Article

Psychosocial factors, respiratory viruses and exacerbation of asthma

June 2001
Psychoneuroendocrinology 26(4):411-20

June 2001
26(4):411-20

DOI:10.1016/S0306-4530(00)00063-9

Source
PubMed

Authors:

Andrew P Smith

Cardiff University

Karl Nicholson

University of Leicester

The aim of this research was study the role of psychosocial factors in exacerbations of asthma in adults induced by upper respiratory tract infections (URTIs). It involved a longitudinal study (one year) of 92 adults with asthma. The volunteers were 27 men and 65 women 19-46 years of age with a mean duration of wheeze of 19 years. The main outcome measure was symptomatic colds producing asthma exacerbations (infections confirmed by laboratory assays and exacerbation of asthma confirmed by objective changes in peak expiratory flow rate). The results showed that about 20% of the sample did not report an episode. This sub-group had a high proportion of males, low negative affectivity scores and consumed more alcohol. When volunteers with at least one episode were considered it was found that those who reported more negative life events and had low levels of social support had more episodes. Smokers were more likely to have to visit their doctor when they developed a cold-induced exacerbation of asthma. Overall, these results show that health-related behaviours, demographic and psychosocial factors influence susceptibility to and severity of exacerbations of asthma by URTIs.

Psychiatric co-morbidity and asthma: A pilot study utilizing a free use tool to improve asthma care

Article

Dec 2019
CLIN INVEST MED

Purpose: To assess the prevalence of co-morbid psychiatric disorders in asthmatic patients in a Western Canadian Regional Severe Asthma Center. Methods: A prospective study was completed of patients evaluated through the Edmonton Regional Severe Asthma Clinic (ERSAC). A standardised evaluation, the Mini International Neuropsychiatric Interview (MINI) screen was used to identify possible psychiatric disorders. Results: Twenty-four individuals with moderate to severe asthma, who presented for treatment at ERSAC, were recruited and underwent assessment with the MINI screen. The average patient age was 48 years (range 18-81 years). Nine patients were male and fifteen were female. Twenty subjects (83%) screened positive for a possible psychiatric co-morbidity using the MINI screen. The most common psychiatric co-morbidities identified were post-traumatic stress disorder (50% of the sampled population), depressive episode or persistent depressive disorder (42%), substance/alcohol abuse (33%), generalized anxiety disorder (335), manic episode (25%), agoraphobia (21%), panic disorder (21%) and obsessive-compulsive disorder (17%). Some individuals had more than one concomitant possible psychiatric co-morbidity identified by the MINI screen. Conclusions: Psychiatric co-morbidity was confirmed to be common in patients with moderate-severe asthma. In individuals with asthma, the MINI screen appeared to be a simple and useful clinical tool to screen for untreated/sub-optimally-managed psychiatric co-morbidities that may impact management.

Commentary In: Psychoneuroimmunology and occupational therapy for inflammatory disorders

Article

Full-text available

Jan 2006

Luis Vitetta

The belief that adverse life stressors and the emotional states that can lead to major negative impacts on an individual's body functions and hence health has been held since antiquity. Adverse health outcomes such as coronary heart disease, gastrointestinal distress, and cancer have been linked to unre-solved lifestyle stresses that can be expressed as a negative impact on human survival and ultimately a decrease of the human life span. Psychological modulation of immune function is now a well-established phenomenon, with much of the relevant literature published within the last 50 years. Psychoneuroimmu-nology and psychoneuroendocrinology embrace the scientific evidence of research of the mind with that of endocrinology, neurology and immunology, whereby the brain and body communicate with each other in a multidirectional flow of information that consists of hormones, neurotransmitters/neuropep-tides, and cytokines. Advances in mind–body medicine research together with healthy nutrition and lifestyle choices can have a significant impact on health maintenance and disease prevention and hence the prolongation of the human life span.

Mind-Body Medicine: Stress and Its Impact on Overall Health and Longevity

Article

Dec 2005

Luis Vitetta

During evolution, DNA viruses have captured a broad array of cellular genes involved in immune recognition and growth control that are nonessential for viral replication. The encoded virokines and viroceptors may act as mimetics or antagonists of their cellular homologues, altering signal transduction and cell communication towards survival of virus-infected cells. Human herpesvirus type 8 (HHV8) is the most recently identified human oncogenic herpesvirus. It is associated with Kaposi's sarcoma and lymphoproliferative diseases, such as pleural effusion lymphomas and multicentric Castleman's disease. HHV8 has captured a unique number of cellular regulatory genes, which redirect gene expression and cell growth, prevent apoptosis and immune recognition, and interfere with tumor suppressor gene function. HHV8 encodes a unique virokine, viral interleukin-6, which is particularly relevant for the pathogenesis of HHV8-associated tumors, since it participates in transformation and mediates autocrine and paracrine mitogenic and proinflammatory effects. Viral IL-6 differs fundamentally from human IL-6 in receptor engagement for signal transduction and thus constitutes a singular model to understand the facets of human and viral cytokine biology. We provide an overview of the role of virokines in cancer, with a particular focus on the differences of human and viral IL-6 in the pathophysiology of HHV8-associated tumors.

Psychosocial factors and susceptibility to or outcome of acute respiratory tract infections [Review article]

Article

Full-text available

Feb 2010

OBJECTIVE: To perform a systematic review of the literature to assess the possible effect that psychosocial variables may have on the susceptibility and/or outcome of acute respiratory tract infections (ARTIs).METHODS: We performed searches for relevant studies on PubMed, Scopus and PsychInfo.RESULTS: We identified 44 studies published between 1986 and 2008, examining the role of psychosocial variables and the onset or progression of ARTI. Of these 44 studies, 41 (93.1%) showed at least one statistically significant association between psychosocial variables and susceptibility to ARTI; 20 (45.5%) revealed at least one statistically significant association between psychosocial variables and outcome of ARTI. Variables associated with susceptibility to and outcome of infection were higher levels of perceived stress, negative affect, anxiety and depression. Negative life events were associated with susceptibility to infection.CONCLUSION: Most of the relevant studies show a significant relationship between psychosocial factors and the onset or progression of acute respiratory tract illness. However, the psychosocial variables were not consistently evaluated across the included studies, and different methodological approaches were used to examine the association between psychosocial factors and acute respiratory tract illness.

Mind‐Body Medicine: Stress and Its Impact on Overall Health and Longevity

Article

Dec 2005
ANN NY ACAD SCI

The belief that adverse life stressors and the emotional states that can lead to major negative impacts on an individual's body functions and hence health has been held since antiquity. Adverse health outcomes such as coronary heart disease, gastrointestinal distress, and cancer have been linked to unresolved lifestyle stresses that can be expressed as a negative impact on human survival and ultimately a decrease of the human life span. Psychological modulation of immune function is now a well-established phenomenon, with much of the relevant literature published within the last 50 years. Psychoneuroimmunology and psychoneuroendocrinology embrace the scientific evidence of research of the mind with that of endocrinology, neurology and immunology, whereby the brain and body communicate with each other in a multidirectional flow of information that consists of hormones, neurotransmitters/neuropeptides, and cytokines. Advances in mind-body medicine research together with healthy nutrition and lifestyle choices can have a significant impact on health maintenance and disease prevention and hence the prolongation of the human life span.

Depressive Symptoms, Social Support, and Risk of Adult Asthma in a Population-Based Cohort Study

Article

Feb 2010
PSYCHOSOM MED

To investigate the association between depressive symptoms, social support, and prevalent as well as incident asthma. Depressive symptoms and social support may affect the development of asthma. This relationship could be mediated by health behaviors and/or inflammatory processes. Evidence from prospective cohort studies on depressive symptoms and social support in relation to asthma risk in adults remains sparse. Between 1992 and 1995, a population-based sample of 5114 middle-aged adults completed questionnaires covering depressive symptoms, social support, self-reported asthma, and potential confounders. Among those alive in 2002/2003, 4010 (83%) were followed-up by questionnaires. Associations with prevalent and incident asthma were estimated by prevalence ratios (PR) and risk ratios (RR) along with corresponding 95% confidence intervals (CIs), using Poisson regression. PRs and RRs were adjusted for demographics, family history of asthma, smoking, alcohol consumption, body mass index, and physical exercise. Cross-sectional analyses indicated that the prevalence of asthma was positively associated with depressive symptoms and inversely related to social support. Prospective analysis suggested a 24% increased risk of asthma with each 1-standard deviation increase in depressive symptoms (RR, 1.24; 95% CI, 1.02, 1.50), whereas the social support z score showed an inverse association with asthma incidence (RR, 0.71; 95% CI, 0.58, 0.88). Analyses with tertiles suggested similar, but nonsignificant, associations. Omitting health-related life-style variables from the multivariable models did not substantially alter these associations. Risk of adult asthma was found to increase with depressive symptoms and to decrease with social support. These associations do not seem to be explained by health-related life-style factors.

Ethnomedicine and ethnobotany of fright, a Caribbean culture-bound psychiatric syndrome

Article

Full-text available

Feb 2010

Marsha B. Quinlan

"Fright" is an English-speaking Caribbean idiom for an illness, or ethnomedical syndrome, of persistent distress. A parallel ethnopsychiatric idiom exists in the French Antilles as sésisma. Fright is distinct from susto among Hispanics, though both develop in the wake of traumatic events. West Indian ethnophysiology (ethnoanatomy) theorizes that an overload of stressful emotions (fear, panic, anguish or worry) causes a cold humoral state in which blood coagulates causing prolonged distress and increased risks of other humorally cold illnesses. Qualitative data on local explanatory models and treatment of fright were collected using participant-observation, informal key informant interviews and a village health survey. Ethnobotanical and epidemiological data come from freelist (or "free-list") tasks, analyzed for salience, with nearly all adults (N = 112) of an eastern village in Dominica, and a village survey on medicinal plant recognition and use (N = 106). Along with prayer and exercise, three herbs are salient fright treatments: Gossypium barbadense L., Lippia micromera Schauer, and, Plectranthus [Coleus] amboinicus [Loureiro] Sprengel. The survey indicated that 27% of village adults had medicated themselves for fright. Logistic regression of fright suffering onto demographic variables of age, education, gender, parental status and wealth measured in consumer goods found age to be the only significant predictor of having had fright. The probability of having (and medicating for) fright thus increases with every year. While sufferers are often uncomfortable recalling personal fright experiences, reporting use of medicinal plants is less problematic. Inquiry on fright medical ethnobotany (or phytotherapies) serves as a proxy measurement for fright occurrence. Cross-cultural and ethnopharmacology literature on the medicinal plants suggests probable efficacy in accord with Dominican ethnomedical notions of fright. Further, the cultural salience and beliefs about these medicines may give these medications extra psychoneuroimmune (i.e. mind-body) benefits, or placebo-like effects, for this stress-related folk illness.

Psychosocial factors and susceptibility to or outcome of acute respiratory tract infections

Article

Feb 2010
INT J TUBERC LUNG D

To perform a systematic review of the literature to assess the possible effect that psychosocial variables may have on the susceptibility and/or outcome of acute respiratory tract infections (ARTIs). We performed searches for relevant studies on PubMed, Scopus and PsychInfo. We identified 44 studies published between 1986 and 2008, examining the role of psychosocial variables and the onset or progression of ARTI. Of these 44 studies, 41 (93.1%) showed at least one statistically significant association between psychosocial variables and susceptibility to ARTI; 20 (45.5%) revealed at least one statistically significant association between psychosocial variables and outcome of ARTI. Variables associated with susceptibility to and outcome of infection were higher levels of perceived stress, negative affect, anxiety and depression. Negative life events were associated with susceptibility to infection. Most of the relevant studies show a significant relationship between psychosocial factors and the onset or progression of acute respiratory tract illness. However, the psychosocial variables were not consistently evaluated across the included studies, and different methodological approaches were used to examine the association between psychosocial factors and acute respiratory tract illness.

Inaccurate perception of asthma symptoms: A cognitive-affective framework and implications for asthma treatment

Article

Apr 2009

Inaccurate perception of respiratory symptoms is often found in asthma patients. Typically, patients who inaccurately perceive asthma symptoms are divided into underperceivers and overperceivers. In this paper we point out that this division is problematic. We argue that little evidence exists for a trait-like stability of under- and overperception and that accuracy of respiratory symptom perception is highly variable within persons and strongly influenced by contextual information. Particularly, expectancy and affective cues appear to have a powerful influence on symptom accuracy. Based on these findings and incorporating recent work on associative learning, attention and mental representations in anxiety and symptom perception, we propose a cognitive-affective model of symptom perception in asthma. The model can act as a framework to understand both normal perception as well as under- and overperception of asthma symptoms and can guide the development of affect-related interventions to improve perceptual accuracy, asthma control and quality of life in asthma patients.

The Psychology of the Common Cold and Influenza: Implications for COVID-19

Article

Full-text available

Apr 2020

Andrew P Smith

Exhaled Nitric Oxide and Vascular Endothelial Growth Factor as Predictors of Cold Symptoms After Stress

Article

Nov 2017
BIOL PSYCHOL

Objective: Prior research has demonstrated that psychosocial stress is associated with respiratory infections. Immunologic, endocrine, and cardiovascular predictors of such infections have been explored with varying success. We therefore sought to study the unexplored role of airway mucosal immunity factors, nitric oxide (NO) and vascular endothelial growth factor (VEGF). NO is secreted by airway epithelial cells as part of the first line of defense against bacteria, viruses, and fungi. VEGF is expressed by mast cells in respiratory infections and recruits immune cells to infected sites, but in excess lead to vulnerability of the airway epithelium. Methods: In this proof-of-concept study we measured exhaled NO, exhaled breath condensate (EBC) VEGF, salivary VEGF, and salivary cortisol in 36 students undergoing final academic examinations at three occasions: a low-stress baseline during the term, an early phase of finals, and a late phase of finals. Participants also reported on cold symptoms at these time points and approximately 5 and 10days after their last academic examination. Results: Higher baseline NO was associated with fewer cold symptoms after stress, whereas higher baseline VEGF in EBC and saliva were associated with more cold symptoms after stress. Perceived stress at baseline as well as salivary VEGF and cortisol late in the finals also contributed to the prediction of later cold symptoms. Conclusion: Basal levels of NO and VEGF may inform about mucosal immunocompetence and add to preventative treatments against airway infections from periods of stress in daily life.

Chronic fatigue syndrome and increased susceptibility to upper respiratory tract infections and illnesses

Article

Full-text available

Apr 2015

Background: Previous research has suggested that chronic fatigue syndrome (CFS) patients report more upper respiratory tract illnesses (URTIs) than controls. Aims: The present study aimed to replicate and extend this research. Method: A prospective study of the incidence of URTIs was conducted. This was similar to previous work involving diary studies but also included objective measures of illness severity (e.g. nasal secretion; sub-lingual temperature) and infection (virus isolation from nasal swabs and antibody changes). Fifty-seven patients with CFS, diagnosed according to the 1994 CDC criteria, were recruited randomly from a volunteer panel compiled of patients who had attended the Cardiff CFS outpatient clinic. A further 57 individuals without CFS were recruited from a general population research panel. Results: The results confirmed that CFS patients report more upper respiratory virus infections and the virological results showed that this was not due to a reporting bias but reflected greater susceptibility to infection. Conclusions: This increased susceptibility to infection in the CFS group can account for the increased reporting of URTIs found in this and previous studies.

Stress, asthma, and respiratory infections: Pathways involving airway immunology and microbial endocrinology

Article

Oct 2012
BRAIN BEHAV IMMUN

Stress and infections have long been independently associated with asthma pathogenesis and exacerbation. Prior research has focused on the effect of psychological stress on Th cells with particular relevance to atopic asthma. In this review, we propose new perspectives that integrate the role of infection in the relationship between psychological stress and asthma. We highlight the essential role of the mucosal epithelia of the airways in understanding the interaction between infections and the stress-asthma relationship. In addition, it reviews findings suggesting that psychological stress not only modulates immune processes, but also the pathogenic qualities of bacteria, with implications for the pathogenesis and exacerbation asthma.

Etiology of the common cold: Modulating factors

Chapter

Full-text available

Nov 2009

The development of a “cold-like illness” (CLI) usually requires infection with an upper respiratory virus such as rhinovirus, influenza virus, respiratory syncytial virus, parainfuluenza virus, coronavirus or adenovirus, among others, and the development of sufficient signs, symptoms and pathophysiologies to qualify as being ill based on personal and cultural definitions. A viral upper respiratory tract infection (vURTI) in the absence of overt illness (subclinical vURTI) will not be made manifest to the individual or to observers and, therefore, will not be diagnosed as a CLI. The degree of illness occurring during a vURTI is directly related to the extent of provoked inflammation, which in turn depends on the engagement of antiviral defense systems. Thus, risk factors for CLI can modulate either the vURTI risk by affecting virus exposure and/or susceptibility to infection, or the CLI risk given a vURTI by affecting immunocompetence, the provoked inflammation and/or the interpretation of ilness as a CLI. In this chapter, we review published studies for evidence of CLI risk-modulating factors and report that climate, crowding and perhaps female gender can affect the probability of exposure to vURTI viruses, that extant immunological factors and age can affect the probability of virus infection given exposure, that stress levels (moderated by social environment), health practices (exercise, tobacco and alcohol consumption, sleep efficiency) and genetics contribute to CLI risk most probably by modulating the immune-inflammatory response to infection, and that other factors such as pollution, home environment and certain personality traits affect CLI risk by biasing illness interpretation for a given set of symptoms and signs.

Positive emotion reduces dyspnea during slow paced breathing

Article

Jan 2012
PSYCHOPHYSIOLOGY

Slow breathing is used to induce cardiovascular resonance, a state associated with health benefits, but it can also increase tidal volume and associated dyspnea (respiratory discomfort). Dyspnea may be decreased by induced positive affect. In this study, 71 subjects (36 men, M = 20 years) breathed at 6 breaths per min. In condition one, subjects paced their breathing by inhaling and exhaling as a vertical bar moved up and down. In condition two, breathing was paced by a timed slideshow of positive images; subjects inhaled during a black screen and exhaled as the image appeared. Cardiac, respiratory, and self-reported dyspnea and emotional indices were recorded. Tidal volume and the intensity and unpleasantness of dyspnea were reduced when paced breathing was combined with pleasant images. These results show that positive affect can reduce dyspnea during slow paced breathing, and may have applications for induced cardiovascular resonance.

Determinants of exacerbation frequency in COPD

Article

Full-text available

Jun 2010

Jennifer K Quint

Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous collection of conditions characterized by irreversible expiratory airflow limitation. The disease is interspersed with exacerbations; periods of acute symptomatic, physiological and functional deterioration. There are large differences in yearly exacerbation incidence rates between patients of similar COPD severity giving rise to the concept of two distinct phenotypes; frequent and infrequent exacerbators. This thesis hypothesizes that frequent exacerbators are a distinct phenotype of COPD, and identifies some of the factors that influence exacerbation frequency. Method: 356 individuals from the London COPD cohort were included in the analyses in different subgroups. All patients completed daily diary cards and reported exacerbations to the study team for sampling and treatment. Blood and sputum were collected in the stable state and at exacerbation. Samples were processed for cytokines, genetic polymorphisms and viruses. A subset of patients also had endobronchial biopsies for epithelial cell work and immunohistochemistry. Results: Patient reported exacerbation frequency can be used to accurately stratify patients into frequent and infrequent exacerbators groups in subsequent years. Frequent exacerbators were more depressed and more likely to be female then infrequent exacerbators. There was no difference in social contacts, HRV positivity or load in sputum, Vitamin D levels, or cytokine variability between frequent and infrequent exacerbators. No differences in genetic polymorphisms (ICAM-1, IL-6, IL-8, VDR, Taq1 α1 –antitrypsin) were identified between the two groups. Conclusions: The frequent exacerbator phenotype exists. There is not one single determinant of exacerbation frequency, and determinants vary with underlying disease severity.

Longitudinal Relationships Between Family Routines and Biological Profiles Among Youth With Asthma

Article

Full-text available

Jan 2010

To investigate whether longitudinal trajectories of inflammatory markers of asthma can be predicted by levels of family routines in youth with asthma. Family routines were assessed through parent questionnaires and peripheral blood samples obtained from youth every 6 months throughout the 18-month study period. Longitudinal relationships were evaluated using hierarchical linear modeling. Mitogen-stimulated production of cytokines implicated in asthma, specifically IL-4, IL-5, and IL-13. Youth with more family routines in their home environment showed decreases in IL-13 (but not IL-4 or IL-5) over the course of the study period. In turn, within-person analyses indicated that at times when stimulated production of IL-13 was high, asthma symptoms were also high, pointing to the clinical relevance of changes in IL-13 over time. A variety of child and parent psychosocial as well as child behavioral characteristics could not explain these effects. However, medication use eliminated the relationship between family routines and stimulated production of IL-13. Our study suggests that family routines predict asthma outcomes at the biological level, possibly through influencing medication use. Considering daily family behaviors when treating asthma may help improve both biological and clinical profiles in youth with asthma.

Psychological Stress Predicts the Risk of Febrile Episodes in Cancer Patients during Chemotherapy

Article

Full-text available

Feb 2009
PSYCHOTHER PSYCHOSOM

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Dyspnea: The role of psychological processes

Article

Oct 2004
CLIN PSYCHOL REV

Breathlessness or dyspnea-the subjective experience of breathing discomfort-is a symptom in many pulmonary, cardiovascular, and neuromuscular diseases. It occurs in normals as well during intense emotional states and heavy labor or exercise. In clinical cases, it generally causes severe suffering. Dyspnea has multifactorial causes and the explanation for the symptom may differ largely among patients. Explanatory models imply the involvement of mechanisms at several levels of functioning, such as afferent signals from the respiratory muscles or blood gas levels related to hypercapnia and hypoxia. Depending on the relative involvement of specific mechanisms and their interactions, dyspnea may be experienced differently and subtypes can be distinguished. More recently, perceptual-cognitive and emotional processes related to symptom perception and interpretation have been investigated in the context of dyspnea. In this review, we focus on the psychological processes that play part in the perception of dyspnea and formulate some practical guidelines for those who are confronted with dyspnea.

The relationship of psychologic stress with childhood asthma

Article

Mar 2005
IMMUNOL ALLERGY CLIN

The psychologic influence on childhood asthma has long been a subject of investigation and controversy. This article illustrates the evidence that psychologic stress is related to children with asthma. Individual experience, the impact of family and neighborhood, the effect of caregiver mental status, and the presence of negative psychologic events affect symptoms and management. The pathways through which these factors influence asthma are mediated through cognitive and biologic mechanisms, with evidence indicating changes in behavior and alteration in immune response as underlying mechanisms. Psychologic issues are important in the patient with severe asthma. The mind-body paradigm that links psychologic stress to disease is necessary when considering the global evaluation of childhood asthma.

Stress and Inflammation in Exacerbations of Asthma

Article

Dec 2007

In this mini-review, we outline a model depicting the immunologic mechanisms by which psychological stress can exacerbate clinical symptoms in patients with asthma. This model highlights the importance of both social and physical exposures in the exacerbation of asthma symptoms. The basic premise of the model is that psychological stress operates by altering the magnitude of the airway inflammatory response that irritants, allergens, and infections bring about in persons with asthma. The biological pathways for how stress amplifies the immune response to asthma triggers include the hypothalamic-pituitary-adrenal (HPA) axis, the sympathetic-adrenal-medullary (SAM) axis, and the sympathetic (SNS) and parasympathetic (PNS) arms of the autonomic nervous system. Empirical evidence for this model is reviewed, and conclusions and future research directions are discussed.

Psychological treatment of Comorbid Asthma and Panic Disorder: A Pilot Study

Article

May 2008
J ANXIETY DISORD

We evaluated two protocols for treating adults with comorbid asthma and panic disorder. The protocols included elements of Barlow's panic control therapy and elements of Barlow's "panic control therapy" and several asthma education programs, as well as modules designed to teach participants how to differentiate asthma and panic symptoms, and how to apply specific home management strategies for each. Fifty percent of subjects dropped out of a 14-session protocol by the eighth session; however, 83% of patients were retained in an eight-session protocol. Clinical results were mostly equivalent: significant decreases of >50% in panic symptoms, clinically significant decreases in asthma symptoms, improvement in asthma quality of life, and maintenance of clinical stability in asthma. Albuterol use decreased significantly in the 14-session protocol and at a borderline level I the 8-session protocol, while pulmonary function was maintained. A controlled evaluation of this procedure is warranted.

The Potential for Reducing Asthma Disparities Through Improved Family and Social Function and Modified Health Behaviors

Article

Full-text available

Dec 2007

The National Workshop To Reduce Asthma Disparities assembled a multidisciplinary group comprised of scientists, clinicians, and community representatives to examine factors related to asthma disparities. Attention was given to the importance of discerning family, social, and behavioral factors that facilitate or impede the use of health-care services suitable to the medical status of an individual. This review highlights select biopsychosocial factors that contribute to these disparities, the manner in which they may contribute or protect persons affected by asthma, and recommended directions for future research.

Fatigue, Susceptibility to the Common Cold and its Behavioural Effects

Article

Full-text available

Jan 2021

Andrew P Smith

The aim of the present article is to describe bi-directional interactions between fatigue and infection with common cold producing viruses. Over one hundred years ago, researchers started to investigate the association between been fatigue and infection. Studies of psychological risk factors for upper respiratory tract illnesses (URTIs) have been carried out for over fifty years. Early research did not control for exposure and also often relied on self-report rather than clinical and virological assessment. Research on experimentally-induced URTIs has demonstrated that susceptibility to infection is increased by stress. Other research has shown that job insecurity, few social contacts, emotional disposition, early childhood experiences, sleep problems and self-rated health are key risk factors for infection. This article provides an interpretation of these results in terms of chronic fatigue increasing susceptibility to infection. Infection and illness also lead to changes in behaviour. These effects include greater fatigue, impaired attention and slower motor speed. Such effects occur not only when the person has symptoms but in the incubation period, with sub-clinical infections, and after the symptoms have gone. Those with URTIs are also more sensitive to other negative factors such as prolonged work, and this has implications for safety-critical jobs. Ingestion of caffeine, which is an established countermeasure for fatigue, can reduce the behavioural malaise induced by URTIs. Further support for the use of a fatigue framework comes from a secondary analysis of data on real-life colds. Previous research has demonstrated that chronic fatigue leads to greater effects of acute fatigue. The new analysis showed that those with high levels of fatigue prior to developing a cold had larger behavioural impairments when they became ill.

Fatigue, Susceptibility to the Common Cold and its Behavioural Effects

Article

Full-text available

Mar 2021

Andrew P Smith

Bibliography: Stress and susceptibility to URTIs (in date order)

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Andrew P Smith

Desafios da complexidade em Medicina Geral e Familiar

Article

Nov 2007

Mariana Tudela

Os autores identificam alguns aspectos da prática da medicina geral e familiar (MGF) que podem beneficiar dos contributos teóricos e metodológicos da teoria dos sistemas complexos. Destacam: a multimorbilidade; os desafios da mudança comportamental para prevenção de doenças e promoção da saúde; os factores associados à «adesão à terapêutica»; o efeito placebo; a trama de factores biológicos, psicológicos, relacionais, familiares, sociais, laborais, económicos e culturais que modelam o sofrimento, os modos de adoecer e a procura de cuidados de saúde dos diferentes pacientes; o papel da autonomia e do «empowerment» das pessoas e da comunidade; e as dificuldades para lidar com os labirintos actuais da tecnologia, dos serviços e dos sistemas de saúde. Abordam sucintamente o percurso teórico desde von Bertalanffy (1968) até ao presente, bem como os níveis de organização sistémica relevantes para a MGF: individual, familiar, organizacional e comunitário. A teoria (ciência) da complexidade é apresentada com enfoque no estudo dos sistemas complexos adaptativos (SCA). Discutem o conceito de «fronteira» ou «margem» do caos («edge of chaos») como zona e estado de maiores possibilidades de mudança e de transformação adaptativa e evolutiva dos sistemas complexos. Apresentam, ainda, alguns princípios e instrumentos para lidar com a complexidade, que podem ser úteis no dia-a-dia da MGF. Os autores concluem pela necessidade de criar e de adoptar progressivamente estratégias cognitivas e modos integradores de ver e de ler a pessoa humana e o mundo, reconhecendo e aceitando sempre o princípio da incompletude e da incerteza do conhecimento possível, em cada momento.

Psychosocial Factors in Pediatric Asthma

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Feb 2011

Lisa Terre

This review discusses evidence-based perspectives on psychosocial factors in pediatric asthma. Future directions for inquiry and clinical management also are addressed.

Clinical Massage in the Healthcare Setting

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Jan 2008

Covering advanced massage therapy skills, this practical resource prepares you to work with medical professionals in a clinical setting, such as a hospital, hospice, long-term care, or other health-related practice. It discusses the many skills you need to succeed in this environment, helping you become a contributing member of an integrated team. Also covered are the essentials of clinical massage, such as indications and contraindications, review of massage methods, range of motion testing, SOAP note documentation, and a massage therapy general protocol. Case studies show how a multidisciplinary approach applies to real-world clients. By coordinating your work with other health professionals, you can enhance patient care in any clinical setting! Includes a DVD with: Two hours of video showing specific applications, featuring author Sandy Fritz. A complete general protocol for massage. State-of-the-art animations depicting biologic functions and medical procedures. 700 full-color illustrations accompany procedures, concepts, and techniques. An integrated healthcare approach covers the healthcare environment and the skills necessary to be a contributing member of an integrated healthcare team. A research-based focus emphasizes research, clinical reasoning, and outcome-based massage application for effective massage application in conjunction with healthcare intervention. A complete general protocol provides a guide to treating disorders and maintaining wellness, with recommendations for positioning and interventions, using a step-by-step sequence that can easily be modified to meet a patients specific needs. A palliative protocol helps you temporarily relieve a patients symptoms of disorders or diseases. Case studies focus on outcome-based massage for individuals with multiple health issues, detailing assessment, medical intervention, justification for massage, and session documentation. Coverage of advanced massage therapy skills and decision-making skills includes specific themes for effective massage application, allowing you to consolidate massage treatment based on the main outcomes useful when working with individuals with multiple pathologies or treatment needs. A discussion of aromatherapy provides safe recommendations for the use of essential oils in conjunction with massage, to promote healing of the body and mind. Descriptions of illness and injury include relevant anatomy/physiology/pathophysiology, as well as strategies and massage applications to use for pain management, immune support, stress management, chronic illness, and post-surgical needs. Coverage of insurance and reimbursement issues relates to you as a massage professional. Strategies for general conditions such as substance abuse, mental health, orthopedic injury, and cardiovascular disorders help you specialize in clinical massage. Expert authors provide knowledge in research, massage therapy in healthcare, and manual therapies. Learning resources include chapter outlines, chapter learning objectives, key terms, and workbook-style exercises. A companion Evolve website includes: PubMed links to research supporting best practices and justification for massage application. More information on topics such as insurance, pharmacology, and nutrition. More information on anatomy and physiology and other subjects. A comprehensive glossary with key terms and some audio pronunciations.

Models of Stress and Adapting to Risk: A Life Course, Developmental Perspective

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Jul 2012
J Public Ment Health

This chapter explores the role of stress in the conduct of both public mental health research and practice. It begins with a discussion of the leading definitions and theories of stress proposed in relation to the experience of mental problems, followed by an examination of the multiple perspectives related to the measurement and study of stress. Given the ubiquitous nature of stress and its association with developmental challenges, this review is couched within a broader life course perspective. This perspective highlights the significance of both human development and the social context in examining the link between stress and mental health problems. The chapter identifies a range of developmental stressors spanning different life stages and describes their effects on mental health and adjustment problems.

The Tottori-Ken Seibu earthquake and exacerbation of asthma in adults

Article

Feb 2005
J Med Investig

The aim of the study was to characterize patients at risk for exacerbations of their asthma as a result of the Tottori-Ken Seibu earthquake and to identify factors that predict exacerbation of asthma after an earthquake. A retrospective cohort study-analysis was conducted of 156 asthmatic patients, aged 18 to 89 years, who were out-patients of Tottori University Hospital and who had completely recorded their asthmatic symptoms and measured their peak expiratory flow (PEF) rates for more than one year prior to the earthquake. Seventeen (11%) patients who experienced the earthquake were identified as having an exacerbation within one month after the earthquake. Diurnal variability of PEF during the month after the earthquake was compared to values during a matched month one year previously. When factors associated with exacerbation were identified by a review of the medical case notes and the contribution of these factors to the exacerbation was determined using multivariate analysis, airflow limitation was shown to be independently associated with exacerbation after the earthquake. Acute asthma attacks are more likely to occur within the first week after the earthquake event without diurnal PEF variability. Asthma is likely to worsen after an earthquake.

The Jones Morbidity Index as an aid for community pharmacists to identify poor asthma control during the dispensing process

Article

Feb 2010
Int J Pharm Pract

T. Nishiyama

Objective To determine if the Jones Morbidity Index can be used in community pharmacy when asthmatic patients collect their prescriptions to identify those who have poor control. Method Structured questionnaires were completed by asthmatics who presented prescriptions at community pharmacies to assess their morbidity and knowledge of asthma and their attitudes towards and usage of medication. Setting Community pharmacies throughout the UK. Key findings Complete data on 306 patients were returned by 41 community pharmacists. Seventy-one patients reported using an asthma diary, 161 attended an asthma clinic and 194 had visited their doctor during the past year because of an acute exacerbation (GPV). Problems with metered dose inhaler (MDI) technique were identified in 165 patients. Patients' mean (SD) asthma knowledge score (K) (maximum 5) was 3.48 (1.32). Over the past six months they had received 0.88 (1.78) courses of oral prednisolone (P), 1.12 (1.85) courses of antibiotics (A) and 1.20 (4.51) courses of cough medicine (CM). Using the Jones Morbidity Index (JMI), 74 patients (24.2%) had low morbidity, 90 (29.4%) had medium morbidity and 142 (46.4%) had high morbidity. Comparisons between the morbidity categories revealed significant differences for P, A, GPV, “happy with” preventer (P < 0.001) and “happy with” reliever (P < 0.01) together with CM, K and compliance (P < 0.05). More patients classed as having high morbidity overused their reliever (P < 0.01) and were less compliant with their preventer (P < 0.001). There was no association between JMI and medication. Conclusion The JMI is a valuable tool to identify poor asthma control when patients present prescriptions at community pharmacies. More than half the asthmatics presenting their prescriptions at pharmacies had symptoms and signs indicating poor control.

A logistic regression analysis of predictors for asthma hospital re-admissions

Article

Jan 2003

In order to identify the risk factors (predictors) of re-hospitalisation for high-risk asthmatic patients, a retrospective logistic regression analysis describing the relationship between the probability of re-admission and possible predictors in hospitalised asthmatics, aged over 5 years, between 1994-1998, was designed. Study setting was a district general hospital in the West Yorkshire, UK. The results obtained showed that there was a 25.5% re-admission rate for 440 patients admitted to the hospital during the period of study. Multivariate logistic regression analysis using the forward stepwise method revealed that only sex (OR=2.65, 95% CI: 1.42, 4.92), Jarman score (OR=2.03, 95% CI: 1.13-3.65) and allergy (OR=1.88, 95% CI: 1.06-3.32) could remain in the model as significant risk factors. It could be concluded that female patients, patients registered within the practices with a higher workload (higher Jarman score) and those who has a history of allergy were at a higher risk of re-admission. More attention should be paid to these patients who are in a higher risk of hospitalisation.

Umbilical Cord Derived Mast Cells as Models for the Study of Inflammatory Diseases

Chapter

Mar 2010

Introduction Mast Cell Triggers Mast Cell Mediators Selective Release of Mast Cell Mediators Natural Mast Cell Secretion Inhibitors Mast–T Cell Interaction Inflammatory Skin Diseases Fibromyalgia Syndrome Asthma Inflammatory Arthritis Coronary Inflammation Ocular Hypersensitivity Reactions Conclusion References

Health Inequalities According to Plant Size—Comparison of Small- and Medium-Sized Enterprises

Article

Aug 2010
J OCCUP ENVIRON MED

Assessing plant size-related differences based on self-reported working conditions and their influence on perceived symptoms at workplace. A total of 799 metal workers from 9 small-sized enterprises (SE) and 10 medium-sized enterprises (ME) German metal working plants were interviewed in 2007/2008. Inclusion criteria were "wet work" and willingness to participate (response rate: 58% in ME, 67.7% in SE). Workers in SE complained more often of hand eczema (20.2% vs 13.8%) whereas workers in ME more frequently reported breathing problems (4.2% vs 0.9%). Work safety was higher in ME. The higher rate of skin impairment in SE might be explained by a lower level of work safety. However, the higher frequency of perceived respiratory symptoms in ME seems to contradict this assumption and except plant size there might exist another potential confounder, especially for breathing impairment.

Predictors of cigarette smoking in adolescents with asthma [electronic resource] : a sample from the third national health and nutrition examination survey /

Article

Full-text available

Title from PDF t.p. Thesis (Ph.D.)--Ohio University, August, 2006. Includes bibliographical references. Available online via OhioLINK's ETD Center. System requirements: Adobe Acrobat Reader. Mode of access: World Wide Web.

Blunted Cortisol Responses to Psychosocial Stress in Asthmatic Children: A General Feature of Atopic Disease?

Article

Sep 2003
PSYCHOSOM MED

Atopy is defined by the individual predisposition to develop a group of inflammatory disorders in response to certain food or environmental substances that are otherwise innocuous for the host. In previous studies we could demonstrate a reduced responsiveness of the hypothalamus-pituitary-adrenal (HPA) axis to psychosocial stress in young and adult patients with atopic dermatitis (AD), a chronic atopic skin disorder. With respect to the important immunoregulatory role of the HPA axis, especially under stress, this observation could be of clinical relevance and may at least partly explain stress-induced exacerbation of AD. The present study was designed to investigate whether attenuated responsiveness of the HPA axis to stress represents a characteristic feature of AD or whether it can also be found in other chronic manifestations of atopy. Children (aged 7-12) with allergic asthma (AA; N = 17) and age- and sex-matched healthy controls (N = 18) were exposed to the "Trier Social Stress Test for Children"(TSST-C), which mainly consists of a free speech and mental arithmetic tasks in front of an audience. Salivary cortisol was measured in ten-minute intervals before and after the TSST-C, while heart rate was monitored continuously. In addition, early morning cortisol levels (after awakening, +10, +20, +30 minutes) were assessed on three consecutive days. Data analysis yielded a significant increase of cortisol concentrations (F (9297)= 16.79; p <.001) and heart rates (F(32,992)= 9.16; p <.001) after the stressor with no between-group difference in heart rate responses. However, AA children showed a significantly blunted cortisol response to the TSST-C when compared with the control group (F(9297)= 2.95; p <.01). Awakening in the morning was accompanied by a significant rise of cortisol levels on all three experimental days in AA and control subjects (all p <.001) that was not different between the two groups. These findings suggest that a blunted adrenocortical response to stress may represent a common feature of chronic allergic inflammatory processes that may be relevant in different forms of chronic manifestation of atopy.

A Cox Regression Analysis of Covariates for Asthma Hospital Readmissions

Article

Sep 2003

Asthma hospital admissions and readmissions are unacceptably high, thus, a method to identify those at greatest risk could be helpful. An observational retrospective study using a Cox regression to determine the relationship between the time interval between admissions and possible covariates of a readmission. The covariates were age, sex, ethnicity, smoking habit, history of allergy or eczema/hay fever, age of onset, Townsend index (TI), Jarman score (JS), and drugs on discharge. Those with p < 0.2, together with interacting covariates, from the preliminary analysis were eligible for the multivariate Cox regression analysis. Of the 523 patients admitted between 1994 and 1998 because of their asthma, complete data were available for 440. Of these, 112 were readmitted. Eligible covariates for the multivariate Cox regression analysis were sex, allergy status, history of eczema/hay fever, the JS and TI together with interactions between JS and TI, JS and allergy, and allergy with eczema/hay fever. There were 278 subjects (71 with a readmission) with complete data for these eligible covariates. The multivariate analysis revealed that female sex (odds ratio [OR] = 2.65, 95% confidence interval [CI] 1.42, 4.92), high JS (OR = 2.03, 95% CI 1.13-3.65), and history of allergy (OR = 1.88, 95% CI 1.06-3.32) formed the final model as significant predictors of readmission. Females with a history of allergy that were registered at a practice with a high workload (JS) had a higher risk of readmission. The analysis method used highlights how those at risk of readmission can be identified so that they can be targeted post discharge.

Socioeconomic Status, Stress, and Immune Markers in Adolescents With Asthma

Article

Nov 2003
PSYCHOSOM MED

Previous research has demonstrated links between low socioeconomic status (SES) and clinical asthma outcomes, as well as links between stress and asthma. The objective of this study was to test whether adolescents with asthma from different SES backgrounds differed in biological profiles relevant to asthma, including immune and cortisol measures. The second objective was to test whether psychological stress and control beliefs could explain these differences. Adolescents with persistent asthma from either low (N= 18) or high (N= 12) SES neighborhoods were interviewed about their stress experiences (chronic stress, acute life events, interpretations of ambiguous life events) and control beliefs. Blood was drawn to assess immune (cytokines, eosinophils, IgE) and neuroendocrine (cortisol) markers associated with asthma. Adolescents in the low SES group had significantly higher levels of a stimulated cytokine associated with a Th-2 immune response (IL-5), higher levels of a stimulated cytokine associated with a Th-1 immune response (IFN-gamma), and marginally lower morning cortisol values compared with the high SES group. Low SES adolescents also had greater stress experiences and lower beliefs about control over their health. Statistical mediational analyses revealed that stress and control beliefs partially explained the relationship between SES and IL-5/IFN-gamma. Our finding that low SES was associated with elevations in certain immune responses (IL-5/IFN-gamma) in adolescents with asthma suggests the importance of further exploration into relationships between SES and Th-2/Th-1 responses in asthma. Our findings also suggest that psychological stress and control beliefs may provide one explanation for links between SES and immune responses in childhood asthma.

Psychiatric Disorders and Asthma Outcomes Among High-Risk Inner-City Patients

Article

Nov 2005
PSYCHOSOM MED

The purpose of this study was to examine the rate of psychiatric disorders among patients attending an ethnically diverse, inner-city asthma clinic for an initial visit and assess the association between psychiatric disorders and asthma morbidity. A semistructured psychological interview was conducted to assess for psychiatric diagnoses. A pulmonary physician, who was blind to psychiatric disorder, established diagnosis of asthma based on national guidelines. Sixty-four percent of 85 participants received at least 1 psychiatric diagnosis. The pulmonary physician rated patients with a psychiatric disorder as achieving fewer goals (M = 2.3 +/- 1.3) for asthma control than patients without a psychiatric disorder (M = 3.6 +/- 1.5, p = .0002). Patients with a psychiatric diagnosis more frequently reported an emergency room visit for asthma during the past 6 months (OR = 4.89; 95% CI, 1.76-13.39) and greater use of short-acting beta2-agonist medication (M = 1.5 +/- 0.9 canisters per month) than patients without a psychiatric diagnosis (M = 0.9 +/- 0.8, p = .003). These findings were independent of demographics, health insurance, and asthma severity. No differences emerged between patients with and without a mental disorder on percent predicted FEV1. Patients with a psychiatric disorder reported a higher severity level for asthma symptoms than the severity level indicated by their pulmonary function in comparison to patients without a psychiatric diagnosis (OR = 3.52; 95% CI, 1.23-10.10). Health insurance appeared to be a confounding factor in this relationship. A high rate of psychiatric disorders was found among inner-city asthma patients. Psychiatric diagnoses were associated with greater perceived impairment from asthma but not objective measurement of pulmonary function.

Comorbidity Between Asthma Attacks and Internalizing Disorders Among Puerto Rican Children at One-Year Follow-Up

Article

Jul 2006
PSYCHOSOMATICS

Authors examined the association between internalizing disorders and asthma attacks at 1-year follow-up among a community sample of 1,789 children and adolescents ages 5-18 years living on the island of Puerto Rico. The Diagnostic Interview Schedule for Children was administered to assess DSM-IV internalizing disorders during the past year. Children with a lifetime history of asthma attacks at baseline had greater odds of having an internalizing disorder at 1-year follow-up, independent of socio-demographic measures. However, an association was not found between asthma attacks and persistence of internalizing disorders. These findings show that the association between internalizing disorders and asthma attacks was replicated 1 year later in the same sample.

The Critical Role of Mast Cells in Allergy and Inflammation

Article

Dec 2006

Mast cells are well known for their involvement in allergic and anaphylactic reactions, but recent findings implicate them in a variety of inflammatory diseases affecting different organs, including the heart, joints, lungs, and skin. In these cases, mast cells appear to be activated by triggers other than aggregation of their IgE receptors (FcepsilonRI), such as anaphylatoxins, immunoglobulin-free light chains, superantigens, neuropeptides, and cytokines leading to selective release of mediators without degranulation. These findings could explain inflammatory diseases, such as asthma, atopic dermatitis, coronary inflammation, and inflammatory arthritis, all of which worsen by stress. It is proposed that the pathogenesis of these diseases involve mast cell activation by local release of corticotropin-releasing hormone (CRH) or related peptides. Combination of CRH receptor antagonists and mast cell inhibitors may present novel therapeutic interventions.

Human Umbilical Cord Blood-Derived Mast Cells: A Unique Model for the Study of Neuro-Immuno-Endocrine Interactions

Article

Feb 2006

Findings obtained using animal models have often failed to reflect the processes involved in human disease. Moreover, human cultured cells do not necessarily function as their actual tissue counterparts. Therefore, there is great demand for sources of human progenitor cells that may be directed to acquire specific tissue characteristics and be available in sufficient quantities to carry out functional and pharmacological studies. Acase in point is the mast cell, well known for its involvement in allergic reactions, but also implicated in inflammatory diseases. Mast cells can be activated by allergens, anaphylatoxins, immunoglobulin-free light chains, superantigens, neuropeptides, and cytokines, leading to selective release of mediators. These could be involved in many inflammatory diseases, such as asthma and atopic dermatitis, which worsen by stress, through activation by local release of corticotropin-releasing hormone or related peptides. Umbilical cord blood and cord matrix-derived mast cell progenitors can be separated magnetically and grown in the presence of stem cell factor, interleukin-6, interleukin-4, and other cytokines to yield distinct mast cell populations. The recent use of live cell array, with its ability to study such interactions rapidly at the single-cell level, provides unique new opportunities for fast output screening of mast cell triggers and inhibitors.

The Role of the Social Environment in Children and Adolescents with Asthma

Article

Oct 2007

Biopsychosocial models of asthma have been proposed in the literature, but few empirical tests of social factors at various levels of influence have been conducted. To test associations of neighborhood, peer, and family factors with asthma outcomes in youth, and to determine the pathways through which these social factors operate. Observational study of youths with asthma (n = 78). Youths completed questionnaires about neighborhood problems, peer support, and family support. Biological (IgE, eosinophil count, production of IL-4) and behavioral (youth smoking, exposure to smoke, adherence to medications) pathways were measured. Asthma symptoms and pulmonary function were assessed in the laboratory and at home for 2 weeks. Lower levels of family support were associated with greater symptoms (beta coefficients: -0.26 to -0.33, P < 0.05) and poorer pulmonary function (beta: 0.30, P < 0.05) via biological pathways (Z statistics from 1.19 to 1.51, P < 0.05). Higher levels of neighborhood problems were associated with greater symptoms (beta coefficients: 0.27-0.33, P < 0.05) via behavioral pathways related to smoking (Z statistics = 1.40, P < 0.05). Peer support was not associated with symptoms or pulmonary function. This study indicates that family factors may affect youths' asthma via physiologic changes, whereas community factors may help shape the health behaviors of youths with asthma.

Binge Drinking, Poor Mental Health, and Adherence to Treatment Among California Adults with Asthma

Article

Jul 2008
J ASTHMA

Binge drinking and poor mental health may affect adherence to treatment for individuals with asthma. The purposes were to (a) examine the relationship of self-reported binge drinking and mental health to adherence to daily asthma control medications and (b) identify other demographic and health-related factors associated with asthma control medication adherence. Secondary analyses of 2003 adult California Health Interview Survey data were undertaken, and these analyses identified 3.2 million California adults who had been told by a physician they had asthma. Of these, approximately 1.7 million were symptomatic. Binge drinking significantly predicted medication nonadherence among California adults with symptomatic asthma (OR = .63, 95% CI = .45-.89), whereas poor mental health did not. Other predictors of nonadherence (odds ratios < 1, p < .05) included being overweight, younger age, having some college education, being a current smoker, and having no usual source of medical care. Predictors of adherence (odds ratios > 1, p < .05) were older age, more frequent asthma symptoms, more ER visits, more missed work days, being African American, and being a non-citizen. Intervention efforts could be directed toward improving medication adherence among adult asthma patients who engage in risky health behaviors such as binge drinking. Also at risk for medication nonadherence and therefore good targets for asthma control medication management interventions are adults who are overweight, younger (18-44 age range), have some college education, and no usual source of medical care.

Does the Social Environment Contribute to Asthma?

Article

Sep 2008
IMMUNOL ALLERGY CLIN

The impact of the social environment on asthma has recently begun to receive increasing attention. This article reviews the current literature to investigate the impact of the social environment at three levels-the neighborhood level, the peer level, and the family level-and to explore pathways through which the social environment "gets under the skin" to impact asthma onset and morbidity. Research to date suggests that adverse social conditions at the neighborhood and family levels impact asthma morbidity through direct effects on physiologic systems as well as by altering health behaviors. The impact on asthma of social networks, such as friendships, is less clear and will need to be investigated further. Future research will need to take into account the impact of the social environment to develop more comprehensive models of asthma pathogenesis.

Psychological stress in humans and susceptibility to the common cold.

Article

Full-text available

Sep 1991

It is not known whether psychological stress suppresses host resistance to infection. To investigate this issue, we prospectively studied the relation between psychological stress and the frequency of documented clinical colds among subjects intentionally exposed to respiratory viruses. After completing questionnaires assessing degrees of psychological stress, 394 healthy subjects were given nasal drops containing one of five respiratory viruses (rhinovirus type 2, 9, or 14, respiratory syncytial virus, or coronavirus type 229E), and an additional 26 were given saline nasal drops. The subjects were then quarantined and monitored for the development of evidence of infection and symptoms. Clinical colds were defined as clinical symptoms in the presence of an infection verified by the isolation of virus or by an increase in the virus-specific antibody titer. The rates of both respiratory infection (P less than 0.005) and clinical colds (P less than 0.02) increased in a dose-response manner with increases in the degree of psychological stress. Infection rates ranged from approximately 74 percent to approximately 90 percent, according to levels of psychological stress, and the incidence of clinical colds ranged from approximately 27 percent to 47 percent. These effects were not altered when we controlled for age, sex, education, allergic status, weight, the season, the number of subjects housed together, the infectious status of subjects sharing the same housing, and virus-specific antibody status at base line (before challenge). Moreover, the associations observed were similar for all five challenge viruses. Several potential stress-illness mediators, including smoking, alcohol consumption, exercise, diet, quality of sleep, white-cell counts, and total immunoglobulin levels, did not explain the association between stress and illness. Similarly, controls for personality variables (self-esteem, personal control, and introversion-extraversion) failed to alter our findings. Psychological stress was associated in a dose-response manner with an increased risk of acute infectious respiratory illness, and this risk was attributable to increased rates of infection rather than to an increased frequency of symptoms after infection.

Psychological stress and susceptibility to the common cold

Chapter

Full-text available

Jan 1997
NEW ENGL J MED

Stress, Social Support, and the Buffering Hypothesis

Article

Full-text available

Sep 1985

The purpose of this article is to determine whether the positive association between social support and well-being is attributable more to an overall beneficial effect of support (main- or direct-effect model) or to a process of support protecting persons from potentially adverse effects of stressful events (buffering model). The review of studies is organized according to (a) whether a measure assesses support structure or function, and (b) the degree of specificity (vs. globality) of the scale. By structure we mean simply the existence of relationships, and by function we mean the extent to which one’s interpersonal relationships provide particular resources. Special attention is paid to methodological characteristics that are requisite for a fair comparison of the models. The review concludes that there is evidence consistent with both models. Evidence for a buffering model is found when the social support measure assesses the perceived availability of interpersonal resources that are responsive to the needs elicited by stressful events. Evidence for a main effect model is found when the support measure assesses a person’s degree of integration in a large social network. Both conceptualizations of social support are correct in some respects, but each represents a different process through which social support may affect well-being. Implications of these conclusions for theories of social support processes and for the design of preventive interventions are discussed.

State and Trait Negative Affect as Predictors of Objective and Subjective Symptoms of Respiratory Viral Infections

Article

Full-text available

Jan 1995

State and trait negative affect (NA) were measured in healthy people immediately before an illness was induced through exposure to a respiratory virus. State NA, disease-specific health complaints (e.g., runny nose, congestion, and sneezing), and an associated objective marker of disease severity (mucus secretion weights) were assessed daily during the illness. Baseline trait and state NA were both associated with increased numbers of subsequent complaints. Although greater numbers of complaints among people high in state NA were explicable in terms of greater disease severity, the association of trait NA and symptoms was independent of objective disease. The trait NA complaint association was also independent of state NA and hence not attributable to trait-elicited state affect. Greater trait NA was associated with biases in complaining during but not before illness. This suggested failure to discriminate between symptoms rather than increased sensitivity or hypochondriacal response.

Negative Life Events, Perceived Stress, Negative Affect, and Susceptibility to the Common Cold

Article

Full-text available

Jan 1993

After completing questionnaires assessing stressful life events, perceived stress, and negative affect, 394 healthy Ss were intentionally exposed to a common cold virus, quarantined, and monitored for the development of biologically verified++ clinical illness. Consistent with the hypothesis that psychological stress increases susceptibility to infectious agents, higher scores on each of the 3 stress scales were associated with greater risk of developing a cold. However, the relation between stressful life events and illness was mediated by a different biologic process than were relations between perceived stress and illness and negative affect and illness. That these scales have independently relations with illness and that these relations are mediated by different processes challenges the assumption that perceptions of stress and negative affect are necessary for stressful life events to influence disease risk.

On becoming virtual

Article

May 1997

S. Cohen

Streptococcal Infections in Families

Article

Jan 1962

Individual Differences in Cellular Immune Response to Stress

Article

Mar 1991

Correlational studies suggest that psychological stress suppresses cellular immune function in some, but not all, individuals. Here, effects of acute mental stress on lymphocyte subpopulations and T-lymphocyte mitogenesis were examined experimentally in healthy young adults. CD8 (T-suppressor/cytotoxic) lymphocytes increased in number and T-cell response to stimulation by phytohemagglutinin was attenuated following exposure to a 20-min laboratory stressor, but only in persons who also showed heightened catecholamine and cardiovascular reactions to stress. Hence, individuals differ substantially in their immunologic responsivity to behavioral stimuli, and such differences parallel (and may be predicted by) interindividual variability in stress-induced sympathetic nervous system activation.

Social Ties and Susceptibility to the Common Cold

Article

Jun 1997

Objective: To examine the hypothesis that diverse ties to friends, family, work, and community are associated with increased host resistance to infection. Design: After reporting the extent of participation in 12 types of social ties (eg, spouse, parent, friend, workmate, member of social group), subjects were given nasal drops containing 1 of 2 rhinoviruses and monitored for the development of a common cold. Setting: Quarantine. Participants: A total of 276 healthy volunteers, aged 18 to 55 years, neither seropositive for human immunodeficiency virus nor pregnant. Outcome measures: Colds (illness in the presence of a verified infection), mucus production, mucociliary clearance function, and amount of viral replication. Results: In response to both viruses, those with more types of social ties were less susceptible to common colds, produced less mucus, were more effective in ciliary clearance of their nasal passages, and shed less virus. These relationships were unaltered by statistical controls for prechallenge virus-specific antibody, virus type, age, sex, season, body mass index, education, and race. Susceptibility to colds decreased in a dose-response manner with increased diversity of the social network. There was an adjusted relative risk of 4.2 comparing persons with fewest (1 to 3) to those with most (6 or more) types of social ties. Although smoking, poor sleep quality, alcohol abstinence, low dietary intake of vitamin C, elevated catecholamine levels, and being introverted were all associated with greater susceptibility to colds, they could only partially account for the relation between social network diversity and incidence of colds. Conclusions: More diverse social networks were associated with greater resistance to upper respiratory illness.

Stress and Immune Function in Humans

Article

Dec 1991

review aspects of the complex interactions among the central nervous system (CNS), the endocrine system, and the immune system from the perspective of behavioral immunology, exploring the hypothesis that various psychological stressors impact on the CNS, with a resulting CNS modulation of the immune response two central questions to be explored involve the mechanisms of the interactions of the CNS-endocrine-immune axis and the implications for health (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Positive Events and Social Supports as Buffers of Life Change Stress1

Article

Apr 1983
J APPL SOC PSYCHOL

A perceived availability of social support measure (the ISEL) was designed with independent subscales measuring four separate support functions. In a sample of college students, both perceived availability of social support and number of positive events moderated the relationship between negative life stress and depressive and physical symptomatology. In the case of depressive symptoms, the data fit a “buffering” hypothesis pattern, i.e., they suggest that both social support and positive events protect one from the pathogenic effects of high levels of life stress but are relatively unimportant for those with low levels of stress. In the case of physical symptoms, the data only partially support the buffering hypothesis. Particularly, the data suggest that both social support and positive events protect one from the pathogenic effects of high levels of stress but harm those (i.e., are associated with increased symptomatology) with low levels of stress. Further analyses suggest that self-esteem and appraisal support were primarily responsible for the reported interactions between negative life stress and social support. In contrast, frequency of past social support was not an effective life stress buffer in either the case of depressive or physical symptomatology. Moreover, past support frequency was positively related to physical symptoms and unrelated to depressive symptoms, while perceived availability of support was negatively related to depressive symptoms and unrelated to physical symptoms.

Viral infection in adults with chronic asthma

Article

Sep 1979
Am J Respir Crit Care Med

To determine the frequency of viral, mycoplasmal, and bacterial infections in adult asthmatic patients, 19 patients were examined for the presence of these organisms during wheezing exacerbations and on a routine monthly basis when the asthma was under control. Subjects were studied during consecutive periods that ranged from 8 to 19 months. During 243 routine visits, 8 viral infections were identified (3.3 per cent). Twenty-nine of 47 sputum specimens contained 'pathogenic' bacteria (62 per cent), but this frequency was due primarily to chronic colonization in 4 patients. During 84 wheezing exacerbations, 8 viral infections were found (11 per cent), an incidence greater than that during routine visits (P<0.02). Three acute bacterial infections were found during exacerbations (9 per cent). Patients whose respiratory tracts were chronically colonized with 'pathogenic' bacteria did not have an increased number of these episodes. It was concluded that (1) viral but not bacterial respiratory tract infections were significantly increased during wheezing exacerbations in adult asthmatic patients, (2) respiratory tract infections can occur without necessarily worsening the asthma, and (3) in some asthmatic patients the respiratory tract may be chronically colonized with 'pathogenic' bacteria without increased frequency of asthmatic exacerbations.

Viral respiratory tract infections and exacerbations of asthma in adults

Article

Oct 1988

The role of viral respiratory tract infections in acute exacerbations of asthma was studied prospectively in 31 patients with atopic asthma aged 15-56 years. Patients recorded symptom scores for asthma and peak expiratory flow rate daily for 11 months. In addition, they reported for detailed clinical, functional, and virological study every four weeks and as soon as possible after the onset of worsening asthma or symptoms suggesting a respiratory tract infection. Thirty viral identifications were made, of which 18 (60%) were associated with an exacerbation of asthma. Viral respiratory tract infection was identified in 18 (10%) of the 178 exacerbations of asthma, and in 10 (36%) of the 28 severe exacerbations. The frequency of viral identifications in 16 non-asthmatic, control subjects during the same period was similar. It is concluded that viral respiratory tract infections may cause or be associated with exacerbations of asthma in adults, and that they are an important factor in severe exacerbations.

Stress and acute respiratory infection

Article

Oct 1986
AM J EPIDEMIOL

To examine the relationship between stress and upper respiratory tract infection, 235 adults aged 14-57 years, from 94 families affiliated with three suburban family physicians in Adelaide, South Australia, participated in a six-month prospective study. High and low stress groups were identified by median splits of data collected from the Life Events Inventory, the Daily Hassles Scale, and the General Health Questionnaire, which were administered both before and during the six months or respiratory diary data collection. Using intra-study stress data, the high stress group experienced significantly more episodes (mean of 2.71 vs. 1.56, p < 0.0005) and symptom days (mean of 29.43 vs. 15.42, p = 0.005) of respiratory illness. The two groups were almost identical with respect to age, sex, occupational status, smoking, passive smoking, exposure to air pollution, family size, and proneness to acute respiratory infection in childhood. In a multivariate model with total respiratory episodes as the dependent variable, 21% of the variance was explained, and two stress variables accounted for 9% of the explained variance. Significant, but less strong relationships were also identified between intra-study stress variables and clinically 'definite' episodes and symptom days in both clinically definite and total respiratory episodes. Pre-study measures of stress emphasized chronic stresses and were less strongly related to measures of respiratory illness than those collected during the study. However, significantly more episodes (mean of 2.50 vs. 1.75, p < 0.02) and symptom days (mean of 28.00 vs. 17.06, p < 0.03) were experienced in the high stress group. In the multivariate analyses, pre-study stress remained significantly associated with total respiratory episodes and symptom days in total and 'definite' respiratory episodes. In all of the multivariate analyses performed, sex (female) and age also appeared as important correlates of respiratory illness.

Some further studies on the prediction of experimental colds in volunteers by psychological factors

Article

Feb 1984
J PSYCHOSOM RES

An analysis of the incidence of colds in volunteers, exposed experimentally to various rhinovirus and influenza virus challenges, confirmed an earlier report that assessments of virus shedding show a higher degree of infection by rhinovirus in Introverts than they do in Extroverts. The influenza trials however did not show such an effect. In addition, people with higher scores on a widely used self-report inventory of mild psychoneurotic symptoms tended to show more evidence of increased nasal secretion after infection by either type of virus. The specific scale showing the latter effect most clearly was that of Obsessional Symptoms. Taking account of these psychological factors greatly increased the sensitivity of a study of the beneficial effects of interferon.

Enzyme-linked immunosorbent assay for detection of antibody in volunteers experimentally infected with human coronavirus strain 229E

Article

Nov 1980

An enzyme-linked immunosorbent assay was developed for detecting antibody rises to human coronavirus strain 229E and related strains in paired sera from infected volunteers. There was a close correlation between development of colds infected volunteers. There was a close correlation between development of colds and significant antibody rises detected by the enzyme-linked immunosorbent assay. Furthermore, the assay was more sensitive than a neutralization assay. This enzyme-linked immunosorbent assay is an easy, accurate, and sensitive assay for measuring significant antibody rises to human coronavirus strain 229E group viruses, and it could be useful in the clinical diagnosis of these infections.

Early asthma onset: The interaction between family stressors and adaptive parenting

Article

Mar 1994

It has been repeatedly noted by clinicians that psychological stressors appear to be associated with the expression of asthma in individuals who have a genetic vulnerability for developing the disease. While retrospective evidence has supported this clinical observation (Levitan 1985; Teiramaa 1986), the association between emotional stressors and illness onset can only be convincingly demonstrated using a longitudinal design (Mrazek 1988; Steinhausen et al. 1983). In 1985 the W. T. Grant Asthma Risk Study was designed to identify which physiological and psychological risk factors for asthma were most highly associated with eventual expression of the disease. Young infants who were genetically at risk for asthma were evaluated and their development was prospectively monitored. The primary objective of the longitudinal study was to identify risk factors for illness expression. If this were possible, these risk factors could then be targeted for intervention efforts designed to delay the initial onset of asthmatic symptoms. The ultimate objective of an effective intervention would be that for some children, the illness could be prevented completely.

Respiratory viruses and exacerbations of asthma

Article

Nov 1993

To study the role of respiratory viruses in exacerbations of asthma in adults. Longitudinal study of 138 adults with asthma. Leicestershire Health Authority. 48 men and 90 women 19-46 years of age with a mean duration of wheeze of 19.6 years. 75% received regular treatment with bronchodilators; 89% gave a history of eczema, hay fever, allergic rhinitis, nasal polyps, or allergies; 38% had been admitted to hospital with asthma. Symptomatic colds and asthma exacerbations; objective exacerbations of asthma with > or = 50 l/min reduction in mean peak expiratory flow rate when morning and night time readings on days 1-7 after onset of symptoms were compared with rates during an asymptomatic control period; laboratory confirmed respiratory tract infections. Colds were reported in 80% (223/280) of episodes with symptoms of wheeze, chest tightness, or breathlessness, and 89% (223/250) of colds were associated with asthma symptoms. 24% of 115 laboratory confirmed non-bacterial infections were associated with reductions in mean peak expiratory flow rate > or = 50 l/min through days 1-7 and 48% had mean decreases > or = 25 l/min. 44% of episodes with mean decreases in flow rate > or = 50 l/min were associated with laboratory confirmed infections. Infections with rhinoviruses, coronaviruses OC43 and 229E, influenza B, respiratory syncytial virus, parainfluenza virus, and chlamydia were all associated with objective evidence of an exacerbation of asthma. These findings show that asthma symptoms and reductions in peak flow are often associated with colds and respiratory viruses; respiratory virus infections commonly cause or are associated with exacerbations of asthma in adults.

Smoking, alcohol consumption, and susceptibility to the common cold

Article

Oct 1993

This study was conducted to test the supposition that both smoking and consuming alcohol suppress host resistance to viral infections. The relations between smoking, alcohol consumption, and the incidence of documented clinical colds were prospectively studied among 391 subjects intentionally exposed to one of five respiratory viruses and 26 subjects given saline. Clinical colds were defined as clinical symptoms verified by the isolation of virus or by an increase in virus-specific antibody titer. Analyses included control variables for demographics; body weight; virus; and environmental, immunological and psychological factors. Smokers were at greater risk for developing colds than nonsmokers because smokers were more likely both to develop infections and to develop illness following infection. Greater numbers of alcoholic drinks (up to three or four per day) were associated with decreased risk for developing colds because drinking was associated with decreased illness following infection. However, the benefits of drinking occurred only among nonsmokers. Susceptibility to colds was increased by smoking. Although alcohol consumption did not influence risk of clinical illness for smokers, moderate alcohol consumption was associated with decreased risk for nonsmokers.

Improved detection of Rhinoviruses in nasal and throat swabs by semi-nested RT-PCR

Article

Jun 1993

A seminested RT-PCR (nRT-PCR) was used to detect picornavirus (PV) RNA in cell cultures inoculated with rhinoviruses (HRVs) and enteroviruses (EVs). PCR tests in which a primary "touchdown" PCR was followed by secondary reactions using PV or HRV specific primers were able to differentiate HRVs of 48 serotypes from EVs. PVnRT-PCR and HRVnRT-PCR were then used to test nasal and throat swabs from adult subjects with naturally acquired respiratory virus infections. The swabs were also analysed for respiratory viruses by cell culture techniques and the rates of PV identification by the two methods were compared. PVnRT-PCR was found to be at least five times more sensitive than cell culture for the detection of PVs in these clinical specimens. Paired acute and convalescent serum samples were tested for complement fixing antibodies to adenovirus, influenza A and B, respiratory syncytial virus, parainfluenza viruses 1, 2, and 3, Myco plasma pneumoniae, and Chlamydia psittaci. An enzyme-linked immunosorbent assay (ELISA) was used to detect rises in antibody level to coronavirus types 229E and OC43. The overall rate of pathogen identification in 159 swabs from adult asthmatics increased from 28% when only cell culture and serology were used to 57% when these methods were supplemented by PVnRT-PCR.

Psychosocial Stress and Susceptibility to Upper Respiratory Tract Illness in an Adult Population Sample

Article

Sep 1996

To assess the influence of life event stress and hassles, and the moderating effects of psychological coping style, social support, and family environment, on susceptibility to upper respiratory tract infectious illness. One hundred seven adults aged 18 to 65 years took part in a 15-week study. Measures of life event stress were obtained for the 12 months preceding the study and for the study period itself, and social support, information seeking and avoidant coping styles, and family environment were assessed. Hassles and perceived stress were measured weekly, whereas dysphoric mood and changes in personal health practices (smoking, alcohol consumption, exercise, and sleep patterns) were assessed at three weekly intervals. Episodes of upper respiratory tract infectious illness were verified by clinical examination. During the study period, 29 individuals experienced at least one clinically verified episode of upper respiratory tract illness. There were no differences in cigarette smoking, sleep habits, or exercise between those who did and did not become ill but alcohol consumption was lower among those who experienced verified episodes. Risk of infectious illness was greater in those who experienced high life event stress both before and during the study period, but the impact of life events was buffered by an avoidant coping style. Strict family organization was associated with illness risk. The three weeks preceding illness onset were characterised by high levels of perceived stress, but also by a decrease in the number of hassles reported. Results suggest that under naturalistic conditions, the influence of stressful experience on risk of infectious illness is moderated by psychosocial resources. Variations in personal health practices do not seem to be responsible.

Self image, coping and familial interaction among asthmatic children and adolescents in Israel

Article

Mar 1997
PATIENT EDUC COUNS

The study was designed to investigate self esteem, modes of coping and interfamilial relationships of asthmatic children and adolescents. Fifty-one asthmatic children (mean age: 12.26 +/- 2.56 years; 57% boys and 43% girls) were questioned about psychological factors of self image, coping with stressful situations and family interaction. The data was compared with that from 32 healthy children who had the same socio-economic parameters. The self image scoring of the asthmatic children were lower in comparison with the healthy children (P = 0.035). The scores for their mode of coping with stressful situations and their chronic disease was lower in comparison with the control group (P = 0.041). Also, the scoring of the asthmatic group for their family interaction was lower in comparison with healthy children (P = 0.036). Thus, clinicians, besides providing regular drug therapy need to invest additional effort in educational and psychological means on behalf of asthmatic children. Children should not feel guilty because of their chronic disease. Psychological support can give them a chance to improve improve their self image with this chronic disease, to improve their mode of coping with their asthma and to improve immediate familial relationships. This can be done by medical social workers, educational counsellors and psychologists in collaboration with physicians. These families can participate in support groups, which will be organized for these 'asthmatic families'.

Increased theophylline metabolism in the menstrual phase of healthy women

Article

Aug 1997
J ALLERGY CLIN IMMUN

We previously reported on a Japanese woman with premenstrual asthma whose serum theophylline concentration was lower before the onset of her menstrual period. We evaluated the clearance of theophylline in each phase of her menstrual cycle and found an increase in clearance in the premenstrual and menstrual phases. This study was designed to investigate whether changes in theophylline clearance may occur with the menstrual cycle in nonasthmatic women. Aminophylline, 250 mg, was infused intravenously for 45 minutes, and the clearance of theophylline was calculated in seven healthy, ovulatory women on days 1 or 2, 10, and 20 or 25 of the menstrual cycle. The serum concentration of theophylline was determined with an enzyme immunoassay (homogeneous). Theophylline clearance was significantly higher and its half-life was significantly shorter in the menstrual phase than in the follicular phase. The metabolism of theophylline, and consequently, its clearance were increased in healthy women around the onset of menses. Clinicians must therefore consider the menstrual variation in theophylline metabolism when prescribing this drug to female patients.

Social ties and susceptibility to the common cold Stress and acute respiratory infection

Jan 1963
389-401

S Cohen
W J Doyle
D P Skoner
B S Rabin
M D Gwaltney
H J Eysenck
S B G Eysenck
N M H Graham

Cohen, S., Doyle, W.J., Skoner, D.P., Rabin, B.S., Gwaltney, M.D., 1997. Social ties and susceptibility to the common cold. J. Am. Med Assoc. 277, 24. Eysenck, H.J., Eysenck, S.B.G., 1963. Manual of the Eysenck Personality Inventory. University of London Press, London. Graham, N.M.H., Douglas, R.B., Ryan, P., 1986. Stress and acute respiratory infection. Am. J. Epidemiol. 124, 389–401.

Jan 2001
411-420

A Smith
Nicholson

A. Smith, K. Nicholson / Psychoneuroendocrinology 26 (2001) 411–420

Psychosocial factors, respiratory viruses and exacerbation of asthma

Abstract

No full-text available

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