Role of psychiatric disorders and irritable bowel syndrome in asthma patients

OBJECTIVES: The goals of the study were the following: 1) to determine the frequency of psychiatric disorders and irritable bowel syndrome in patients with asthma and 2) to compare the frequency of these disorders in patients with asthma to their frequency in healthy controls. INTRODUCTION: Patients with asthma have a higher frequency of irritable bowel syndrome and psychiatric disorders. METHODS: We evaluated 101 patients with bronchial asthma and 67 healthy subjects. All subjects completed the brief version of the Bowel Symptoms Questionnaire and a structured clinical interview for DSM-IV axis disorders (SCID-I/CV). RESULTS: There were 37 cases of irritable bowel syndrome in the group of 101 stable asthma patients (36.6 percent) and 12 cases in the group of 67 healthy subjects (17.9 percent) (p = 0.009). Irritable bowel syndrome comorbidity was not related to the severity of asthma (p = 0.15). Regardless of the presence of irritable bowel syndrome, psychiatric disorders in asthma patients (52/97; 53.6 percent) were more common than in the control group (22/63, 34.9 percent) (p = 0.02). Although psychiatric disorders were more common in asthma patients with irritable bowel syndrome (21/35, 60 percent) than in those without irritable bowel syndrome (31/62, 50 percent), the difference was not significant (p = 0.34). In asthma patients with irritable bowel syndrome and psychiatric disorders, the percentage of forced expiratory volume in 1 s (FEV1) was lower than it was in those with no comorbidities (p = 0.02). CONCLUSIONS: Both irritable bowel syndrome and psychiatric disorders were more common in asthma patients than in healthy controls. Psychiatric disorders were more common in asthma patients with irritable bowel syndrome than in those without irritable bowel syndrome, although the differences failed to reach statistical significance. In asthma patients with IBS and psychiatric disorders, FEV1s were significantly lower than in other asthma patients. It is important for clinicians to accurately recognize that these comorbid conditions are associated with additive functional impairment.

Drug Therapy of Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic relapsing disorder of gastrointestinal function, the main features of which are abdominal pain or discomfort and an alteration of the bowel habit. Rome Ⅱ criteria is the most recent international consensus definition for IBS. Rome Ⅱ consensus provides working definitions for constipation-(C-IBS) and diarrhea-predominant (D-IBS) subgroups. Initial management begins with a detailed history taking, including a careful dietary history. The presence of obvious causative factors of stress should be identified. Therapeutic trials may include those of dietary fiber supplementation for C-IBS, dietary manipulation and/or antidiarrheal agents for D-IBS, and antispasmodics for prominent pain. Reassurance of the patient is vital in the initial management. Current approaches to the long-term management of IBS include dietary measures, fiber and bulking agents, antispasmodic agents, antidiarrheal agents, laxatives, psychotroic drugs, and psychological and behavioral therapy. Medications should be prescribed as required, rather than on a regular basis. For moderate or severe abdominal pain, antispasmodics and certain smooth muscle relaxants may be used. These types of drugs are ideally used for a short term during an exacerbation of symptoms. In resistant cases, low-dose antidepressants have been used to treat the abdominal pain of IBS. For diarrhea, loperamide can be used effectively on a p.r.n. basis. For constipation, an increase in dietary fiber and/or dietary fiber supplements should be continued in a long-term basis. If symptoms continue, osmotic laxatives can be tried. Anthraquinone laxatives such as aloe or senna should be avoided in long-term treatment.