Daily life negative mood and exhaled nitric oxide in asthma.

BACKGROUND: Psychosocial stress and negative affect have been linked to asthma exacerbations, but longitudinal studies demonstrating a daily life association between negative affect and airway nitric oxide are missing. OBJECTIVE: The longitudinal association between negative mood fluctuations, exhaled nitric oxide, and lung function in asthma was examined. METHODS: Self-assessments of the fraction of exhaled nitric oxide (FeNO), spirometry (forced expiratory volume in the first second, FEV1), negative mood, and daily activities were obtained from 20 patients with asthma for 2 months, resulting in 1108 assessments for the analyses (approximately 55 per patient). Concurrent and prospective associations between FeNO, FEV1, and negative mood were analyzed using mixed effects regression models for longitudinal data. RESULTS: Negative mood was positively associated with changes in FeNO during the same day, and to a stronger extent when prior day negative mood was included in the prediction. FeNO and negative mood were positively associated with same-day FEV1, with the latter relation being partially mediated by changes in FeNO. Associations between FeNO and FEV1 were stronger in younger patients, with earlier onset of asthma, or with lower asthma control. Findings were not changed when controlling for physical activity, medication, cold symptoms, air pollution, and hours spent outside. CONCLUSION: Daily life changes of negative mood in asthma are positively associated with FeNO changes and FeNO increases are associated with a mild bronchodilation. These findings indicate that psychological influences need to be considered when using FeNO as indicator of airway inflammation and guide for treatment decisions.

Airway response to emotional stimuli in asthma: the role of the cholinergic pathway.

In asthma, airways constrict in response to emotion and stress, but underlying mechanisms, potential extrathoracic contributions, and associations with airway pathophysiology have not been elucidated. We therefore investigated the role of the cholinergic pathway in emotion-induced airway responses in patients with asthma and the association of these responses with airway pathophysiology. Patients with asthma (n=54) and healthy participants (n=25) received either 40 microg ipratropium bromide or a placebo in a double-blind double-dummy cross-over design in two laboratory sessions with experimental emotion induction. Stimuli were preevaluated films and pictures of pleasant, unpleasant, and neutral quality. Respiratory resistance and reactance at 5 and 20 Hz were measured continuously before and during presentations, together with respiration by impedance plethysmography and end-tidal PCO2 by capnometry. In addition, measures of airway inflammation (fraction of exhaled nitric oxide), airway hyperreactivity (methacholine challenge), and reversibility of obstruction were obtained. Respiratory resistance at 5 and 20 Hz increased during unpleasant stimuli in asthma patients. This response was blocked by ipratropium bromide and was not substantially associated with asthma severity, airway inflammation, hyperreactivity and reversibility, or pattern of ventilation and PCO2. Under the placebo condition, changes in resistance during unpleasant films were positively correlated with patients' reports of psychological asthma triggers. In conclusion, airway constriction to unpleasant stimuli in asthma depends on an intact cholinergic pathway, is largely due to the central airways, and is not substantially associated with other indicators of airway pathology. Its link to the perceived psychological triggers in patients' daily lives suggests a physiological basis for emotion-induced asthma.

Emotional reactivity of the airways in asthma: consistency across emotion-induction techniques and emotional qualities.

Considerable individual differences exist in asthma patients' airway responses to emotional stimuli, but little is known about the generalization of such responses across situations or states of airways constriction. Fifty-four asthma patients and 25 healthy controls viewed in two separate sessions, films and blocks of pictures from each of three emotional qualities, pleasant, unpleasant, and neutral. At the beginning of each session, patients received a placebo or anti-cholinergic bronchodilator (ipratropium bromide), respectively, in a randomized double-blind design. Respiratory resistance, reactance and impedance were recorded throughout stimulus presentations with impulse oscillometry. Resistance increases showed a moderate degree of generalization across unpleasant films and pictures, unpleasant and pleasant pictures, as well as cholinergic blockade and placebo. Thus, the intensity of airway responses to unpleasant emotional stimuli is a moderately stable characteristic of asthma patients. In addition to the central airway, peripheral and extrathoracic airways may also contribute the consistency of such responses.

Can virtual reality increase the realism of role plays used to teach college women sexual coercion and rape-resistance skills?

The present study evaluated whether virtual reality (VR) can enhance the realism of role plays designed to help college women resist sexual attacks. Sixty-two female undergraduate students were randomly assigned to either the Role Play (RP) or Virtual Role Play (VRP) conditions, which were differentiated only by the use of VR technology in the VRP condition. A multimethod assessment strategy was used to evaluate the effects of VR on the experienced realism of sexually threatening role plays. Realism was assessed by participant self-reports of negative affect and perceptions of realism, direct observation of participants' verbal displays of negative affect during the role plays, and measurements of participant heart rate during the role plays. Results indicated that VR can indeed heighten the realism of sexually threatening role plays. Discussion focuses on issues regarding the use of VR-enhanced role plays for helping college women resist sexual attacks.

Associations of maternal lifetime trauma and perinatal traumatic stress symptoms with infant cardiorespiratory reactivity to psychological challenge.

OBJECTIVE: To examine associations of maternal lifetime trauma and related psychological symptoms in the perinatal period with infant cardiorespiratory reactivity and behavioral distress in response to a laboratory stressor, using a novel advanced system recently adapted for infants. METHODS: Participants were mothers and their 6-month-old infants. Assessments included mothers' self-reported lifetime exposure to trauma, perinatal traumatic stress, and current symptoms of posttraumatic stress disorder (PTSD) and depression. Through the use of a noninvasive respiratory inductance plethysmography device, heart rate and indices of respiratory volume, timing, and thoracoabdominal coordination were recorded continuously in 23 infants during the Still-Face Paradigm, a videotaped mother-infant dyadic assessment that included baseline, stressor, and recovery phases. Infant behavioral distress during the procedure was also assessed. RESULTS: Infants of mothers with low exposure to trauma and perinatal traumatic stress showed expected increases in behavioral distress and cardiorespiratory activation from baseline to stressor and decreases in these parameters from stressor to recovery. Infants of mothers exposed to multiple traumas and with elevated perinatal traumatic stress showed similar patterns of activation from baseline to stressor but failed to show decreases during recovery. These patterns were maintained after controlling for current maternal PTSD and depressive symptoms. CONCLUSIONS: Maternal lifetime trauma exposure and traumatic stress during the perinatal period were associated with disrupted infant cardiorespiratory regulation and behavioral distress during a stressor protocol. These results support the concept of perinatal programming and its potential role in physical and mental health outcomes.

Maternal intimate partner violence and increased asthma incidence in children: buffering effects of supportive caregiving.

OBJECTIVES: To examine the relationship between maternal intimate partner violence (IPV) and asthma onset in children and the role of supportive caregiving factors in modifying this relationship. DESIGN: Prospective birth cohort. SETTING: In-person interview at enrollment as well as in-home interviews during study follow-up. PARTICIPANTS: Children (N = 3116) enrolled in the Fragile Families and Child Wellbeing Study. Main Exposures Maternal report of IPV assessed after the child's birth and at 12 and 36 months. In addition, mothers indicated how many days a week they participated in activities with the child and the amount and type of educational/recreational toys available for the child. Main Outcome Measure Maternal report of physician-diagnosed asthma by age 36 months. RESULTS: Asthma was diagnosed in 19% of children. In adjusted analysis, children of mothers experiencing IPV chronically, compared with those not exposed, had a 2-fold increased risk of developing asthma. In stratified analysis, children of mothers experiencing IPV and low levels of mother-child activities (relative risk, 2.7; 95% confidence interval, 1.6-4.7) had a significant increased risk for asthma. Those exposed to IPV and high levels of mother-child activities had a lower risk for asthma (relative risk, 1.6; 95% confidence interval, 0.9-3.2). A similar buffering effect was noted among children with high numbers of educational/recreational toys. CONCLUSIONS: Intimate partner violence is associated with increased early childhood asthma risk. Maternal ability to maintain positive caregiving processes in this context may buffer the effects of violence on child asthma risk. The best way to promote positive health in toddlers may be to help their mothers.

Psychological triggers and hyperventilation symptoms in asthma.

BACKGROUND: Anecdotal accounts have identified hyperventilation as one route through which psychological factors can trigger bronchoconstriction. However, little is known about the empirical association between psychological and other trigger factors and hyperventilation in asthma exacerbations. OBJECTIVE: To study the cross-sectional association between perceived triggers and hyperventilation symptoms in 1 British and 1 German sample of patients with asthma who were recruited from the community and from primary care clinics. METHOD: Patients completed relevant language versions of the Asthma Trigger Inventory and the Asthma Symptom Checklist. RESULTS: After controlling for demographics and asthma severity, perceived asthma triggers measured by subscales of the Asthma Trigger Inventory explained 12.5% to 37.3% of the variance in Asthma Symptom Checklist hyperventilation-hypocapnia symptoms. Psychological triggers accounted for 10.6% to 26.7% of the variance alone and 4.3% to 11.0% of the variance over and above other trigger factors. In contrast, perceived animal and pollen allergen triggers did not contribute unique variance to the hyperventilation symptom report. Psychological triggers did not explain variance in classic airway obstruction symptoms, thus arguing against a general bias toward inflated symptom reports in patients with psychologically induced asthma. CONCLUSION: Differences in perceived asthma triggers are substantially associated with hyperventilation symptoms, and patients with more frequent psychological triggers also tend to report that they experience more hyperventilation symptoms during their asthma symptom episodes.

Stress effects on lung function in asthma are mediated by changes in airway inflammation.

OBJECTIVE: To examine the association of changes in current negative mood and long-term daily hassles with changes in lung function and airway inflammation in patients suffering from asthma and in healthy controls. Associations between psychological factors and asthma symptoms have been documented, but the relationship between airway inflammation and psychological factors has been largely unexplored. METHOD: Data were analyzed from 46 asthma patients and 25 controls who completed questionnaires on current mood and daily hassles at two assessments 3 months apart. Lung function was measured by spirometry (forced expiratory volume in the first second (FEV(1))) and airway inflammation by the fraction of nitric oxide in exhaled air (FeNO). Regression analyses controlling for allergen load and air pollution (ozone) were calculated to study the association between changes in psychological factors and changes in lung function and airway inflammation, and to examine the mediational role of airway inflammation in the stress-lung function association. RESULTS: In patients with asthma, increases in negative affect were associated with decreases in FEV(1) and increases in FeNO. For daily hassles, a reverse pattern of associations was found, with decreases in daily hassles linked to decreases in FEV(1) and increases in FeNO. Mediation analyses showed that FeNO was a significant mediator of the association of both negative affect and daily hassles with lung function changes. No significant associations were found for healthy controls. CONCLUSION: Psychological variables are consistently associated with spirometric lung function and airway inflammation in asthma patients. For asthma patients, effects of acute negative affect must be distinguished from more chronic distress due to daily hassles.

Perceived triggers of asthma: evaluation of a German version of the Asthma Trigger Inventory.

BACKGROUND AND OBJECTIVE: Patients' perception of asthma triggers has been explored in a largely unstructured fashion in the past. Therefore, we developed the Asthma Trigger Inventory (ATI), a questionnaire that allows for a psychometrically valid measurement of patients' perceived asthma triggers. Here we evaluate a German language version of the ATI and studied the relationship of subscales with self-reported health status, health care use, psychopathology, and results of allergy skin testing. METHOD: Data were obtained from 370 asthma patients recruited from the community, primary care, and in-patient asthma treatment and education. RESULTS: Analysis revealed a five-factor structure that largely confirmed results with the English original. Reliability was good to satisfactory (Cronbach's alpha=0.77-0.89) for allergy, exercise, air pollution/irritants, infection, and psychological trigger subscales. In hierarchical regression analysis adjusting for demographics and asthma severity, asthma patients with stronger non-allergic triggers showed less physical and mental well-being and more asthma-related health care use. Psychological triggers showed unique associations with anxious and depressed mood. Pollen and animal allergen scores of the ATI were significantly related to skin test results for relevant allergens. Non-allergic but not allergic triggers showed substantial associations with asthma control. CONCLUSION: The German version of the ATI reliably measures asthma patients' trigger perceptions. Non-specific asthma triggers exert a greater burden on patients' well-being and primary health care use.

Association of depression and anxiety with health care use and quality of life in asthma patients.

INTRODUCTION: Demographic factors, symptom severity, and psychopathology, in particular anxiety and depression, are known to influence health care use and quality of life in asthma. Because depression and anxiety are typically correlated, we sought to explore whether depression specifically is associated with health care utilization and quality of life when effects of anxiety are controlled for. METHOD: In a cross-sectional questionnaire study, 88 asthma patients (46 women; age range 27-70 years) reported on symptoms and treatment of their disease, as well as anxiety and depression (Hospital Anxiety and Depression Scale, HADS), general quality of life (Short Form 12 Health Survey Questionnaire, SF-12) and asthmatic-specific quality of life (Living with Asthma, LAQ). RESULTS: While no considerable associations between anxiety and health care use were found, the associations between higher scores in depression and hospital visits as well as days of corticosteroid intake were significant. Furthermore, considerable variance in all subscales of quality of life questionnaires was explained by higher scores in depression, even when controlling for anxiety. For anxiety scores these associations were comparable, except for physical well-being. CONCLUSION: Depression is an important issue in asthma, as it is substantially related to quality of life and intake of corticosteroids, and marginally to hospitalization. Routine screening for depression should be considered in hospital and primary care.

End-tidal pCO2 in blood phobics during viewing of emotion- and disease-related films.

OBJECTIVE: Many patients with blood, injection, and injury (BII) phobia respond to specific stimuli with vasovagal dysregulation and fainting. However, little is known about the role of hyperventilation in the distress of these patients. Hyperventilation, defined by subnormal arterial pCO2 levels, induces anxiety and may promote the development of fainting. We studied end-tidal pCO2 in 12 patients with BII phobia and 14 nonanxious controls during presentation of emotional films. METHOD: Ten film clips were shown, two in each of 5 categories: pleasant, unpleasant, neutral, BII-related (surgery), and asthma-related (portraying labored breathing). For each subject, two subsets were created, each containing one clip from each category. For one subset, the instruction was simply to view the film, and for the other subset, to view the film while tensing the leg muscles. PCO2, heart rate, blood pressure, and leg electromyogram were recorded continuously during viewing, and self-report of symptoms and emotion was collected after each film. RESULTS: Patients reported the greatest anxiety and disgust during surgery films. PCO2 was relatively stable throughout all categories except surgery films, during which minima were below 30 mm Hg, indicating significant hypocapnia. Cardiovascular variables suggested biphasic patterns in two patients with BII phobia. These patients, together with one additional patient and one control who were close to fainting after or during one surgery film, also showed a marked fall in pCO2) Leg muscle tension raised heart rate and systolic blood pressure for all films, but was not related to near-fainting or endurance in surgery film viewing. CONCLUSION: Hyperventilation is part of the fear response of patients with BII phobia, but was transitory in experimental fear induction using surgery films. Its role in real-life exposure and fainting deserves further study.