Ritz Thomas, Wittchen Hans-Ulrich, Klotsche Jens, Mühlig Stephan, Riedel Oliver
1 Department of Psychology, Southern Methodist University, Dallas, Texas.
2 Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
Ann Am Thorac Soc. 2016 Feb;13(2):204-11. doi: 10.1513/AnnalsATS.201506-390OC.
Despite the importance of trigger perceptions for asthma diagnosis and management, associations among asthma triggers, affective disorders, and asthma outcome have received little attention.
Because anxiety and depression are known to influence patients' health reports, we measured and controlled for these affective disorders in analyzing associations among patient perceptions of asthma triggers and asthma treatment outcomes.
Patients from a nationally representative sample of respiratory specialist practices (N = 459) were assessed for clinically significant anxiety and depression and completed questionnaires on asthma triggers, quality of life, and asthma control. Physicians recorded exacerbation and emergency treatment frequencies in the prior year, spirometric lung function, and allergy test results. Hierarchical multiple regressions examined associations among reported trigger factors, anxiety, depression, and asthma outcomes, including quality of life, asthma control, exacerbations, emergencies, and spirometry.
Patients across asthma severity levels were well represented. Anxiety and depression were associated with more frequent nonallergic, in particular psychological, triggers. Controlling for demographics, asthma severity, anxiety, and depression, nonallergic asthma triggers (including psychological triggers) explained substantial portions of variance in asthma control (total of 19.5%, odds ratios [ORs] = 2.07-1.37 for individual triggers), asthma-related quality of life (total of 27.5%, ORs = 3.21-1.49), and general quality of life (total of 11.3%, ORs = 1.93-1.55). Psychological triggers were consistently associated with exacerbations and emergency treatments (ORs = 1.96-2.04) over and above other triggers and affective disorders. Spirometric lung function was largely unrelated to perceived asthma triggers.
Patients' perceptions of asthma triggers are important determinants of asthma outcomes, which can help identify individuals at risk for suboptimal asthma management.
尽管触发因素认知对于哮喘的诊断和管理很重要，但哮喘触发因素、情感障碍和哮喘结局之间的关联却很少受到关注。
由于已知焦虑和抑郁会影响患者的健康报告，因此我们在分析患者对哮喘触发因素的认知与哮喘治疗结局之间的关联时，对这些情感障碍进行了测量和控制。
对来自全国具有代表性的呼吸专科诊所样本（N = 459）的患者进行临床显著焦虑和抑郁评估，并完成关于哮喘触发因素、生活质量和哮喘控制的问卷。医生记录前一年的加重和急诊治疗频率、肺功能仪检测的肺功能以及过敏测试结果。分层多元回归分析了报告的触发因素、焦虑、抑郁与哮喘结局之间的关联，包括生活质量、哮喘控制、加重、急诊以及肺功能检测。
各哮喘严重程度级别的患者均有充分代表性。焦虑和抑郁与更频繁的非过敏性触发因素相关，尤其是心理触发因素。在控制了人口统计学因素、哮喘严重程度、焦虑和抑郁后，非过敏性哮喘触发因素（包括心理触发因素）解释了哮喘控制（总计19.5%，单个触发因素的比值比[ORs]=2.07 - 1.37）、哮喘相关生活质量（总计27.5%，ORs = 3.21 - 1.49）和总体生活质量（总计11.3%，ORs = 1.93 - 1.55）中很大一部分的变异。心理触发因素始终与加重和急诊治疗相关（ORs = 1.96 - 2.04），超过其他触发因素和情感障碍。肺功能仪检测的肺功能在很大程度上与感知到的哮喘触发因素无关。
患者对哮喘触发因素的认知是哮喘结局的重要决定因素，这有助于识别哮喘管理欠佳风险的个体。
