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Psychological and social-economic characteristics of patients with severe asthma

Psychological and social-economic characteristics of patients with severe asthma. Index. Introduction Methods Database Results Discussion of the Results Limitations Gantt Chart. Introduction Definition. No consensual definition: 1

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Psychological and social-economic characteristics of patients with severe asthma

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  1. Psychologicaland social-economic characteristics of patients with severe asthma

  2. Index • Introduction • Methods • Database • Results • Discussion of the Results • Limitations • Gantt Chart

  3. IntroductionDefinition No consensual definition: 1 Different disease: lack of response to usual treatment2: 1) resistance to corticosteroids (CS) 2) altered response to CS because of modified airways structure. Different Phenotype: heterogeneity in the severe asthma group 1) Wenzel S.E., A different disease, many diseases or mild asthma gone bad? Challenges of severe asthma, European Respiratory Journal, 2003; 22: 397-938 2) M. Gaga, N.Papageorgiou, G. Yougiotti, P. Karydi, A. Liapikou, H.Bitsakoy, E.Zervas, Risk factors and characteristics associated with severe and difficult to treat asthma phenotype: an analysis of the ENFUMOSA group of patients based on the ECRHS questionnaire, Clinical and Experimental Allergy, 2005; 35: 954-959

  4. Introduction Characteristics of severe/ difficult to treat asthma patients • Predominance of female1 • High level of corticosteroids use3 • Increased in healthcare utilization1 • High level of neutrophils in sputum1 • High number of activated T lymphocytes4 1) Wenzel S.E., A different disease, many diseases or mild asthma gone bad? Challenges of severe asthma, European Respiratory Journal, 2003; 22: 397-398 3) Brinke A., Ouwerkerk M., Zwinderman A., Spinhoven P., Bel E., Psychopathology in Patients with Severe Asthma Is Associated with Increased Health Care Utilization, American Journal of Respiratory and Critical Care Medicine, 2001; Vol 163, page 1093-1096 4) Caramori G., Pandit A., Papi A., Is there a difference between chronic airway inflammation in chronic severe asthma and chronic obstructive pulmonary disease?, Current Opinion in Allergy and Clinical Immunology, February 2005; 5(1):77-83

  5. Introduction Characteristics of severe/ difficult to treat asthma patients • Chronic airway inflammationcentral and peripheral5 • High air-trapping and obstruction1 • Low diffusing capacity1 • Forced expiratory volume during the first second (FEV1) ≤60% of predicted6 • Peak expiratory flow (PEF) variability over 30%6 • Wenzel S.E., A different disease, many diseases or mild asthma gone bad? Challenges of severe asthma, European Respiratory Journal, 2003; 22: 397-398 • 5) Smith J. R., Mildenhall S., Noble M. J., Shepstone L., Koutantji M. Mugford M.,Harrison B. D., The Coping with Asthma Study: a randomised controlled trial of a home based, nurse led psychoeducational intervention for adults at risk of adverse adthma outcomes, Thorax, December 2005;30/12):1003-11 • 6) Stirling R. G., Chung K. F., Severe asthma: definition and mechanisms, Allergy, September 2001; 56(9):825-40

  6. IntroductionRationale • Psychological aspects of severe/ difficult to treat asthma have been insufficiently studied7; • Psychosocial problems are a known risk factor for dying from asthma8; • High costs of the severe asthma due to hospitalizations, emergency and domiciliary care7. 7) Osborne M., Deffebach M., The Epidemiology and Natural History of Asthma Outcomes and Treatment Regimens (TENOR)Study, Annals of Allergy, Asthma and Immunology, 2004 8) Barton C.A., McKenzie D.P., Walters E.H., Abramson M.J., Interactions between psychosocial problems and management of asthma: who is at risk of dying?, The Journal of asthma, May 2005; 42(4):249-56

  7. Introduction Aims of the study To compare psychological and social characteristics in adult patients with severe asthma and patients with mild to moderate asthma; Relevant Questions that may be answered in this study • Is depression related to severe asthma? • Is there any relation between anxiety scores and the severity of asthma? • Is there any association between severe asthma and the age of severe asthma patients? • Is social status related to severe asthma? • Is there any relation between schooling and the severity of asthma? • May factors as age and gender cause overfitting?

  8. Instruments • Self-Anxiety (Zung, 1975) • Depression Inventory (Beck, 1961) • Asthma Control Questionnaire (Juniper, 1999) • Mini-Asthma Quality of Life Questionnaire (Juniper, 1998) • Spirometry • Peak Expiratory Flow (PEF) • Forced Expiratory volume in 1st second (FEV1)

  9. Flowchart Phase 2: Database analysis

  10. 100 100 non-severe non-severe severe severe 80 80 Percent (%) Percent (%) 60 60 40 40 20 20 0 0 Male Female <31 =>31 Gender Age (years) p<0.001 p=0.003 Sample descriptionDemographic Characteristics

  11. 80 non-severe severe 60 Percent (%) 100 40 non-severe severe 80 20 Percent (%) 60 40 0 Married Single Widower Divorced or 20 Separated Marital Status 0 p=0.051 class I, II and III class IV and V graffar social classification p=0.005 Sample description Social Characteristics

  12. 60 50 non-severe non-severe severe severe 50 40 40 Percent (%) Percent (%) 30 30 20 20 10 10 0 0 0-4 years 0 1 5-9 2 10-12 3 >12 5 Education Number of children p=0.003 p=0.264 Sample description Social Characteristics

  13. 100 80 non-severe non-severe severe severe 80 60 Percent (%) Percent (%) 60 40 40 20 20 0 0 No Pathologic Anxiety Pathologic Anxiety No Depression or Light Depression Middle or Severe Depression Anxiety Level Depression Level p=0.013 p=1.000 Sample description Psychological Characteristics

  14. Multivariate Analysis Social Characteristics

  15. Multivariate Analysis Social Characteristics

  16. Multivariate Analysis Social Characteristics

  17. Multivariate Analysis Psychological Characteristics

  18. Multivariate Analysis Psychological Characteristics

  19. Multivariate Analysis Psychological Characteristics

  20. Discussion • Related results • Gender and Age • Different from other studies (9) • Non related results • Education • Anxiety • Similar to other studies (11) 9) Baumeister, H., Korinthenberg, K., Bengel, J., Härter, M.Bronchial asthma and mental disorders - A systematic review of empiricalstudies. Psychotherapie Psychosomatik Medizinische Psychologie (2005), 55 (5),Pages 247-255 10) Eisner, M.D., Katz, P.P., Lactao, G., Iribarren, C. Impact of depressive symptoms on adult asthma outcomes. Annals of Allergy, Asthma and Immunology (2005), 94 (5), Pages 566-574.

  21. Inconsistent results Social-economic status: Low social status may determine worse physical condition, wich explain frequent emergency care (10) , but not influence severity of asthma Depression: Depressive symptoms associated with asthma severity (10) Severe asthma individuals with low levels of depression after asthma treatment (12) Depression is a heavier factor in the severity of asthma than anxiety (11) Lavoie, K.L., Cartier, A., Labrecque, M., Bacon, S.L., Lemière, C., Malo, J.-L., Lacoste, G., (...), Ditto, B.Are psychiatric disorders associated with worse asthma control and quality of life in asthma patients? Respiratory Medicine (2005), 99 (10), Pages 1249-1257 (12) Heaney, L.G., Conway, E., Kelly, C., Gamble, J.Prevalence of psychiatric morbidity in a difficult asthma population: Relationship to asthma outcome. Respiratory Medicine (2005), 99 (9), Pages 1152-1159

  22. Limitations • Small Sample • Nature of study • Instruments

  23. Authors Mariana Cunha Mariana Koehler Mariana Taveira Marta Rodrigues Marta Tavares da Silva Marta Santos Silva Marta Alves Marta Lopes Miguel Almeida Project Managers Prof. Doutor Altamiro da Costa Pereira Dr. João Fonseca Web Site

  24. Gantt Chart First Phase

  25. Gantt Chart Second Phase

  26. Gantt Chart Third Phase

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