Hôpital du Sacré-Coeur de Montréal, Research Center, Department of Chest Medicine, J-3190, 5400 Gouin West, Montreal, QC, Canada H4J 1C5.
Chest. 2010 Jun;137(6):1324-31. doi: 10.1378/chest.09-1979. Epub 2010 Jan 22.
Though several biologic factors have been suggested to play a role in the development and persistence of severe asthma, those associated with psychologic factors remain poorly understood. This study assessed levels of psychologic distress and a range of disease-relevant emotional and behavioral coping styles in patients with severe vs moderate asthma.
Eighty-four patients (50% women, mean [M] age 46 years) with severe (n = 42) and moderate (n = 42) asthma were recruited. Severe asthma was defined according to American Thoracic Society criteria. Patients underwent demographic and medical history interviews and pulmonary function and allergy testing. Patients also completed questionnaires measuring asthma symptoms and the Millon Behavioral Medicine Diagnostic Inventory, which assesses psychologic distress and emotional/behavioral coping factors that influence disease progression and treatment.
After adjustment for covariates and applying a correction factor that reduced the significant P level to < .01, patients with severe vs moderate asthma reported experiencing more psychologic distress, including worse cognitive dysfunction (F = 6.72, P < .01) and marginally worse anxiety-tension (F = 4.02, P < .05). They also reported worse emotional coping (higher illness apprehension [F = 9.57, P < .01], pain sensitivity [F = 10.65, P < .01], future pessimism [F= 8.53, P < .01], and interventional fragility [F = 7.18, P < .01]), and marginally worse behavioral coping (more functional deficits [F = 5.48, P < .05] and problematic compliance [F = 4.32, P < .05]).
Patients with severe asthma have more psychologic distress and difficulty coping with their disease, both emotionally and behaviorally, relative to patients with moderate asthma. Future treatment studies should focus on helping patients with severe asthma manage distress and cope more effectively with their illness, which may improve outcomes in these high-risk patients.
尽管有几种生物因素被认为在严重哮喘的发展和持续中起作用，但与心理因素相关的因素仍知之甚少。本研究评估了严重哮喘与中度哮喘患者的心理困扰程度以及一系列与疾病相关的情绪和行为应对方式。
招募了 84 名患者（50%为女性，平均年龄 46 岁），其中 42 名患有严重哮喘，42 名患有中度哮喘。严重哮喘根据美国胸科学会标准定义。患者接受了人口统计学和病史访谈以及肺功能和过敏测试。患者还完成了评估哮喘症状的问卷和 Millon 行为医学诊断量表，该量表评估影响疾病进展和治疗的心理困扰以及情绪/行为应对因素。
在调整了协变量并应用了一个校正因子，将显著 P 值降低到<.01 后，与中度哮喘患者相比，严重哮喘患者报告经历了更多的心理困扰，包括更严重的认知功能障碍（F=6.72，P<.01）和边缘性焦虑紧张（F=4.02，P<.05）。他们还报告了更差的情绪应对（更高的疾病担忧[F=9.57，P<.01]，疼痛敏感性[F=10.65，P<.01]，未来悲观主义[F=8.53，P<.01]和干预脆弱性[F=7.18，P<.01]），以及边缘性更差的行为应对（更多的功能缺陷[F=5.48，P<.05]和有问题的依从性[F=4.32，P<.05]）。
与中度哮喘患者相比，严重哮喘患者的心理困扰更大，在情绪和行为上都更难以应对自己的疾病。未来的治疗研究应专注于帮助严重哮喘患者管理困扰，并更有效地应对疾病，这可能会改善这些高风险患者的结局。
