Psychological and self-management factors in near-fatal asthma☆

Abstract 

Background

Several studies that have analyzed differences in psychological and self-management variables between patients with a near-fatal asthma (NFA) attack and asthmatics without a NFA attack (non-NFA) have shown conflicting results, probably due to the heterogeneity of the events studied and the selection of comparison groups.

Objective

To determine whether NFA patients, in stable situation, have greater psychological morbidity and worse self-management behavior than non-NFA patients with similar sociodemographic and clinical characteristics.

Methods

A sample of 44 NFA patients (mean=5.65 years after the NFA episode) and 44 non-NFA patients matched for age, sex, and asthma severity was assessed. All patients were in clinical stable situation. Information about sociodemographic, clinical, functional, and morbidity variables was collected for each patient, and the Cognitive Depression Inventory, the Trait-Anxiety Scale, the Toronto Alexithymia Scale, the Practical Knowledge of Self-management questionnaire, and the Medication Adherence scale were administered.

Results

In comparison with non-NFA patients, NFA patients showed higher levels of trait-anxiety (23.84 vs. 16.86; P=.001) and more difficulties describing and communicating feelings (11.36 vs. 8.90; P=.002). NFA and non-NFA patients did not differ in self-management variables. After adjustment in multivariate logistic regression analysis for age, sex, and asthma severity, significant differences were observed between NFA and control group patients in marital status [odds ratio (OR)=0.26; P=.017; 95% confidence interval (CI)=0.09–0.78], prescribed dose of inhaled corticoids (OR=4.48; P=.006;95% CI=1.53–13.09), and trait-anxiety (OR=1.071;P=.025;95%CI=1.01–1.14).

Conclusions

NFA patients show higher psychological morbidity than non-NFA, even years after the NFA episode.

Abbreviations: CDI, Cognitive Depression Index, CG, control group, NFA, near-fatal asthma, STAI-T, Trait-Anxiety Scale, TAS-20, Toronto Alexithymia Scale of 20 items

Keywords: Near-fatal asthma, Depression, Anxiety, Alexithymia, Knowledge self-management, Adherence