O. Van den Bergh

Evaluation of an individualised asthma programme directed at behavioural change

An individualised asthma programme directed at behavioural change was evaluated in asthmatic subjects who reported complaints and impairment, despite adequate medical treatment. Mild-to-moderate asthma patients (n=23) were randomly assigned to a programme or waiting list condition. Outcome measures were: McMaster Asthma Quality of Life Questionnaire, Asthma Symptom Checklist, Negative Emotionality Scale, Knowledge, Attitude and Self-Efficacy Asthma Questionnaire, Adherence Scale, and peak flow measurements. Both groups were evaluated at three consecutive moments, each separated by 3 months; the programme was delivered between the first two evaluations. At onset the patient received a workbook containing information, exercises and homework assignments. Psycho-education, behavioural and cognitive techniques were introduced during six 1‐h individual sessions. Compared with controls the programme group reported less symptoms (obstruction, fatigue), better quality of life (activity, symptoms, emotions), decreased negative affectivity, and increased adherence, immediately after finishing the programme and at 3 months follow-up. All three cognitive variables (knowledge, attitude towards asthma, self-efficacy) and day and night peak flow ratings improved in the programme group but not in the waiting list group. Participation in an individualised programme resulted in improvement of asthma morbidity, and asthma-related behaviour and cognitions, in subjects reporting symptoms and impairment despite adequate medical therapy.

Acquisition and extinction of somatic symptoms in response to odours: a Pavlovian paradigm relevant to multiple chemical sensitivity.

OBJECTIVES: Multiple chemical sensitivity is a poorly understood syndrome in which various symptoms are triggered by chemically unrelated, but often odorous substances, at doses below those known to be harmful. This study focuses on the process of pavlovian acquisition and extinction of somatic symptoms triggered by odours. METHODS: Diluted ammonia and butyric acid were odorous conditioned stimuli (CS). The unconditioned stimulus (US) was 7.4% CO2 enriched air. One odour (CS+) was presented together with the US for 2 minutes (CS+ trial), and the other odour (CS-) was presented with air (CS-trial). Three CS+ and three CS-exposures were run in a semi-randomised order; this as the acquisition (conditioning) phase. To test the effect of the conditioning, each subject then had one CS+ only--that is, CS+ without CO2--and one CS- test exposure. Next, half the subjects (n = 32) received five additional CS+ only exposures (extinction group), while the other half received five exposures to breathing air (wait group). Finally, all subjects got one CS+ only test exposure to test the effect of the extinction. Ventilatory responses were measured during and somatic symptoms after each exposure. RESULTS: More symptoms were reported upon exposure to CS+ only than to CS-odours, regardless of the odour type. Altered respiratory rate was only found when ammonia was CS+. Five extinction trials were sufficient to reduce the level of acquired symptoms. CONCLUSION: Subjects can acquire somatic symptoms and altered respiratory behaviour in response to harmless, but odorous chemical substances, if these odours have been associated with a physiological challenge that originally had caused these symptoms. The conditioned symptoms can subsequently be reduced in an extinction procedure. The study further supports the plausibility of a pavlovian conditioning hypothesis to explain the pathogenesis of MCS.

Unsteadiness of breathing in patients with hyperventilation syndrome and anxiety disorders

The breathing pattern of 399 patients with hyperventilation syndrome (HVS) and/or with anxiety disorders and that of 347 normal controls was investigated during a 5 min period of quiet breathing and after a 3 min period of voluntary hyperventilation. The diagnosis of HVS was based on the presence of several suggestive complaints occurring in the context of stress, and reproduced by voluntary hyperventilation. Organic diseases as a cause of the symptoms were excluded. The anxiety disorders were diagnosed by means of an abbreviated version of the Anxiety Disorders Interview Schedule (ADIS). There was a large overlap between the two diagnoses. Simply breathing via a mouthpiece and pneumotachograph made end-tidal CO2 fractional concentration (FET,CO2) decrease progressively both in hyperventilators and in patients with anxiety disorders, but not in normals. At the start of the measurement the FET,CO2 was not different between patients and healthy subjects. In patients < or = 28 yrs, the decrease of FET,CO2 resulted from a higher tidal volume, and in patients > or = 29 years from an increase in frequency. After voluntary hyperventilation, the recovery of FET,CO2, was delayed in patients, due to a slower normalization of respiratory frequency in females and in older males, and of tidal volume in younger males, and also due to less frequent end-expiratory pauses. When breathing was recorded first by means of inductive plethysmography (Respitrace), the progressive decline of FET,CO2 seen in patients was not observed: from the onset of the recording, FET,CO2 was reduced in patients. It did not change further when, immediately afterwards, the subject switched to mouthpiece breathing. The finding that breathing through a mouthpiece induces hyperventilation in patients and that recovery of FET,CO2 is delayed after voluntary hyperventilation, suggests that the respiratory control system is less resistant to challenges (mouthpiece or voluntary hyperventilation) in those patients. On the other hand, the lower values of FET,CO2 measured during recording by means of a Respitrace probably result from a challenge, prior to the recordings, induced by the fitting of the measuring device to the patient. This unsteadiness of breathing characterizes patients with hyperventilation syndrome and those with anxiety disorders, but is not sufficiently sensitive to be used for individual diagnosis.

SUBJECTIVE SYMPTOMS AND BREATHING PATTERN AT REST AND FOLLOWING HYPERVENTILATION IN ANXIETY AND SOMATOFORM DISORDERS

The purpose of the present study was to investigate the diagnostic specificity of bodily symptoms and respiratory behavior at rest and after a hyperventilation provocation test (HVPT) in patients that were either grouped according to the DSM classification or diagnosed as suffering from hyperventilation syndrome. Nine hundred three anxiety and somatoform patients, showing symptoms supposedly caused by psychogenic hyperventilation, and 170 healthy subjects, were studied. Breathing pattern and end-tidal CO2 concentration were recorded during breathing at rest and following a HVPT. Subjective symptoms in daily life and after HVPT were measured. A principal-components analysis was performed on both the symptoms and breathing variables and their specificity levels were compared in the two classifications of patients. Some symptoms in daily life were grouped together with the same symptoms after the HVPT, other symptoms were not. This suggests that the HVPT elicited partly specific symptoms, and partly reproduced the symptoms experienced in daily life. Similar findings were observed with respect to the breathing variables. Patients with panic differed from other patients with anxiety disorders by an increased level of symptoms and a FETCO2 decline at rest. The HVPT may be informative for diagnosis because it provokes some of the typical somatic and psychological symptoms, and it identifies the breathing instability that is characteristic of both patients with HVS and with anxiety. The same symptoms and breathing variables characterized the patients, whatever their classification. Overall, the specificity of breathing variables is rather low.

Psychosomatic symptoms and breathing pattern

OBJECTIVE Study of the links between breathing pattern, negative affectivity, and psychosomatic complaints at rest and following hyperventilation. METHODS In 819 patients with anxiety and somatoform disorders and 159 healthy subjects, self-reported symptoms, breathing pattern, and end-tidal CO(2) concentration (FetCO(2)) were recorded during rest and following a hyperventilation provocation test (HVPT). The relationship between disorder category, symptoms, age, and score of STAI-trait (as a measure of negative affectivity) on the one hand, and breathing pattern on the other was investigated, separately in men and women. RESULTS Anxiety disorders, and to a lesser extent, somatoform disorders, were characterized by breathing instability (progressive decrease of FetCO(2) at rest during mouthpiece breathing, delayed recovery of FetCO(2) following HVPT), the mean values of respiratory frequency, and FetCO(2) being modulated by STAI-trait. After grouping the symptoms into independent factors, links were observed between symptoms and breathing pattern, independently from the presence of an anxiety or somatoform disorder. CONCLUSION Some symptom factors appeared to be related to a lower FetCO(2) during hyperventilation, others likely directly influenced the breathing pattern. Among those, mainly respiratory symptoms were accompanied by a reduction of FetCO(2) at rest, with slower recovery of FetCO(2) following HVPT. The latter was observed also in the presence of marked anxiety. In contrast, subjects complaining of dizziness, fainting, and paresthesias in daily life presented higher values of FetCO(2) following HVPT, probably due to a voluntary braking of ventilation during HVPT.

Effects of a shortened asthma self-management group program

Abstract Objective Asthma self-management programs are effective but often time-consuming. We evaluated the effects of a shortened asthma self-management program on asthma knowledge, morbidity and asthma-related behaviour in a group of moderate to severe adult asthmatics. Methods The effects of the program were evaluated with a one year prospective trial in a group of 55 asthmatics (mean age 45 yrs, 42% males, N=26 in intervention group, N=29 in control group) by administering questionnaires and diary exercises at baseline, immediately, 3 and 12 months after the end of the program. Results Asthma-related knowledge and hyperventilation symptoms improved more in the intervention than in the control group and this effect was maintained until 3 months after participation. General asthma symptoms improved significantly, but substantial symptom improvements were also found in the control group. The original effects in the intervention group persisted partly but not significantly 1 year after participation. No significant effects were found on pulmonary function. Conclusions Based on our preliminary results, we conclude that our shortened asthma self-management program had an impact on knowledge and asthma symptoms, especially hyperventilation symptoms, until 3 months after the end of the program. Continuous reinforcement and specifying the program content are essential aspects to obtain more robust and long-lasting effects when administering shortened asthma self-management programs.

The latent structure of the functional dyspepsia symptom complex: a taxometric analysis.

Rome III introduced a subdivision of functional dyspepsia (FD) into postprandial distress syndrome and epigastric pain syndrome, characterized by early satiation/postprandial fullness, and epigastric pain/burning, respectively. However, evidence on their degree of overlap is mixed. We aimed to investigate the latent structure of FD to test whether distinguishable symptom‐based subgroups exist.

Long-term neurodevelopmental disorders in mice with apneas during prematurity

Introduction Epidemological evidence points towards a link between the severity of apneas of prematurity and developmental disorders. However, the causality in this relation has not yet been established. In this study, we made use of a genetic mouse model (Phox2b) that is characterized by an increased apnea time (approximately 6-fold at age P5 compared to wildtype littermates) during normoxia. These breathing problems are, however, confined to 2 to 5 days of postnatal age (≈ severe to moderate prematurity in humans) and mice survive normally without ventilatory support. Furthermore, Phox2b is not expressed in higher brain areas, thus excluding direct effects of the mutation on cognitive development. The described phenotype is particularly useful in light of our interest in the consequences of apneas of prematurity on cognitive functioning. To address this issue, we conducted a behavioural test battery in Phox2b adult mice. Methods We conducted a behavioural study in a genotype (Phox2b heterozygote (HZ) vs wildtype (WT))- and gender-mixed group of adult mice ( N =37). Neuromotor performance (rotarod, grip strength) and cage activity were tested, as well as anxiety and exploration (open field, social exploration and elevated plus maze), and learning and memory (passive avoidance learning and Morris water maze). Results Phox2b HZ mice showed no differences in weight, nor alterations in neuromotor performance or activity level compared to controls. During the open field and social exploration tests Phox2b HZ exhibited significantly less exploratory behaviour than WT. This behavioural observation was also confirmed in the elevated plus maze. Passive avoidance learning was abolished in a subgroup of Phox2b heterozygotes. Moreover, we found that Phox2b HZ mice were slower to acquire learning in the Morris water maze and displayed small but significant memory deficits in both Morris water maze protocols we applied. Conclusion In this study, we investigated the long term effects of postnatal apneas by conducting a behavioural study on adult Phox2b mice. We found important deficits in exploratory behaviour, and learning and memory functioning in Phox2b HZ. Since Phox2b is not expressed in higher brain regions which are involved in behavioural tests, these differences are likely to arise from neonatal apneas.

Negatieve emoties en lichamelijke aandoeningen

Bij de heer De Groot, 55 jaar, werd twee jaar geleden de diagnose reumatoide artritis gesteld. Hoewel de ziekte vooral de eerste maanden een ernstig en agressief beloop had, bleek de behandeling goed aan te slaan en na enkele maanden werd er zelfs nauwelijks ziekteactiviteit geregistreerd. Helaas stelt de reumatoloog nu, twee jaar na de diagnose, bij een controlebezoek een terugval vast. Als eerste valt op dat meneer wat moeilijk loopt en enigszins gezwollen handgewrichten heeft. Hij zegt de laatste maand weer wat pijn en weinig energie te hebben en na een halve dag werken al erg moe te zijn. Hij slaapt slecht en maakt zich grote zorgen over het weer actief worden van de ziekte. Hij kan er niet over uit dat dit hem juist moet overkomen nu hij weer parttime is gaan werken. Door zijn ziekte heeft hij zijn vooraanstaande positie binnen het ICT-bedrijf al moeten opgeven en werd hij afgescheept met wat kleinschalige projecten. Hij maakt een sombere indruk en zegt nogal geirriteerd te zijn over het feit dat hij niets meer kan. Hij mist vooral de contacten met zijn vroegere medewerkers en de internationale relaties uit zijn vroegere functie. De laatste maand is hij opvliegend en zijn er toegenomen spanningen in de relatie met zijn veel jongere vrouw.

A sporadic case of Legionnaires' disease in Belgium.

SummarySporadic cases of Legionnaires’ disease, a recently described pulmonary infection, have been reported from several countries. The ease of a 67-year old Belgian who developed a similar pulmonary infection, is described.The clinical picture included fever, cough, dyspnoea and confusion.The chest roentgenogram showed multilobar pulmonary involvement with tendency to nodular consolidation.The patient was treated with ampicilline and cephapirine and recovered slowly.The antibody titer against Legionella pneumophila, determined retrospectively by means of an indirect fluorescent-antibody test was 1: 1024.