He asthma Is a heterogeneous disease characterized by chronic inflammation of the airways. As a consequence respiratory symptoms such as wheezing, shortness of breath, chest tightness and coughing, which vary in time and intensity are observed.
If we pay attention to the etymological origin of the word, we observe that it comes from the Greek verb Aazein , Whose meaning is to"exhale with the mouth open or to gasp".
Since antiquity it has been recognized that the asthmatic patient suffers a psychosomatic suffering, where emotional aspects such as anguish, fear or sadness, play a relevant role. In other words, it is based on a multicausal etiopathogenic conception of bronchial asthma, where a genetic predisposition hinders multiple precipitating stimuli, including those of psychological origin.
The general concept of emotional role and social environment in asthma is described by Hippocrates In century IV a.C. On the other hand, Franz Alexander In 1950, was the first to propose a classification of 7 psychosomatic diseases among which asthma was present and ensured that the coexistence of psychological and somatic factors explained why the symptoms may disappear when certain changes are made in some of them.
Asthma Psychosocial Consequences
With respect to the psychosocial consequences, the psychiatric pathologies that have been seen related to asthma are depression, anxiety, panic attacks and substance abuse.
Depression is the most frequent, its prevalence in pediatric asthmatic patients is 5 to 15%, and depressive symptoms are described up to 50%, more frequent than in the healthy population.
In adolescents, the prevalence of depression increased to 16.3%. Depression increases in the face of the unpredictability of the attack and its multiple causality, and Learned helplessness , That is, the person behaves passively, with the subjective feeling of being unable to do anything, although there really are real opportunities to change the aversive situation. On the other hand, apathy makes it difficult for the person to respond to prodromal symptoms and is associated with pediatric death.
Anxiety occurs mainly in patients with persistent asthma and affects their own breathing difficulty during the asthmatic attack, as well as intermittent asthma and different precipitants. Such anxiety is related to the feelings of panic and fear discussed earlier.
On the other hand, the increase of anxiety in patients is favored in relation to their body image due to the consumption of Corticoids . These affect the full moon face, hair on the arms and legs, stretch marks, weight gain, bruises on the skin and acne.
The importance of knowing the comorbidity of asthma and emotions are related to the course of the disease since patients with asthma and with depression or anxiety are more likely to come to the ER. With the costs of the disease, asthmatic patients suffering from a second pathology, consume more drugs and visit a greater number of health specialists.
With the increase of the mortality rate and also with the prevention, since there are data that those patients in treatment with Antidepressants Cyclic patients suffering from major depression have shown improvement in symptoms and less frequent use of inhaled steroids.
Another of the psychological consequences observed are somatic complaints. They are people who are attentive to the physical symptoms and present an anxious and vigilant attitude.
One aspect that can be especially troublesome in the asthmatics is the deprivation of the physical exercise and even of the game. However, it is important to know that not all physical activities can be detrimental, sports like the swimming , Gymnastics, cycling, being a goalkeeper on a football team, do not have to cause asthma.
On the other hand with adequate preventive medication and pre-exercise warm-up, the chances of suffering an asthmatic attack are practically zero. As a curious fact, I would like to comment that during the 1984 Olympic Games, 67 athletes with bronchial asthma participated and 41 of them received medals.
As for the behavioral disorders, it is observed in the patients a decrease in social competence and increase of aggressiveness as well as the accomplishment of affective blackmail, using asthma as a means to achieve things.
Other times the medication participates in such behavioral alterations producing side effects such as restlessness, all of these aspects make adherence to treatment difficult. However, other authors have reported that they are patients with Greater empathy And emotional sensitivity.
The deterioration of self-concept is another aspect involved and is explained by experiences derived from the disease, such as hospitalizations, emergency visits, deprivation of physical exercise and school absenteeism. In many schools children have to ask permission to go out and take their medication, because only some children are allowed to take the inhaler to class. This causes separation of peers, delaying treatment and increasing the probability of truancy. The latter implies anxiety upon return and can lead to negatively reinforced crises if school is avoided.
Finally, there are perceptual and attentional deficits that are often attributed to the effects of medication or to excessive attention to symptoms.
What happens in an asthma attack?
In the following image you can see graphically what happens in the lungs before an asthma attack.
There are several degrees of severity, which is what we talk about mild, moderate and severe asthma. According to this the treatment will go in one direction or another, and will be temporary, punctual or for life.
In 2009, in the Spanish Guide to Asthma Management (GEMA), a classification of the severity of asthma was proposed. Then I leave you a table so you can see the differences.
As for epidemiological aspects, it is the most common chronic disease in childhood. The distribution by sex is higher in children in men, with a ratio of 2: 1, in adolescence the ratio between men and women is equal, being 1: 1 and in adulthood, however, the prevalence is higher in women. In addition, 80% of patients develop asthma before age 5.
With respect to infant-juvenile mortality, this is low, approximately 1/100000, however it is increasing slightly. The worst prognosis is if there is a Passive exposure to tobacco , If the symptoms have appeared late, if there is low birth weight or prematurity, if the attacks are severe and frequent and if the person's lung function is reduced.
If we focus on Spain, the prevalence of cases in 2003 offers the following data. Asthma occurs in 7.8% of infants, 13.5% of preschoolers, 11.5% of schoolchildren and 9.9% of adolescents. In the latter, asthma is very difficult to manage. Although the diagnosis is easier since the differential diagnosis is less extensive, however there is a high rate of underdiagnosis and undertreatment. Many experience anger, resentment, or frustration at being diagnosed.
In addition, treatment failure is more frequent in adolescents than in any other age group, it may be unintentional (forgetting to take it, not understanding or not having taught it well how to use it) or intentional (negation of the need for treatment, The side effects or rejection of the council by an authoritarian person). This is why it is not surprising that the level of morbidity and mortality is 6 times higher in this age range than in the range of 5 to 9 years.
Factors that influence asthma
The studies carried out on this aspect speak of the presence of Allergens (Pollen, mites, certain foods, animals...), infections, Physical exercise As well as changes in temperature, especially if the person is exposed to cold climates.
Regarding the role of psychological factors in asthma (cognitive, emotional, and behavioral variables), what patients and their relatives know, feel, and do about asthma can have a beneficial or harmful effect on the disease.
The exacerbating psychological factors are the emotions, the stress And psychiatric disorders such as depression , the anxiety and the panic attack . Fear and anxiety are negative feelings, because they influence the loss of emotional control and undermine good health. These emotional factors play an important role in the triggering, evolution, maintenance and recovery of asthmatic crisis.
Psychological variables of asthma
With Conditioning processes This author refers to the classical conditioning And the operant conditioning . That is, asthma appears before certain non-allergic stimuli that may have been associated with recurrent experiences of bronchial irritation. It may also occur in situations where manifestations of the disease are instrumental responses that allow the patient to gain benefits (positive reinforcement) or eliminate situations of aversion (negative reinforcement).
Refering to suggestion, It is a phenomenon that produces changes in the organism by the expectations generated by the patient. This was proved by an experiment in which it was found that the saline solution Bronchoconstrictor ) Implied a reduction of the bronchial gauge in 25-50% of people.
The Role of Emotions
The emotions , On the other hand, play an important role in the pathophysiology of asthma. In a study by Marx et al. The asthmatic patients' emotions were compared with the healthy ones, and it was observed that the former had a greater number of facial expressions, hostile attitudes and expressions of impotence in asthmatic patients, in relation to healthy patients. For his part, Rees in 1964, concludes that 71% of child crises are preceded by emotional precipitants.
Knowledge about the disease
With regard to Knowledge about the disease , 60% of the children have low adherence to the preventive medication, besides not applying it correctly. While 20-30% have important knowledge deficits about the pathophysiology of asthma, in addition to showing negative attitudes towards it.
Perception of degree of obstruction
The Perception of the degree of bronchial obstruction Is also important and worrying, as it has been seen that up to 15% of patients do not even perceive a state of bronchospasm even when the expiratory level is reduced by half. This may influence what has been said above about adherence to treatment.
There are also opposite cases in which anxiety could raise the threshold of perception of airway constriction, as well as the interpretation of different physical signs such as bronchospasm. This is reflected in the hospitalization data, with 39.8% of hospitalized patients with correct perception compared to 84.2% with an incorrect perception.
Personality the patient
As to the personality Of the patient with asthma the following has been observed. People with greater fear-panic exaggerate symptoms, react with anxiety and use medication alternately, depending on symptoms.
That is, there are periods when they use drugs excessively to control crises and phases in which they take less medication than necessary by focusing their attention on the potential side effects of the drug, which can trigger a new asthmatic attack. However, those with less fear-panic deny their symptoms, impacting on low adherence.
There is a curious fact about this and is that doctors are very sensitive to this variable and tend to prescribe more Corticoids Those with high levels of fear-panic
On the other hand, asthmatic children can have repercussions in the social aspect, and they feel annoyed to take the medication as well as with fear towards the onset of asthma crises.
Many of them worry about death, the side effects of medications, and have doubts about their physical ability. The fact of having to visit the emergency services and nocturnal asthmatic attacks, influence this feeling of vulnerability and emotional stress.
Attitudes of the patient
The Attitudes Of the person towards the asthma influence greatly, there are positive and negative. As for the former, it has been seen that the optimism Plays an important role in the self-management of asthma, as well as the internal consciousness of the patient who pays attention to the prodromal indicators of asthma. Also we speak of the locus of control, of great importance in the self-management.
Regarding the second, we refer to the dissatisfaction of these patients with the health personnel, and the psychological stigma or degree to which the asthma is seen as a defect of the person.
And what role does the family have?
Another interesting aspect to consider is how asthma affects the family and how it causes significant changes in the behavior and personal life of all members.
It is not unusual for parents to see over-protective behavior of the asthmatic child as parents often consider asthma endangering their child's life. This affects the degree of autonomy of the child as well as the reduction of their social skills, increasing their dependence on the family group. Parents also experience depression and sometimes experience the asthma situation as something that is out of their control and they constantly resort to asking the doctor.
There are studies that show that asthmatic children with socially isolated parents have more frequent symptoms of asthma, more days of limited activity and poor management of their symptoms, and also attend more frequently to the emergency department.
However, in the face of therapeutic intervention, it is important to bear in mind that parents play a fundamental role in the psychological support and control of children and adolescents, as well as support, self-control and knowledge of the disease.
CONCLUSIONS
Throughout this article we have been able to see how there is a circular relation between the psychological variables and the asthma, where each of them can act as cause or consequence, and concurrently or successively, throughout the life of the patient.
All this must be taken into account when intervening in asthmatic people, paying attention to all the contexts surrounding the subject, both family, school and social.
Because asthma usually affects more in childhood and adolescence, we must take into account all influential variables in this age range and the added complications.
After all, a chronic illness such as asthma requires basic medical treatment, with the consequent repercussions on the life of the asthma, discussed throughout this article. For this reason, the work of psychologists is essential to help alleviate and eliminate such repercussions as much as possible.
Bibliography
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- Jaúregui Presa, I., Tejedor Alonso, M.A. (2004). Clinical Immunological Allergology, vol. 19, pp. 101-109.
- Rodríguez López, G., Rodríguez Vázquez, J.C. (nineteen ninety six). Psychological factors of bronchial asthma. Revista Cubana Medicina, vol. 35.
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