惊恐发作对合并或未合并惊恐障碍的哮喘患者支气管收缩和主观痛苦的影响。

Impact of Panic Attacks on Bronchoconstriction and Subjective Distress in Asthma Patients With and Without Panic Disorder.

作者信息

Boudreau Maxine, Bacon Simon L, Paine Nicola J, Cartier André, Trutschnigg Barbara, Morizio Alexandre, Lavoie Kim L

机构信息

From the Montreal Behavioural Medicine Centre (Boudreau, Bacon, Paine, Trutschnigg, Morizio, Lavoie), Hôpital du Sacré-Cœur de Montréal-CIUSSS-NIM, Montréal, Québec, Canada; Department of Psychology (Boudreau, Lavoie), University of Quebec at Montreal, Montreal, Quebec, Canada; Department of Exercise Science (Bacon, Paine, Morizio), Concordia University, Montreal, Quebec, Canada; and Research Center (Boudreau, Bacon, Cartier, Trutschnigg, Lavoie), Hôpital du Sacré-Coeur de Montréal-CIUSSS-NIM, Montréal, Québec, Canada.

出版信息

Psychosom Med. 2017 Jun;79(5):576-584. doi: 10.1097/PSY.0000000000000443.

DOI:10.1097/PSY.0000000000000443

PMID:28033197

Abstract

OBJECTIVE

Panic disorder (PD) is common among asthma patients and is associated with worse asthma outcomes. This may occur because of psychophysiological factors or cognitive/affective factors. This study evaluated the impact of panic attacks (PAs) on bronchoconstriction and subjective distress in people who have asthma with and without PD.

METHODS

A total of 25 asthma patients (15 with PD who had a PA [PD/PA], 10 without PD who did not have a PA [no PD/no PA]) were recruited from an outpatient clinic. They underwent a panic challenge (one vital capacity inhalation of 35% carbon dioxide [CO2]) and completed the Panic Symptom Scale, the Subjective Distress Visual Analogue Scale, and the Borg Scale before and after CO2. Forced expiratory volume in 1 second was assessed pre- and post-CO2; respiratory (i.e., CO2 production, minute ventilation, tidal volume) was continuously recorded, and physiological measures (i.e., systolic and diastolic blood pressure [SBP/DBP]) were recorded every 2 minutes.

RESULTS

Analyses adjusting for age, sex, and provocative concentration of methacholine revealed no significant differences between groups in forced expiratory volume in 1 second change after CO2 inhalation (F(1, 23) < 0.01, p = .961). However, patients with PD/PA reported more panic (F(1, 22) = 18.10, p < .001), anxiety (F(1, 22) = 21.93, p < .001), worry (F(1, 22) = 26.31, p < .001), and dyspnea (F(1,22) = 4.68, p = .042) and exhibited higher levels of CO2 production (F(1, 2843) = 5.89, p = .015), minute ventilation (F(1, 2844) = 4.48, p = .034), and tidal volume (F(1, 2844) = 4.62, p = .032) after the CO2 challenge, compared with patients with no PD/no PA.

CONCLUSIONS

Results, presented as hypothesis generating, suggest that asthma patients with PD/PA exhibit increased panic-like anxiety, breathlessness, and a respiratory pattern consistent with hyperventilation that was not linked to statistically significant drops in bronchoconstriction.

摘要

目的

惊恐障碍（PD）在哮喘患者中很常见，且与更差的哮喘预后相关。这可能是由于心理生理因素或认知/情感因素导致的。本研究评估了惊恐发作（PA）对合并或不合并PD的哮喘患者支气管收缩和主观痛苦的影响。

方法

从门诊招募了25名哮喘患者（15名合并PD且有PA发作的患者[PD/PA组]，10名不合并PD且无PA发作的患者[无PD/无PA组]）。他们接受了一次惊恐激发试验（一次肺活量吸入35%二氧化碳[CO₂]），并在吸入CO₂前后完成了惊恐症状量表、主观痛苦视觉模拟量表和博格量表。在吸入CO₂前后评估一秒用力呼气量；持续记录呼吸参数（即CO₂产生量、分钟通气量、潮气量），并每2分钟记录一次生理指标（即收缩压和舒张压[SBP/DBP]）。

结果

在对年龄、性别和乙酰甲胆碱激发浓度进行校正的分析中，吸入CO₂后两组间一秒用力呼气量的变化无显著差异（F(1, 23) < 0.01，p = 0.961）。然而，与无PD/无PA组患者相比，PD/PA组患者报告了更多的惊恐（F(1, 22) = 18.10，p < 0.001）、焦虑（F(1, 22) = 21.93，p < 0.001）、担忧（F(1, 22) = 26.31，p < 0.001）和呼吸困难（F(1,22) = 4.68，p = 0.042），并且在CO₂激发试验后表现出更高水平的CO₂产生量（F(1, 2843) = 5.89，p = 0.015）、分钟通气量（F(1, 2844) = 4.48，p = 0.034）和潮气量（F(1, 2844) = 4.62，p = 0.032）。