma effective

Answer 23

yes, Individualised asthma self management education

Improves medical adherence and clinical markers of asthma control

Question 24

how are symptoms and medical outcomes effected

Answer 24

Perception of symptoms and medical outcomes are affected by anxiety, pessimism and perceived stigma
Likelihood of hospitalisation and duration of stay predicted better by psychological factors than objective symptoms

Question 25

what is the incidence of lung cancer

Answer 25

Cancer of lung and throat = 7% of male and 5% of female deaths

Question 26

how is smoking linked to lung cancer

Answer 26

Dose response effects linking number of cigarettes, depth of inhalation
Over 90% of lung cancer may be avoided by quitting smoking
Declines in smoking prevalence reflected in declines in lung cancer cases

Question 27

what are other causes of lung cancer

Answer 27

Other causes include exposure to asbestos, radon gas, other radioactive substances eg uranium

Question 28

how have declines in smoking prevalence effected lung cancer

Answer 28

Due to Individual behaviour change (psychological) and structural change (social)
Smokers are 18% of men and 14% of women
More common in lower SES groups

Question 29

what are smoking cessation aids

Answer 29

Nicotine replacement 
Buproprion (zyban)
Smoking cessation groups
Education (eg quit line)
Buddy systems
Hypnotherapy
Self-help/bibliotherapy