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Respiratory Medicine 2022Adolescent asthma is highly prevalent and frequently uncontrolled despite control being achievable with good self-management. Anxiety, depression, and stress are... (Review)
Review
BACKGROUND
Adolescent asthma is highly prevalent and frequently uncontrolled despite control being achievable with good self-management. Anxiety, depression, and stress are associated with worse asthma outcomes, and may impact self-management; no previous review has examined this relationship.
AIM
This scoping review assessed the nature of the current literature on mental health and asthma self-management among adolescents ages 11 to 24 and synthesized their relationships.
METHODS
Guided by the PRISMA-ScR guidelines, we systematically searched the literature using MEDLINE, Embase, CINAHL, PsycInfo, and Scopus in September 2020 and updated it in June 2021. Included studies examined associations between anxiety, depression, and/or stress and asthma self-management in adolescents ages 11-24. We did not restrict study design, location, or date.
RESULTS
Out of 1559 records identified, 14 met inclusion criteria. Types of self-management included trigger control, healthcare adherence, and overall symptom prevention and management. Anxiety symptoms were associated with poorer asthma self-management in four studies, but better in three. Depressive symptoms were associated with poorer asthma self-management in five studies, but better in two. Stress was associated with poorer self-management in one study. Mental health symptoms were nearly universally associated with poorer trigger control, but associations with healthcare adherence and overall symptom prevention and management varied.
CONCLUSION
Mental health symptoms may facilitate or hinder asthma self-management depending on the types of mental health and self-management. Further research is needed to better understand this relationship and inform future interventions. Providers might assess mental health as a potential barrier to adolescent asthma self-management.
Topics: Adolescent; Adult; Anxiety; Asthma; Child; Health Behavior; Humans; Mental Health; Self-Management; Young Adult
PubMed: 35714575
DOI: 10.1016/j.rmed.2022.106897 -
Current Allergy and Asthma Reports Aug 2014The placebo effect is a complex phenomenon occurring across a variety of clinical conditions. While much placebo research has been conducted in diseases defined by... (Review)
Review
The placebo effect is a complex phenomenon occurring across a variety of clinical conditions. While much placebo research has been conducted in diseases defined by self-report such as depression, chronic pain, and irritable bowel syndrome (IBS), asthma has been proposed as a useful model because of its easily measured objective outcomes. Studies examining the placebo response in asthma have not only contributed to an understanding of the mechanisms behind the placebo response but also shed an interesting light on the current treatment and diagnosis of asthma. This paper will review current literature on placebos in general and specifically on the placebo response in asthma. It focuses on what we know about the mechanisms behind the placebo effect, whether there is a specific portion of the population who responds to placebos, which patient outcomes are influenced by the placebo effect, and whether the effect can be augmented.
Topics: Asthma; Clinical Trials as Topic; Humans; Models, Immunological; Placebo Effect; Treatment Outcome
PubMed: 24951239
DOI: 10.1007/s11882-014-0456-2 -
Allergy and Asthma Proceedings 2016
Topics: Asthma; Humans; Hypersensitivity; Risk Factors
PubMed: 26831838
DOI: 10.2500/aap.2016.37.3929 -
Annals of Allergy, Asthma & Immunology... Apr 2022To explore the evidence for adopting a "treatable traits" approach to asthma management. (Review)
Review
OBJECTIVE
To explore the evidence for adopting a "treatable traits" approach to asthma management.
DATA SOURCES
PubMed, Medline, and Google Scholar.
STUDY SELECTIONS
The above-mentioned databases were searched for randomized, controlled phase III or IV trials of adults containing the word "asthma" in the title published in the previous 10 years and for all articles containing the title words "treatable AND trait(s)," "asthma AND biomarker(s) OR smoking OR obesity OR laryngeal OR management" published within the previous 5 years. Articles were excluded if they were not published in English. Our search identified 257 articles for consideration. We also manually searched the reference lists of studies identified and searched the websites of the British Thoracic Society, European Respiratory Society, National Institute for Health and Care Excellence, and Global Initiative for Asthma for specific guidance related to asthma management.
RESULTS
The "treatable traits" are described within 3 domains of pulmonary, extrapulmonary, or behavioral and lifestyle traits. We consider whether treatment should be targeted toward these traits where they are present in asthma patients, based on currently available evidence, rather than increasing treatment in response to symptoms in line with current step-up, step-down asthma management guidelines.
CONCLUSION
We advocate that a treatable traits approach should be applied more broadly to the assessment and management of inadequately controlled asthma, rather than a step-up, step-down approach based on patient symptoms. This approach should be focused on the 2 treatable pulmonary traits of T2 inflammation and airflow obstruction along with smoking cessation, in the first instance.
Topics: Adult; Asthma; Humans; Lung; Phenotype
PubMed: 35172180
DOI: 10.1016/j.anai.2022.02.005 -
Experimental Biology and Medicine... Nov 2014The effects of obesity on asthma diagnosis, control, and exacerbation severity are increasingly recognized; however, the underlying pathophysiology of this association... (Review)
Review
The effects of obesity on asthma diagnosis, control, and exacerbation severity are increasingly recognized; however, the underlying pathophysiology of this association is poorly understood. Mainstream clinical practice has yet to adopt aggressive management of obesity as a modifiable risk factor in asthma care, as is the case with a risk factor like tobacco or allergen exposure. This review summarizes existing data that support the pathophysiologic mechanisms underlying the association between obesity and asthma, as well as the current and future state of treatment for the obese patient with asthma. Our review suggests that evidence of chronic inflammatory response linking obesity and asthma indicates a need to address obesity during asthma management, possibly using patient-centered approaches such as shared decision making. There is a need for research to better understand the mechanisms of asthma in the obese patient and to develop new therapies specifically targeted to this unique patient population.
Topics: Asthma; Humans; Obesity; Primary Health Care; Nicotiana
PubMed: 24719380
DOI: 10.1177/1535370214525302 -
Thorax Apr 1998We believe that the asthma phenotypes we have defined as types 1 and 2 brittle asthma appear to be defined subgroups of asthma. For example, we have characterised... (Review)
Review
We believe that the asthma phenotypes we have defined as types 1 and 2 brittle asthma appear to be defined subgroups of asthma. For example, we have characterised patients with type 1 brittle asthma, as defined in this review, on the basis of peak flow variability and treatment and these patients remain a separate group when assessed by other means such as psychosocial factors, immunoglobulin levels, and atopy. The question remains as to whether they are truly separate groups with entirely different pathogenetic influences or whether they simply represent the severe end of the spectrum. Our suggested classification into types 1 and 2 forms a useful start for studies of this condition, although prospective evaluation of patients with severe asthma is the only way of substantiating the validity of these definitions which will then enable investigation of possible mechanisms. However, these patients are rare and in order to study them as a group a national register would need to be set up along the lines of the West Midlands Brittle Asthma Register, perhaps recruiting all "at risk" patients and then using this resource as a means of exploring the different asthma phenotypes within this broad grouping, including brittle asthma.
Topics: Anti-Asthmatic Agents; Asthma; Humans; Peak Expiratory Flow Rate; Phenotype; Risk Factors; Terminology as Topic
PubMed: 9741378
DOI: 10.1136/thx.53.4.315 -
British Journal of Clinical Pharmacology Jul 19961. Our understanding of asthma and its therapy has changed markedly over the last few years, particularly with the application of molecular and cell biology and the... (Review)
Review
1. Our understanding of asthma and its therapy has changed markedly over the last few years, particularly with the application of molecular and cell biology and the discovery of new and more specific pharmacological tools. 2. Many inflammatory cells participate in the inflammatory process in asthma and mediate a complex mixture of mediators. Cytokines are of particular importance as mediators of chronic inflammation and the means by which cytokines amplify and perpetuate the inflammatory process is now emerging. Airway epithelial cells may be a particularly important source of cytokines and other mediators, such as nitric oxide and endothelin, and may be a major target cell for inhaled steroids, which are the most effective therapy for asthma currently available. 3. The inflammatory process in asthma results not only in bronchoconstriction, but also plasma exudation, the activation of neural mechanisms, mucus secretion. The chronic inflammation may lead to structural changes, including an increase in airway smooth muscle and fibrosis, that are essentially irreversible. There is increasing evidence that transcription factors, such as NF-kappa B, play a pivotal role in the expression of inflammatory genes in asthma and may be the major molecular target for glucocorticoids.
Topics: Animals; Asthma; Humans; Inflammation Mediators; Transcription Factors
PubMed: 8807137
DOI: 10.1046/j.1365-2125.1996.03721.x -
Allergology International : Official... Apr 2017Adult bronchial asthma is characterized by chronic airway inflammation, and presents clinically with variable airway narrowing (wheezes and dyspnea) and cough.... (Review)
Review
Adult bronchial asthma is characterized by chronic airway inflammation, and presents clinically with variable airway narrowing (wheezes and dyspnea) and cough. Long-standing asthma induces airway remodeling, leading to intractable asthma. The number of patients with asthma has increased; however, the number of patients who die of asthma has decreased (1.2 per 100,000 patients in 2015). The goal of asthma treatment is to enable patients with asthma to attain normal pulmonary function and lead a normal life, without any symptoms. A good relationship between physicians and patients is indispensable for appropriate treatment. Long-term management by therapeutic agents and elimination of the causes and risk factors of asthma are fundamental to its treatment. Four steps in pharmacotherapy differentiate between mild and intensive treatments; each step includes an appropriate daily dose of an inhaled corticosteroid, varying from low to high levels. Long-acting β-agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonist are recommended as add-on drugs, while anti-immunoglobulin E antibody and oral steroids are considered for the most severe and persistent asthma related to allergic reactions. Bronchial thermoplasty has recently been developed for severe, persistent asthma, but its long-term efficacy is not known. Inhaled β-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches are used as needed during acute exacerbations, by choosing treatment steps for asthma in accordance with the severity of exacerbations. Allergic rhinitis, eosinophilic chronic rhinosinusitis, eosinophilic otitis, chronic obstructive pulmonary disease, aspirin-induced asthma, and pregnancy are also important issues that need to be considered in asthma therapy.
Topics: Adult; Age Factors; Asthma; Diagnosis, Differential; Disease Management; Disease Progression; Humans; Japan; Mortality; Patient Education as Topic; Phenotype; Physician-Patient Relations; Practice Guidelines as Topic; Prevalence; Severity of Illness Index
PubMed: 28196638
DOI: 10.1016/j.alit.2016.12.005 -
Asian Pacific Journal of Allergy and... Jun 2014Exposure to indoor pollutants and allergens has been speculated to cause asthma symptoms and exacerbations and influence the risk of developing asthma. The aim of this... (Review)
Review
OBJECTIVE
Exposure to indoor pollutants and allergens has been speculated to cause asthma symptoms and exacerbations and influence the risk of developing asthma. The aim of this article is to review the medical literature regarding the role of the indoor environment on inner-city childhood asthma.
DATA SOURCES
A literature search was performed in PubMed. Studies focusing on inner-city indoor allergen, childhood asthma, and environmental controls were included.
RESULTS
The prevalence of asthma in children is increasing especially in inner-city area. Exposure to high levels of indoor allergens and pollutants has been related to asthma development. Studies have shown that mouse, cockroach, pets, dust mite, mold, tobacco smoke, endotoxin and nitrogen dioxide are the important exposures. Recent studies have shown that indoor environmental control is beneficial in reducing asthma morbidity and development.
CONCLUSIONS
Inner-city children are exposed to various indoor allergens and pollutants that may lead to asthma development and exacerbation of existing asthma. Multifaceted environmental controls are beneficial in improving asthma symptom and maybe a viable prevention strategy. Further prospective studies of environmental intervention are needed to further identify effective strategies to improve and prevent asthma symptoms in inner-city children.
Topics: Adolescent; Air Pollution, Indoor; Allergens; Animals; Asthma; Child; Child, Preschool; Humans; Mice; PubMed; Urban Population
PubMed: 25003723
DOI: No ID Found -
International Journal of Molecular... Dec 2018Asthma is one of the most common chronic respiratory diseases worldwide. It affects all ages but frequently begins in childhood. Initiation and exacerbations may depend... (Review)
Review
Asthma is one of the most common chronic respiratory diseases worldwide. It affects all ages but frequently begins in childhood. Initiation and exacerbations may depend on individual susceptibility, viral infections, allergen exposure, tobacco smoke exposure, and outdoor air pollution. The aim of this review was to analyze the role of the gut⁻lung axis in asthma development, considering all asthma phenotypes, and to evaluate whether microbe-based therapies may be used for asthma prevention. Several studies have confirmed the role of microbiota in the regulation of immune function and the development of atopy and asthma. These clinical conditions have apparent roots in an insufficiency of early life exposure to the diverse environmental microbiota necessary to ensure colonization of the gastrointestinal and/or respiratory tracts. Commensal microbes are necessary for the induction of a balanced, tolerogenic immune system. The identification of commensal bacteria in both the gastroenteric and respiratory tracts could be an innovative and important issue. In conclusion, the function of microbiota in healthy immune response is generally acknowledged, and gut dysbacteriosis might result in chronic inflammatory respiratory disorders, particularly asthma. Further investigations are needed to improve our understanding of the role of the microbiome in inflammation and its influence on important risk factors for asthma, including tobacco smoke and host genetic features.
Topics: Animals; Asthma; Gastrointestinal Microbiome; Humans; Lung
PubMed: 30598019
DOI: 10.3390/ijms20010123