Boudreau Maxine, Bacon Simon L, Paine Nicola J, Cartier André, Trutschnigg Barbara, Morizio Alexandre, Lavoie Kim L
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.
Psychosom Med. 2017 Jun;79(5):576-584. doi: 10.1097/PSY.0000000000000443.
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.
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.
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.
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.
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。
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]）。
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）。
作为假设生成的结果表明，合并PD/PA的哮喘患者表现出增加的惊恐样焦虑、呼吸急促以及与过度通气一致的呼吸模式，这与支气管收缩的统计学显著下降无关。
