Psychological Factors and Asthma Control

Question 1

Identify a factor which can increase the risk of death for asthma patients.

Answer 1

-Adverse psychosocial factors (e.g. alcohol or drug abuse, social isolation, psychosis or depression)
-Patients with severe asthma and one or more adverse psychosocial factors are at risk of death

Question 2

True or False: Difficult asthma is often associated with coexistent psychological morbidity.

Answer 2

True, difficult asthma is indeed associated with coexistent psychological morbidity.

Question 3

Why are psychological factors important in asthma ?

Answer 3

1) They affect disease process: difficulties with adherence to treatment or taking in information + may directly lead to worsening of symptoms
2) Respiratory illness has significant psychological impact (esp. anxiety and depression)
Overall, reduced QOL compared to controls
3) Influences the service level (more demand on the NHS, and on hospital staff)

Question 4

What specific health-related (in the context of asthma) events are adverse psychosocial factors associated with ?

Answer 4

-Asthma-related deaths
-Near fatal asthma
-Brittle-asthma
-Non-compliance
-Visits to A and E

Question 5

Which specific psychosocial factors are closely related with health-related events in asthma ?

Answer 5

1) Emotions
Depression
Anxiety
Panic
Denial

2) Cognitive Factors
Reduced confidence
Beliefs around vulnerability

Question 6

What proportion of children/adolescents with asthma also have anxiety ? Panic ?

Answer 6

33%
Up to 24%

Question 7

Define anxiety.

Answer 7

State of intense apprehension, uncertainty, and fear resulting from the anticipation of a threatening event or situation, often to a degree that normal physical and psychological functioning is disrupted

Question 8

What is the appropriate course of action when dealing with an asthmatic patient with an anxiety/panic attack ?

Answer 8

Expression of fear allows for appropriate psychological formulation, planned intervention and treatment plan
Therefore, need to encourage exploration of fears through active listening, comforting, guidance, quiet and accepting presence.

Question 9

What are the physical, psychological, behavioral, and cognitive symptoms of anxiety ?

Answer 9

Physical: Quicker and shallower breathing + dry mouth + faster heartbeat + tunnel vision + bladder urgency

Psychological: Thoughts that something bad is going to happen + fear of losing control + sense of dread, impending doom + loss of confidence

Behavioral: Fidgeting, hesitating, avoidance, shaking

Cognitive: Difficulties with concentration and attention + memory problems

Question 10

Give a specific way in which anxiety/panic attacks relates with asthma.

Answer 10

Breathlessness is a symptom of both asthma and panic attacks.

Question 11

Describe the vicious cycle of breathlessness and anxiety/panic.

Answer 11

♠ Thoughts: I cannot breath, I’m going to die etc.
♠ Feelings: Anxiety, panic, fear
♠ Physical sensations: Fight or flight (i.e. increasing breathing rate, shallow breathing, heart racing)
♠ Behaviours: Concentrate on breathing (hypervigilent of body sensations)
♠ Thoughts: Confirmation of initial thoughts.
♠ Feelings (etc.)

Question 12

Define denial in the context of asthma. What proportion of patients does this affect ?

Answer 12

While some patients respond to asthma with anxiety, others cope with denial or avoidance.
Up to 20%

Question 13

What are the short and long term consequences of denial on asthma ?

Answer 13

In the short term (i.e. within three days) can be good.
In the long term, leads to more anxiety and depression, reduces physical functioning, and increases discomfort

Question 14

Distinguish denial from avoidance ? Is it advised to cope using avoidance ?

Answer 14

Avoidance = mentally or physically avoiding something that causes distress

Denial = refusing to acknowledge that an event has occurred

Not advised to cope with avoidance

Question 15

What are common misconceptions about asthma ?

Answer 15

-People with asthma should not exercise
-Asthma is curable

Question 16

Where do misconceptions about asthma come from ?

Answer 16

– Conflicting information
– Interaction with doctor

Question 17

What is the old model of QOL ?What are its main features ?

Answer 17

Impairment Disability Triad

-Focus on Impairment and Disability
-Has an internal focus only (focuses on individual, does not take context into consideration)

Question 18

Define impairment and disability in the context of the Impairment Disability Triad (WHO).
Draw the Triad.

Answer 18

Impairment = any loss or abnormality of psychological, physiological or anatomical structure or function. In comparison to the range considered ‘normal’ for a healthy human being.
Disability = any restriction or lack of ability to perform an activity (resulting from an impairment). Relative to prior status.

Refer to slide 26 in lecture on “Asthma Control” for full diagram

Question 19

What is the new model for QOL ? Draw this and describe its main features.

Answer 19

International Classification of Function – Interaction of Concepts

Refer to slide 28 in lecture on “Asthma Control” for diagram.

-This model takes into consideration the context of the person’s life as well as the individual him/herself. This allows us to say that even with an impairment a person can have a good QOL.

Disability and functioning are viewed as outcomes of interaction between health conditions (diseases, disorders and injuries) and contextual factors. Among contextual factors are external environmental factors (for example, social attitudes, architectural characteristics, climate, terrain…), and internal personal factors (e.g. gender, age, coping styles, social background, education, and other factors that influence how disability is experienced by the individual).

Question 20

Give examples for each of the components of “International Classification of Function – Interaction of Concepts” in an old patient with asthma.

Answer 20

♦ Health condition: asthma
♦ Body function and structure: breathlessness, tight chest, asthma attacks, wheezing
♦ Activities (limitations): Independent in self-care, looks after young family, works (but part time)
♦ Participation (restrictions): Participation in family in role of mother and wife. On days of poor health unable to do this as much as wants + Needs to pace how much she does each day and therefore can only participate in a reduced amount of activity
♦ Personal factors: Supportive husband + difficult relationship with mother + loss of confidence
♦ Environmental factors: newly built house (no damp)

Question 21

Identify the main models of illness.

Answer 21

The Biomedical Model
The Biopsychosocial Model
The Common Sense Model (i.e. Leventhal’s Self-Regulation Model)

Question 22

Describe the biomedical model of illness.

Answer 22

-Assumes a direct relationship between physical damage and illness
-Does not work well for chronic conditions, or in instances where health behaviors have an impact on the condition

Refer to slide 33 in lecture on “Control of Asthma” for diagram

Question 23

Describe the biopsychosocial model of illness.

Answer 23

-Integrates biological, psychological, and social factors.
Refer to slide 34 in lecture on “Control of Asthma” for diagram

Question 24

Describe the common sense model of illness (Leventhal’s Self-Regulation Model).

Answer 24

-Looks at how the person makes sense of their condition
-Looks at Illness Representations (beliefs about the condition) and how these go on to affect mood, motivation and behaviou.
-Illness representations include identity (name, signs and symptoms), cause (internal or external), consequences (physical, social, economic, emotional), time-line (acute, recurrent, chronic), and cure/control.

Refer to slide 37 in lecture on “Control of Asthma” for diagram

Question 25

Describe the significance of casual attributions in asthma.

Answer 25

Knowing the cause of an illness or other traumatic incident can helps make the experience less anxiety provoking and the future more predictable. Indeed, it helps patients to make sense of their illness experience to guide their future actions to cope with the condition – their self-management.

Question 26

Identify psychological factors in intervention of asthma.

Answer 26

-Patient education: Fluctuating nature of asthma means patients need to acquire decision making skills to respond appropriately to changes in symptoms (i.e. patients need to be aware of bodily changes and act accordingly BUT over 50% of adults are poor subjective discriminators of objective severity). Patient education helps acquisition and development of these skills.
-Staff can help patients through effective and practical communication skills

Question 27

What is the significance of models of illness in the context of psychological factors and asthma ? (i.e. what is the point of these models of illness)

Answer 27

Models of health behaviour can help us understand the relationship between psychological distress and impact on asthma and quality of life