Change in airflow among patients with asthma discussing relationship problems with their partners.

This study examined the covariation of negative emotions with airflow among 48 persons with asthma and their partners as they discussed relationship problems. Measures included self-reported questionnaires, airflow and behavior coded from videotaped discussions. Significantly increased self-reported hostility and statistically but not clinically significant declines in airflow were found post- versus pre-discussion. Self-reported responses to asthma symptoms of more anger and less loneliness predicted lower post-discussion airflow after accounting for pre-discussion airflow. The use of effort-independent measures of airflow and autonomic nervous system monitoring may inform future research regarding the physiological mechanisms through which mood and behavior affect airflow.

[An evaluation of a patient education programme for children with asthma at a French teaching hospital ("l'espace du souffle", Nantes) (2002-2003)]. / Programme d'éducation thérapeutique collective pour l'enfant asthmatique à Nantes.

A program of patient education was set up at the CHU of Nantes, for groups of children with asthma in 1997. The aim of this study is to realize a formative evaluation to corelate with some effects. This study was proposed to 99 families with asthmatic children. A written questionnaire, was administered to the parents and children, exploring their satisfaction with the programme, their general knowledge and know-how, biomedical parameters. The observation focused on skills and day-to-day life with the illness. The study was completed by 21 families. The majority of the children, aged 7 to 11 years old, had asthma that needed treatment. All of the parents and children were satisfied with their visit to "l'espace du souffle". They all declared having increased their general knowledge and know-how and biomedical parameters did better. They did, however, feel that they did not know enough about how to recognise precursory symptoms of an attack, about how to practise a sport or how to use "corticoids". They also could not control their personal fear during an attack. During the oral questionnaire a general feeling of stress and worry was clearly noticeable in the parents feeling, that did not appear in the written questionnaire. This patient education program appears to be beneficial. Furthermore, this evaluation highlights some subjects that pass unseen during current individual consultations.

[Asthma related knowledge among parents of asthmatic children at the moment of admission to a specialized service]. / Conhecimentos de pais de crianças asmáticas sobre a doença no momento da admissão a um serviço especializado.

OBJECTIVE: To assess asthma related knowledge among parents of asthmatic children at the moment of admission to a specialized service. METHODS: This was a descriptive study. Parents of 93 asthmatic children (aged from 29-18 yr) were interviewed, at the moment of admission to the Pediatric Pulmonary Outpatient Service of a university hospital, using a questionnaire to assess their asthma related knowledge. The assessment focused on understanding of the nature, prognosis and treatment of asthma. Only the data from parents of 87 children aged from 29 days to 10 years were analyzed. RESULTS: Upon self-assessment, 93.1% of the parents considered their asthma related knowledge insufficient and 88.5% showed interest in obtaining more information. With regard to understanding of the nature, prognosis and treatment of asthma, 96.6% of the parents did not know the role of airway inflammation on synthesis of symptoms and 51.7% believed in a cure for the disease. Among the parents whose children use a home nebulizer, 80.6% used it incorrectly; all of the parents whose children use spray without a spacer were not familiar with the correct inhalation technique; 65.5% of the parents were unaware of the importance of environmental control. Presence of allergic sources and of smokers was found in 77.0% and 68.9% of families respectively. CONCLUSIONS: This study shows an insufficient asthma related knowledge among parents of asthmatic children at the moment of admission to a specialized service, characterized by ignorance about the nature and prognosis of the disease, inadequate technique to use inhaled drugs and unawareness of home environmental control.

[Is the asthmatic patient competent to manage his disease? A study of 280 patients in Seine-Saint-Denis, France]. / L'asthmatique est-il compétent pour gérer sa maladie ? Étude de 280 patients en Seine-Saint-Denis, France.

INTRODUCTION: The correct use of medication and the ability to assess the severity of the disease and to react appropriately in the case of exacerbation are essential objectives in the management of asthma patients. This study, conducted in a school of asthma in Seine-Saint-Denis, aims to measure the influence of socio-demographic and clinical factors, before any educational process, on these four security skills. METHODS: A prospective observational study concerning 280 consecutive patients managed between 2008 and 2011 (70 % women, mean age: 44 years [14-85 years]; deprivation: 48 %; born abroad: 39 %, low level of education: 23 %). The initial educational diagnosis was compared with the clinical and socio-demographic characteristics. RESULTS: In relation to asthma control, social characteristics (unemployment, deprivation), geographic or ethnic origin and educational level significantly influence the command of all or some of the security skills. In medical terms, a period of evolution of the disease of less than 10 years, outpatient follow-up without specialized monitoring and the absence of recent exacerbations also appear as predictors of inappropriate conduct in the management of the disease. CONCLUSIONS: This study suggests new priority targets for therapeutic education in asthma.

[Functional laryngeal obstruction]. / Obstrucción laríngea funcional.

We describe 4 patients with reversible obstruction of the upper airways, a condition that usually presents with crises of dyspnea and respiratory sounds. No organic cause could be identified and the symptoms were initially confused with those of bronchial asthma. During episodes, the flow-volume curve suggested obstruction of the upper airways with poor reproducibility and repeatedly normal resistance values. Fiberoptic bronchoscopy allowed us to confirm the functional nature of the obstruction in these cases.

The needs of a patient in severe status asthmaticus: experiences of a nurse-patient in an intensive care unit.

Biopsychosocial being is now accepted in nursing as a term which can be used to describe any human being. This is an account of what it means, illustrated in the life of one person. Pilar Arcas Ruiz is a Spanish nurse who left medical education to train as a nurse, but later completed the requirements for medical qualification in order to use it when necessary to advance nursing in Spain.

[How do asthmatic women experience the illness?]. / Como mulheres portadoras de asma vivenciam a doença?

This study aimed to identify and understand the essence of the anguish of five asthmatic women, patients of the Pneumology Service of a hospital in Porto Alegre, and how they interact with the health professionals. It uses the qualitative methodology, with semi-structured interviews. The content analysis identified: a dependent relationship and an incidence of separation anguish demonstrated by the way the women deal with medication and the caregivers; some of the women's impediments; difficulties to describe the illness and asthma crisis. The separation anxiety and the dependent behavior of the patient must be understood by the caregiver.

Recurrent, severe, and rapidly reversible apical ballooning syndrome in status asthmaticus.

Apical ballooning syndrome, or Tako-tsubo cardiomyopathy, is a peculiar form of transient left-ventricular dysfunction originally described as triggered by emotional stress. Subsequent reports indicated that physical stressors can also induce this clinical syndrome. We describe for the first time, to the best of our knowledge, a case of recurrent, severe, and quickly reversible apical ballooning syndrome provoked by the use of high-dose inhaled ß-adrenergic agonists in status asthmaticus.

[Adult asthma exacerbations in questions]. / Les exacerbations de l'asthme de l'adulte en questions.

In this article a French working party critically review the international literature to revise the definition, pathophysiology, treatment and cost of exacerbations of adult asthma. The various guidelines do not always provide a consistent definition of exacerbations of asthma. An exacerbation can be defined as deterioration of clinical and/or functional parameters lasting more than 24 hours, without return to baseline, requiring a change of treatment. No single clinical or functional criterion can be used as an early marker of an exacerbation. Innate and acquired immune mechanisms, modified by contact with infectious, irritant or allergenic agents, participate in the pathogenesis of exacerbations, which are accompanied by bronchial inflammation. In 2010, mortality is related to progression of exacerbations, often occurring before the patient seeks medical attention. The objective of treatment is to control asthma and prevent exacerbations. However, many factors can trigger exacerbations and often cannot be controlled. The efficacy of inhaled corticosteroids has been demonstrated on reduction of the number of exacerbations and the number of asthma-related deaths. This treatment is cost-effective, especially in terms of reduction of exacerbations.

Factors associated to recurrent visits to the emergency department for asthma exacerbations in children: implications for a health education programme.

INTRODUCTION: Recurrent emergency department (ED) visits for asthma exacerbations produce anxiety as well as high costs to the health system and the family. OBJECTIVE: To identify factors associated with recurrent ED visits for asthma exacerbations in children in Bogotá, Colombia. METHODS: Data obtained from a survey of parents of 223 patients with asthma (mean +/- SD: 4.8+/-3.5 years of age) attending an asthma clinic were analysed. Demographic data and a broad asthma knowledge and attitudes questionnaire were completed by the parents. RESULTS: Of the 223 asthmatic patients enrolled, 60 (26.9 %) had 3 or more visits to the ED for asthma in the last 6 months ("recurrent ED visits"). After controlling by age, educational level of the father, and severity of the disease; parents of children with "recurrent ED visits" were more prone to report that they attended ED because the asthma exacerbations were severe enough to go to the primary care physician (OR, 2.45; CI 95 %, 1.13-5.30; p=0.02); that asthma medications should be administered only when the children are symptomatic (OR, 3.26; CI 95 %, 1.45-7.36; p=0.004), and conversely they were less prone to have knowledge that asthma exacerbations can be avoided if medications are administered in the asymptomatic periods (OR, 0.31; CI 95 %, 0.14-0.68; p=0.003). CONCLUSIONS: An educational programme intended to reduce the recurrent ED visits for asthma exacerbations should consider the inclusion of an explanation about the chronic nature of the disease and the importance of long-term therapy.

[Level of knowledge about asthma among parents of asthmatic children]. / Nivel de conocimientos acerca del asma en padres de niños asmáticos.

OBJECTIVE: To determine the level of knowledge of asthma in asthmatic children's parents. MATERIAL AND METHODS: A questionnaire was applied in asthmatic children's parents that had not taken some course about asthma, to explore the knowledge that they have about the illness. A questionnaire of the National Asthma Education Program of NIH was used. They were only questions of false or true options. RESULTS: 512 questionnaires were applied finding mainly that 53.1% considered to the asthma an emotional illness, 52.5% believed that the way that parents raise their children cause the asthma, 32.8% considered that the acute episodes are not dangerous. The 39.1% ignored that it is possible to measure the lung function, 23.4% considered that the patient with asthma should not carry out exercise and 57.8% "knew" that the asthma in the children disappears spontaneously in the adolescence. CONCLUSIONS: The level of education about asthma in the parents is insufficient, and also is wrong in almost half of them.

The young Damocles. The adolescent at high risk for serious or fatal status asthmaticus.

The most vulnerable population in the recent increase in morbidity and mortality in asthma is the preteen and teenaged group. This particular group, remarkably resistant to outside input, would seem the most likely audience for programs dealing with asthma self-care. We have postulated 4 problem areas for this group that may be important in patients who have severe or refractory disease. These problems involve physiology, noncompliance with the medical regimen, stress, and depression and suicide. Each problem requires a specific intervention strategy and should be amenable to treatment in a comprehensive management plan.

Conhecimentos de pais de crianças asmáticas sobre a doença no momento da admissão a um serviço especializado / Asthma related knowledge among parents of asthmatic children at the moment of admission to a specialized service

OBJETIVO: Avaliar conhecimentos de pais de crianças asmáticas sobre a doença no momento da admissão a um serviço especializado. MÉTODOS: O presente trabalho foi um estudo descritivo. Foram entrevistados os pais de 93 crianças asmáticas com idade entre 29 dias e 18 anos, no momento da admissão ao ambulatório de Pneumologia Pediátrica de um hospital universitário, por meio de um questionário para avaliar os conhecimentos deles sobre asma. As avaliações concentraram-se no entendimento da natureza, do prognóstico e do tratamento da asma. Foram analisados somente os dados obtidos em pais de 87 crianças com idade entre 29 dias e 10 anos. RESULTADOS: Na auto-avaliação, 93,1 por cento dos pais consideraram seus conhecimentos sobre asma insuficientes; e 88,5 por cento demonstraram interesse em adquirir mais informações. Na avaliação específica de conhecimentos sobre natureza, prognóstico e tratamento da asma, 96,6 por cento dos pais não sabiam o papel da inflamação das vias aéreas na síntese dos sintomas da doença; e 51,7 por cento acreditavam na cura desta doença; entre os pais cujos filhos usavam nebulizador domiciliar, 80,6 por cento costumavam cometer erros na sua aplicação; e todos os pais cujos filhos usavam inalador pressurizado sem espaçador não conheciam a técnica inalatória correta; 65,5 por cento dos pais não tinham consciência da importância sobre o controle do ambiente domiciliar; e a presença de fonte dos alérgenos e de fumantes foi encontrada respectivamente em 77 por cento e 68,9 por cento dos domicílios. CONCLUSÕES: O presente trabalho mostra a insuficiência de conhecimento sobre asma por parte dos pais de crianças asmáticas no momento da admissão a um serviço especializado, caracterizando-se pelo desconhecimento sobre natureza e prognóstico da doença, técnica inadequada no uso dos fármacos inalatórios e descuido no controle do ambiente domiciliar.

A psicossomática de um caso clínico infantil / The psychosomatic in infant clinical case

O autor apresenta o atendimento em psicoterapia de menina de dez anos e meio, com o seguinte quadro clínico psicossomático: asma, obsidade e dores de cabeça. Nos antecedentes foram encontradas as seguintes manifestaçöes : cólicas abdominais, insônia, sono agitado e pesadelos. Com base na evoluçäo da criança em tratamento, num período de oito anos, foi possível demonstrar a relaçäo das crises de asma com ansiedade e depressäo. Verificou-se que à medida que a menina externava sua agressividade e seu ódio, diminuía a freqüência das crises asmáticas. Demonstrou-se ainda o fracasso do tratamento multidisciplinar em relaçäo à obesidade e que esta era fonte de angústia para a paciente, o que gerava baixa auto-estima e dificuldades de relacionamento interpessoal. A ligaçäo da paciente com o terapeuta permitiu que aquela pudesse vivenciar um relacionamento de confiança e amor mútuo. Dentro desse contexto transferencial, a paciente pôde vivenciar a mäe boa e o pai bom. Essa situaçäo restabeleceu-lhe o amor próprio e a confiança em si