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Asthma

October 30, 2007

Weiss, Gergen, & Hodgson (1992)

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Pediatric Statistics

Prevalence increasing

School absencesEstimated as more than 10 million in 1990

for children between the ages of 5 and 17

Parental work absencesEstimated to cost $726 million in 1990

Death rate = 1.9 per 100,000 (1980-89)

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Respiratory System

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The Respiratory System

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Physiology of Asthma

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What is an Asthma Episode?

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Characteristics of Asthma

Episodes are variable

Episodes are reversible

Airway hyper-responsiveness

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Triggers of Asthma Episodes

Viral respiratory infections

Exercise

Cold air or changes in weather

Irritants

Allergens

Emotional upsets

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Signs of Asthma Episode

Wheezing

Chest retractions (especially with infants)

Breathing is faster

Feeling chest tightness (or heaviness)

Coughing

“Status asthmaticus”

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Asthma Medications

Two types of medicine

Preventive or Controller = Anti-inflammatory

Rescue = Bronchodilators

Oral steroids

Preferred delivery = Inhalation

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Taking Inhaled Medications

Nebulizer (with or without face mask)

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Taking Inhaled Medications

Metered Dose Inhaler (MDI)

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Taking Inhaled Medications

Spacer or chamber devices

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Preventing an Asthma Episode

Avoid irritants

Control allergens in the environment

Take inhaled bronchodilator PRIOR to exercise

Monitor lung functioning with peak flow meter

Use “preventer” or “controller” medicine REGULARLY

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Psychological Factors Affecting Asthma

Stress

Anxiety

Depression

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Psychological Factors Affecting Asthma

Family dysfunction

Attachment

Critical mothers

Purcell et al. (1969)

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Psychosocial Dysfunction Associated With…

Needing more asthma medications

Having a greater # of hospitalizations

Requiring longer hospitalizations

Dying more frequently from asthma

Not complying with asthma care regimen

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Medical Noncompliance

Multiple medications on multiple schedules with varying periods when symptoms are not present

As high as 90% of patients

Negative consequences

Typically “partial” in nature

Assessment of compliance

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Psychological Assessment

Interviews, observation, & testing

Parental functioning

Marital status & satisfactionEmployment status & functioningSocial supports & stressorsUnderstanding of asthma & its treatment

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Psychological Assessment

Child functioning

Developmental skillsQuality of peer interactionsSchool performanceUnderstanding of asthma & its treatment

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Psychological Assessment

Family functioning

Interaction patternsRoutinesAsthma management & family division of

responsibility/supervision

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When should patients obtain psychotherapy?

Are markedly anxious or depressed

Demonstrate decreased capacity to manage their asthma

Have been erratic in medication use

Have poor perceived control of symptoms

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When should patients obtain psychotherapy?

Experience a decline in functioning in school or work

Are in frequent conflict with medical staff

Have made repeated visits to the ER

Family appears dysfunctional, disorganized, or distressed

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Treating Medical Noncompliance

Strategies fit into 3 categories

Educational

Organizational

Behavioral

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Other Approaches to Treatment

Operant proceduresPositive reinforcementSatiationDifferential reinforcement of incompatible

behavior (DRI)Response costExtinction

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Other Behavioral Approaches to Treatment

Systematic desensitization

Biofeedback

Modeling

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Other Behavioral Approaches for Non-Adherence

Contracts

Family approaches

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Self-Management Programs

Patient education

Training in device techniques

Self-assessment of symptoms

Group & family therapy

Relaxation & stress reduction