Psychological factors in asthma control and attack risk
Psychological factors in asthma control and attack risk
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哮喘控制和发作风险的心理因素
作者：
L. Osman
哮喘发作的风险可能取决于心理因素和最近发作经历之间的复杂关系。
在澳大利亚的一系列研究中，Yellowlees、1 Ruffin、2 和 Campbell3 发现，患有近乎致命性哮喘发作的患者中，焦虑和恐慌症的发病率很高。在英国，Ayres 和他的同事发现，脆性哮喘患者终生精神症状和精神疾病发病率较高。4,5 澳大利亚的研究和 Ayres 等人的研究均报告了高度否认哮喘和在急性发作时延迟寻求帮助的一致模式。对哮喘死亡的秘密调查6-8表明，包括否认和拖延在内的心理因素导致了一些死亡。死于哮喘的患者更有可能是那些难以配合医疗管理的患者。
然而，这些研究仅涉及一小部分哮喘患者，是事后研究，并且可能仅与特殊的哮喘受试者群体相关。在一般实践中，将非常严重的高风险受试者的这些发现转化为中度哮喘患者并不容易。
哮喘控制不佳的患者并不总是焦虑较高。 Barboni 等人 9 将近乎致命的哮喘患者与一组匹配的对照组进行了比较，发现两组之间的精神焦虑评分没有差异。 Boseley 等人 10 发现依从性和非依从性患者的焦虑程度没有显着差异。一些焦虑可能有助于自我管理。 Spinhoven 等人 11 发现，焦虑的受试者在 1 年内检测用力呼气量故障的准确性更高
The risk of asthma episodes may depend on a complex relationship between psychological factors and the experience of a recent attack.
In a series of Australian studies Yellowlees,1 Ruffin,2 and Campbell3 have found high rates of anxiety and panic disorder among patients who have suffered near fatal asthma episodes. In the UK Ayres and coworkers have found a high lifetime prevalence of psychiatric symptoms and psychiatric morbidity in patients with brittle asthma.4,5 Both the Australian studies and that by Ayres et al report a consistent pattern of high levels of denial of asthma and delay in seeking help in acute attacks. The confidential enquiries into asthma deaths6–8 suggest that psychological factors including denial and delay contribute to some deaths. Patients who had died from asthma were more likely to be those who found it difficult to cooperate with medical management.
However, these studies only refer to a small minority of asthma patients, are post hoc, and may be relevant only to a special group of asthmatic subjects. It is not easy to translate these findings for very severe high risk subjects to moderate asthmatics in general practice.
Anxiety is not always found to be higher among patients with poorly controlled asthma. Barboni et al 9 compared patients with near fatal asthma with a group of matched controls and found no difference in psychiatric anxiety scores between the two groups. Boseley et al 10 found no significant difference in anxiety between adherent and non-adherent patients. Some anxiety may be useful in self-management. Spinhoven et al 11 found that anxious subjects were more accurate in detecting a fault in forced expiratory volume in 1 …