life style in asthma management ; stress , home / workplace , and intellectual state
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Life Style in Asthma Management ; Stress , home / workplace , and intellectual state. Prof. Dr. A. Füsun Kalpaklıoğlu Turkish Thoracic Society Meeting , Apr 6, 2013, Antalya. - PowerPoint PPT PresentationTRANSCRIPT
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Life Style in Asthma Management; Stress, home/workplace, and intellectual state
Prof. Dr. A. Füsun KalpaklıoğluTurkish Thoracic Society Meeting, Apr 6, 2013, Antalya
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”Stress“ is the organism’s response to stressful conditions or stressors, consisting of a pattern of physiological and
psychological reactions.
“STRESS”
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”Vagal-Bias”
Miller BD, et al. JACI 2009;124:66-73
•171 children , age 2 to 17 yr;• evaluated in ED for asthma attack•11 preselected film stressors•Correlation between depression, vagal bias, airway resistance
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Social Networks as a new source of psychological stress?
• 18 y. M (fluticasone 250 mg BID, montelukast 10 mg )
“Facebook friend”“Friending”“Facebook profile”“Post-Facebook PEF”“Facebook: a new trigger for asthma?”
D’Amato G, et al. Lancet 2010; 376: 1740
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• Facebook users 800 million (since 2011 increasing 30%)
• Twitter surpassed 500 million
• 65% online adults ,83% of 18-29 y. use social networks
”Virtual Relationship”
• Self-esteem• Facebook depression
& loneliness
“Cyberostracism”“Cyberbullying”
Social Networks and Asthma
D’Amato G, et al. Curr Opin 2013; 1: 87-91
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Araujo L, et al. J Invest All Clin Imm 2012; 22: 22-34
Web-Based vs Standart Asthma Self-Management
Portal for Assessment and Self-Management of Asthma P’ASMA(www.pasma.med.up.pt)
PiKo: FEV1/PEF
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Haczku A, et al. JACı 2010;125: 550-8
Corticosteroid Insensitivity
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SOCIAL SUPPORT
HEALTH/FUNCTIONING Loneliness/isolation
Self efficacy
STRESSAsthma/Allergy
Letourneau N, et al. J Pediatr Nursing 2012; 27: 65-73
COPING Support
seeking
Intervening Processes Social learning
Social comparingSocial exchange
Relationship of social support to stress, coping and health
•28 Canadian adolescents•3 months of weekly online chat sessions
Hypotesis 1: Increase support-seeking copingHypothesis 2: Increase support satisfaction/ reduce support needsHypothesis 3: Increase support network sizeHypothesis 4: Decrease loneliness/social isolationHypothesis 5: Increase self-efficacy
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Parental relationshipQuality/Conflict
Relation SecurityParenting
Biobehavioral ReactivityEmotional Dysregulation/ Depression
FAMILY
PATIENT
PARENT CHILD
Emotional Climate
Disease SeverityPSYCHOBIOLOGICAL MECHANISMS
Wood et al. 2000, 2008
BIOBEHAVIORAL Famiy Model
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• PFT• Perceived Stress Scale
(PSS) F(1.54)=1.48,p=.23
Hockemeyer J, et al. Behavioral Med 2002; 27:161-72
• 60 p, 18-51 y• tape-recorded deep-breathing relaxation exercise,•a cognitive-behavioral treatment,•a 20-minute exercise to write about a stressful life event.
Stress Management in Asthma
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Mancuso C, et al. J Asthma 2010; 47: 883-8
•180 patients, 84% F•M age 43 y,
Attitude for Asthma Management
Positive Attitude Self- Efficacy
Knowledge
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Fukuhara A, et al. AJRCCM 2012; 186: 1309
3/11 Disaster in Fukushima&Asthma Control
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ASTHMA
STRESS
ANXIETY
• Reduce stressors •Exercise•Delegate responsibility•Relaxation exercises; ie.muscle relaxation breathing
•SSRIs•Anxiolytics•Cognitive- behavioral tx
POOR COGNITION
POOR ADHERENCE
THER
APY
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A+R(n=85)
COPD (n=50)
Total (n=135)
p
EPQR-A
Extraversion 3.7 (1.9) 2.8 (1.1) 3.3 (1.9) 0.01
Neuroticism 3.2 (1.8) 3.0 (1.8) 3.2 (1.7) 0.4
Psychoticism 0.9 (0.9) 0.9 (0.9) 0.9 (0.8) 0.8
MARS
Total score 21.3 (3.9) 20.6 (4.1) 21 (3.9) 0.4
Intentional score 17.6 (2.5) 16.8 (3.3) 17.3 (2.8) 0.2
Unintentional score 3.8 (1.0) 3.8 (1.1) 3.79 (1.0) 0.8
SF-36
PCS 65.7 (20.7) 51.0 (26.4) 60.6 (23.8) 0.001
MCS 61.8 (21.6) 54.8 (29.0) 59.3 (24.6) 0.2
Identifying Nonadherence
Kalkan IK, Baccioglu A, Kalpaklioglu AF. Invest Allergol Clin Immunol (accepted)
Extraversion F>M Adherence F<M Adherence not correlated w personality traits
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57 (33M/24F) mild-to-moderate asthma
YOGA Group (29) CONTROL Group (28)4 hr/d/2 wkAsanas (postures)Prayanamas (breathing techs)Kriyas (cleansing techs)Meditation Shavasana (relaxation)
Asthma & Yoga
Vempati R, et al. BMC Pulm Med 2009; 9: 37
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W 0 W 8 pFEV1 YOGA
C70.2±17.462.5±19.2
77.9± 17.2 59.9±19.1
0.009NS
AQOL YOGAC
3.72±1.23.64±1.1
5.46±1.14.5±1.5
0.013NS
% fall in FEV1 w exercise challenge
YOGAC
15.05±149.13±10.8
5.18±11.85.81±10.1
0.005NS
% change in 11-PGF2 excretion
YOGAC
17.6±18.616.6±21
16.8±19.720.7±23.5
0.490.84
Asthma & Yoga
”Breath is central to yoga because it is central to life”T. Krishnamacharya
Vempati R, et al. BMC Pulm Med 2009; 9: 37
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Kalpaklioglu AF, et al. WAO J 2011; 4: 170
Ashma/Allergy Awareness
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SYMPTOMS N (%)Nasal• Hay fever 142 (56.1)• Itchy nose 176 (69.6)• Runny nose 141 (55.7)• Nasal congestion 130 (51.4• Postnasal drip 119 (47)• Sneezing 196 (77.5• Poor sense of smell 96 (37.9)• Itchy eyes183 (72.3)• Watery/red eyes 157 (62.1)
Chest• Cough 156 (61.3)• Wheezing 131 (51.8)• Chest tightness 119 (47)• Shorthness of breath
130 (51.4)
Kalpaklioglu AF, et al. WAO J 2011; 4: 170
Ashma/Allergy Awareness
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Brackbill RM, et al. JAMA 2009; 302: 502-16
Asthma & Sept 11, 2001 Disaster in WTC
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Brackbill RM, et al. JAMA 2009; 302: 502-16
Asthma & Sept 11, 2001 Disaster in WTC
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Szema AM, et al. JACI 2004; 113: 420-6
Clinical visits &Asthma prescriptions ,P<0.05Rescue inhalerOral steroid use, P>0.05
Clinical deterioration -Sept 11, 2001 Disaster in WTC
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Martino and Prescott. Chest 2011;139:640-7
Epigenetic Regulation
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DNA methylation is an epigenetic mechanism that can result in gene silencing
• Environmental exposures alter DNA methylation• Examples of epigenetic-environmental interaction:
– Diet– Allergens– Cigarette smoke– Air pollution– Ageing
This interaction has implications possibly for the asthma clinic, in the future.
Bowman et al. Expert Opin Ther Targets 2009;13:625-40, Yang I, AAAAI 2013
Gene silencing by DNA methylation
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Fresno (n=62, high air pollution), Stanford (n=40, low air pollution)Secondhand smoke exposure (SHS); verified by urinary cotinine
Kohli et al. Clinical Epigenetics 2012;4:17, Yang L,. AAAI 2013AAP=ambient air pollution (PM2.5, PM10, PAH, ozone)
AAP SHS + 0 + 0
IFN- inCD4+CD25T effector cells
Secondhand smoke and ambient air pollution - CpG methylation and expression of IFN-
in T cells
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Pieper MR, et al. Life Sci 2012; 91: 1113-8
The non-neuronal cholinergic system as novel drug target in the airways
Asthma & Smoking
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Mancuso C, et al. J Gen Intern Med 2000; 15: 301-10
Depression/QoL/Intellectual State
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Kalpaklioglu AF, et al. J Invest Allergol Clin Immunol 2008; 18: 168-173
•316 pts with asthma w/wo rhinitis•Correlation of HRQoL (SF-36 ) iwith sociodemographic data, educational state
QOL in Asthma & Intellectual State
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Patients with asthma (w/wo rhinitis) experience physical and mental impairment
Kalpaklioglu AF, et al. J Invest Allergol Clin Immunol 2008; 18: 168-173
QOL in Asthma & Intellectual State
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Gonzales-Barcala, et al. Multi Resp Med 2012; 7: 32
VAS
Factors influencing quality of life in Asthma
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Busse W. JACı 2010;125: 529-37
Inner City Risk Factors in Asthma
CR
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“one size fits all” NOT