Psychosocial Barriers to Asthma Education: Psychological Factors

The most extreme example of this interaction between asthma and work is that of occupational asthma. In this instance, patients face double jeopardy in that not only does continuation of a particular occupation lead to ongoing symptoms, but disability insurance may not be available and the eventual outcome is loss of work with inadequate compensation. Data suggest that psychological parameters are important features to be considered, from both the profile of patients with difficult-to-control asthma as well the fact that programs that take account of the psychological profile of participants are likely to be successful. Garden and Ayres compared patients with difficult-to-control asthma, termed brittle asthma patients in the study, and control asthmatics matched for age, sex, and duration of disease. The authors concluded from their study that the brittle asthma group had greater psychiatric morbidity than those with less severe asthma. In contrast, there was no difference in personality profiles and overall life event experiences between both groups. In a more homogeneous population of patients with asthma, Teiramaa showed that certain psychic characteristics combined with particular psychosocial stress factors possibly increased the vulnerability of subjects with regard to the onset of asthma and its severity. Perrin et al showed that an educational program for children that included a stress management program not only was associated with an improvement in asthma control as defined by functional status but also a significant improvement in their total behavior problems score and internalizing scale on the child behavior checklist. asthma medications inhalers

An important component of all asthma education programs is attempting to improve patient compliance. In a study of children and adolesents, Chris-tiaanse et al showed that a combination of psychological adjustment, degree of family conflict vs cohesiveness, and the interaction of these two variables were predictive of compliance. The data cited above would therefore suggest that asthma education programs, if they are to have maximal impact, must consider psychosocial variables in determining their content as well as the likely participation especially of high-risk patients. A detailed review of the importance of considering the psychological aspects of asthma has recently been published and readers are referred to it for a more comprehensive assessment of this topic. The successful implementation of an asthma education program requires the active involvement of the physician of a patient with asthma, especially the primary care physician. Barriers that may obstruct the asthma education process at the level of a physician and asthma educator are as follows: (1) physician focus on therapeutic interventions; (2) consultation time limited; (3) physicians fear of loss of control; and (4) reimbursement structure geared toward pharmacotherapy and consultations as opposed to education.

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