Towards an assessment of perceived COPD exacerbation triggers: Initial development and validation of a questionnaire.

BACKGROUND AND OBJECTIVE: Prevention of exacerbations in chronic obstructive pulmonary disease (COPD) is important to decrease overall declines in functioning and improve quality of life. The present study sought to develop a psychometrically valid measure of perceived triggers of exacerbations in COPD patients, the COPD Exacerbation Trigger Inventory (CETI). METHODS: Participants (n = 192) were recruited through local clinics and online to complete surveys of the CETI, demographic information, disease-specific information and the COPD Assessment Test (CAT). The CETI included a free response section on patients' individual top triggers, combined with ratings of their controllability. RESULTS: Exploratory principal component analyses identified a stable 5-factor structure (33 items), from which trigger subscales for weather/climate, air pollution/irritants, exercise, infection/illness and psychological factors were formed (internal consistency Cronbach's α = 0.90-0.94). Trigger factors were associated with COPD functional status, exacerbation frequency and healthcare utilization. Participants found personal triggers related to dust, air pollution, smoking and physical activity to be the most easily controlled, whereas those related to psychological factors, climate, infection, respiratory symptoms and sleep to be more difficult to control. Greater perceived controllability of triggers was associated with lower CAT scores, indicating better health status and less impact of the disease on functioning. CONCLUSION: The CETI is a psychometrically valid measure of perceived exacerbation triggers in patients with COPD. Perceived triggers are associated with clinical outcomes. Assessment of trigger classes and their controllability may prove useful in both research and clinical settings with COPD patients and to further our knowledge in prevention and disease management.

Hippocampal metabolites in asthma and their implications for cognitive function.

Emerging research indicates that individuals with asthma have an increased risk of cognitive impairment, yet the associations of asthma with neural correlates of memory remain relatively unknown. The hippocampus is the predominant neural structure involved in memory, and alterations in the hippocampal metabolic profile are observed in individuals with mild cognitive impairment. We therefore hypothesized that individuals with asthma may have altered hippocampal metabolites compared to healthy controls. Structural magnetic resonance imaging (sMRI) and proton magnetic resonance spectroscopy (1H-MRS) were used to compare hippocampal volume and metabolites of otherwise healthy adults with and without asthma (N = 40), and to study the association of these measures with cognitive function and asthma-related variables. Participants underwent 3-Tesla sMRI and 1H-MRS, with the volume of interest placed in the left hippocampus to measure levels of N-acetylaspartate (NAA), glutamate (Glu), creatine (Cr), and myo-inositol (MI), as indicators of neuronal viability, cellular activity, cellular energy reserve, as well as glial activation. Individuals with asthma had lower hippocampal NAA compared to healthy controls. For all participants, poorer cognitive function was associated with reduced NAA and Glu. For individuals with asthma, poorer cognitive function was associated with reduced disease control. Additionally, short-acting rescue bronchodilator use was associated with significantly lower NAA, and Glu, whereas inhaled corticosteroid use was related to significantly higher Cr and in tendency higher NAA and Glu. All findings controlled for left hippocampal volume, which was not different between groups. These findings highlight that asthma and/or its treatment may affect hippocampal chemistry. It is possible that the observed reductions in hippocampal metabolites in younger individuals with asthma may precede cognitive and hippocampal structural deficits observed in older individuals with asthma.

Airway reactivity in response to repeated emotional film clip presentation in asthma.

Emotional stimuli elicit airway constriction in individuals with asthma and in healthy individuals, but little is known about effects of repeated stimulation. We therefore explored the effect of repeated emotion induction on respiratory resistance (Rrs) using unpleasant, high-arousal surgery films and investigated effects of respiration and emotional reactivity. Twenty-six participants (13 with asthma) watched a series of 12 short, 45-s surgery films followed by 2-min recovery periods. Rrs assessed with impulse oscillometry was significantly elevated during films in both groups compared to baseline and recovered quickly after that. No habituation of airway responses occurred. Rrs was higher in participants who felt more aroused and less in control when watching the films. Changes in Rrs remained significant when controlling for changes in respiration or emotional experience. Thus, although unpleasant stimuli lead to elevated Rrs, airway obstruction is not exacerbated with repeated stimulation due to a fast return to baseline after stimulation.

The desire to belong: Social identification as a predictor of treatment outcome in social anxiety disorder.

OBJECTIVE: Perception of personal identity cannot be separated from the perception of the social context and one's social identity. Full involvement in group psychotherapy may require not only the awareness of personal impairment, but also social identification. The aim of the current study was to examine the association between social identification and symptom improvement in group-based psychotherapy. METHOD: 169 participants received 12 sessions of group-based cognitive behavioral therapy for social anxiety disorder. Social identification, the extent to which a person identifies with those who suffer from the same psychological problem as themselves and/or with those lacking psychopathology (non-sufferers), and clinical outcome were assessed at baseline, mid-and posttreatment, and 1, 3, and 6-months follow-up. RESULTS: At baseline, patients aspired for closeness with non-sufferers, and viewed themselves as distant from fellow sufferers and non-sufferers. After treatment, participants viewed not only themselves, but also other individuals with social anxiety, as closer to both non-sufferers and fellow sufferers. These ratings were related to clinical outcomes. CONCLUSIONS: The increase in closeness to both sufferers and non-sufferers across treatment may reflect a movement towards a more tolerant, less dichotomous and rigid, separation of ill and healthy that occurs with successful social anxiety treatment.

Investigating the role of self-disgust in nonsuicidal self-injury.

Self-directed disgust, a component of self-criticism, may present an important, yet unexplored emotion in the context of nonsuicidal self-injury (NSSI). The aim of this study was to examine the role of self-disgust in NSSI, specifically as a potential mediator in the relations between depression and NSSI as well as sexual abuse and NSSI, and to also better understand characteristics that might differentiate recent and past self-injurers. A total of 549 college students completed measures assessing NSSI, self-disgust, depression, anxiety sensitivity, and physical and sexual abuse. Results indicated self-disgust fully mediated the relation between depressive symptoms and NSSI status and partially mediated the relation between sexual abuse and NSSI status. Additionally, compared to past self-injurers (4.6%; n = 25), recent self-injurers (6.4%; n = 35) endorsed significantly higher self-disgust and depressive symptoms. Self-disgust may be an important component in NSSI and should be addressed in treatment.

Controlling asthma by training of Capnometry-Assisted Hypoventilation (CATCH) vs slow breathing: a randomized controlled trial.

BACKGROUND: Hyperventilation has been associated with adverse effects on lung function, symptoms, and well-being in asthma. We examined whether raising end-tidal CO2 levels (ie, Pco2) compared with slow breathing is associated with improvements in asthma control, including peak flow variability. METHODS: One hundred twenty patients with asthma were randomly assigned to capnometry-assisted respiratory training (CART) for raising Pco2 or slow breathing and awareness training (SLOW) for slowing respiratory rate. Patients received five weekly sessions and completed bid homework exercises over 4 weeks. Blinded assessments at baseline, posttreatment, 1- and 6-month follow-up of asthma control, Pco2, and diurnal peak flow variability were primary outcome measures. Additionally, we measured pulmonary function (spirometry, forced oscillation, exhaled nitric oxide, and methacholine challenge), symptoms, quality of life, and bronchodilator use. Because the control group received active treatment, we expected improvements in asthma control in both groups but more pronounced benefits from CART. RESULTS: Improvements were seen in 17 of 21 clinical indexes (81.0%) in both interventions, including the primary outcome variables asthma control (d = 0.81), peak flow variability (d = 0.54), quality of life, bronchodilator use, lung function, and airway hyperreactivity. Most improvements were sustained across the 6-month follow-up. Compared with slow breathing, CART showed greater increases in Pco2 (d = 1.45 vs 0.64 for CART vs SLOW, respectively) and greater reductions in respiratory impedance during treatment, less distress during methacholine challenge, and greater reduction in asthma symptoms at follow-up (P < .05). CONCLUSIONS: Brief interventions aimed at raising Pco2 or slowing respiratory rate provide significant, sustained, and clinically meaningful improvements in asthma control. Raising Pco2 was associated with greater benefits in aspects of lung function and long-term symptoms. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00975273; URL: www.clinicaltrials.gov.

Discrepancies between lung function and asthma control: asthma perception and association with demographics and anxiety.

Understanding asthma symptom perception is necessary for reducing unnecessary costs both for asthma sufferers and society and will contribute to improving asthma management. The primary aim of this study was to develop and test a standardized method for classification of asthma perceiver categories into under-, normal, and overperceiver groups based on the comparison between self-report and lung function components of asthma control. Additionally, the degree to which demographic variables and anxiety contributed to the classification of patients into perceiver groups was examined. Patients underwent methacholine or reversibility testing to confirm asthma diagnosis. Next, participants completed lung function testing over 3 days before their next appointment. Finally, patients filled out demographic and self-report measures including the Asthma Control Test (ACT). Each self-report category of control assessed by the ACT (interference, shortness of breath, nighttime awakenings, rescue inhaler usage, and a composite total score) was compared with lung function measurements using a modified version of the asthma risk grid. Using the modified asthma risk grid to determine perceiver categorization, this sample included 14 underperceivers, 29 normal perceivers, and 36 overperceivers. A discriminant analysis was performed that indicated that a majority of underperceivers were characterized by being African American and having low asthma-specific anxiety. Normal perceivers in this sample tended to be older. Overperceivers tended to be female. Our findings encourage further research using the reported method of classifying asthma patients into perceiver categories.