1 asthma october 30, 2007. weiss, gergen, & hodgson (1992)2 pediatric statistics prevalence...
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1
Asthma
October 30, 2007
Weiss, Gergen, & Hodgson (1992)
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Pediatric Statistics
Prevalence increasing
School absencesEstimated as more than 10 million in 1990
for children between the ages of 5 and 17
Parental work absencesEstimated to cost $726 million in 1990
Death rate = 1.9 per 100,000 (1980-89)
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Respiratory System
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The Respiratory System
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Physiology of Asthma
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What is an Asthma Episode?
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Characteristics of Asthma
Episodes are variable
Episodes are reversible
Airway hyper-responsiveness
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Triggers of Asthma Episodes
Viral respiratory infections
Exercise
Cold air or changes in weather
Irritants
Allergens
Emotional upsets
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Signs of Asthma Episode
Wheezing
Chest retractions (especially with infants)
Breathing is faster
Feeling chest tightness (or heaviness)
Coughing
“Status asthmaticus”
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Asthma Medications
Two types of medicine
Preventive or Controller = Anti-inflammatory
Rescue = Bronchodilators
Oral steroids
Preferred delivery = Inhalation
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Taking Inhaled Medications
Nebulizer (with or without face mask)
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Taking Inhaled Medications
Metered Dose Inhaler (MDI)
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Taking Inhaled Medications
Spacer or chamber devices
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Preventing an Asthma Episode
Avoid irritants
Control allergens in the environment
Take inhaled bronchodilator PRIOR to exercise
Monitor lung functioning with peak flow meter
Use “preventer” or “controller” medicine REGULARLY
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Psychological Factors Affecting Asthma
Stress
Anxiety
Depression
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Psychological Factors Affecting Asthma
Family dysfunction
Attachment
Critical mothers
Purcell et al. (1969)
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Psychosocial Dysfunction Associated With…
Needing more asthma medications
Having a greater # of hospitalizations
Requiring longer hospitalizations
Dying more frequently from asthma
Not complying with asthma care regimen
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Medical Noncompliance
Multiple medications on multiple schedules with varying periods when symptoms are not present
As high as 90% of patients
Negative consequences
Typically “partial” in nature
Assessment of compliance
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Psychological Assessment
Interviews, observation, & testing
Parental functioning
Marital status & satisfactionEmployment status & functioningSocial supports & stressorsUnderstanding of asthma & its treatment
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Psychological Assessment
Child functioning
Developmental skillsQuality of peer interactionsSchool performanceUnderstanding of asthma & its treatment
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Psychological Assessment
Family functioning
Interaction patternsRoutinesAsthma management & family division of
responsibility/supervision
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When should patients obtain psychotherapy?
Are markedly anxious or depressed
Demonstrate decreased capacity to manage their asthma
Have been erratic in medication use
Have poor perceived control of symptoms
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When should patients obtain psychotherapy?
Experience a decline in functioning in school or work
Are in frequent conflict with medical staff
Have made repeated visits to the ER
Family appears dysfunctional, disorganized, or distressed
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Treating Medical Noncompliance
Strategies fit into 3 categories
Educational
Organizational
Behavioral
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Other Approaches to Treatment
Operant proceduresPositive reinforcementSatiationDifferential reinforcement of incompatible
behavior (DRI)Response costExtinction
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Other Behavioral Approaches to Treatment
Systematic desensitization
Biofeedback
Modeling
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Other Behavioral Approaches for Non-Adherence
Contracts
Family approaches
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Self-Management Programs
Patient education
Training in device techniques
Self-assessment of symptoms
Group & family therapy
Relaxation & stress reduction