Valentine Lemaigre

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.

Can subjective asthma symptoms be learned

Objective: We investigated whether perception of subjective asthma symptoms can be brought under control of biomedically irrelevant cues in the environment, i.e., whether subjective asthma symptoms can be learned in response to harmless stimuli. Methods: Twenty patients with asthma and 20 healthy participants were presented with two placebo-inhalers presented as new chemicals for diagnosing asthma. One inhaler was coupled three times with rebreathing 5% CO2 in oxygen, the other inhaler was coupled three times with rebreathing oxygen. In the subsequent test phase, both inhalers were coupled once with oxygen. We assessed airway resistance and subjective symptoms throughout the study. Results: Both groups expected and reported more symptoms with the inhaler that was previously associated with the CO2 trials compared with trials with the inhaler that was used on trials without CO2 without concomitant effects on respiratory resistance. The learning effects were most pronounced in a subgroup of patients reporting symptoms of hyperventilation during asthma exacerbations in daily life. Conclusions: Subjective respiratory symptoms can be learned in response to harmless stimuli and a substantial proportion of patients with asthma might be especially vulnerable to this phenomenon. Because asthma patients rely mainly on perceived symptoms for their medication use, it is likely that they will take reliever medication based on expected symptoms instead of real exacerbations of respiratory dysfunction. ASC = Asthma Symptom Checklist; ANX = ASC anxiety subscale; DYS = ASC dyspnea subscale; FAT = ASC fatigue subscale; FOT = forced oscillation technique; HYP = ASC hyperventilation subscale; IRR = ASC irritability subscale; NA = negative affectivity; OBS = ASC obstruction subscale; VAS = visual analog scale.

Illness-Specific Catastrophic Thinking and Overperception in Asthma

OBJECTIVE This study investigated the role of illness-specific catastrophic thinking in symptom perception in asthma. DESIGN AND MAIN OUTCOME MEASURES A total sample of 72 patients with intermittent to moderate persistent asthma completed the Catastrophizing about Asthma Scale and completed the Asthma Symptom Checklist to measure retrospective symptom reporting. In addition, symptoms were concurrently assessed during different respiratory challenges eliciting mild and ambiguous versus salient and pronounced symptoms. RESULTS Catastrophic thinking in general, when patients are not having an exacerbation, is related to an increase in emotional symptoms, especially in ambiguous situations where respiratory difficulties could occur. Catastrophic thinking during exacerbations is related to an increase in emotional symptoms as well as in respiratory symptoms during respiratory challenges. CONCLUSION These strong relationships between catastrophic thinking and increased perception of asthma symptoms suggest a link between illness-specific catastrophic thinking and overperception. Consequently, catastrophic thoughts are an important target for psychological interventions in support of drug treatment.

Context-evoked overperception in asthma

We investigated associative learning as a possible explanation of overperception in asthma. Thirty newly diagnosed patients with asthma (eight men) underwent a histamine provocation to elicit airway obstruction (Cockcrofts protocol). Patients testing positive and reporting symptoms underwent an identical procedure on the next day with saline, a substance that does not elicit any significant airway changes. Symptoms of airway obstruction and fatigue increased significantly from pre- to post-saline inhalation on day 2, whereas physiological parameters did not change. Increases in symptoms were significantly related to the level of dispositional negative affectivity, but not to the degree of airway reactivity or changes in objective lung function. These results suggest that the experience of asthmatic symptoms in a specific context may evoke the experience of similar symptoms when confronted with the context only. Learning was more likely to occur in those patients with high negative affectivity.