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Life Style in Asthma Management ; Stress , home / workplace , and intellectual state

Life Style in Asthma Management ; Stress , home / workplace , and intellectual state. Prof. Dr. A. Füsun Kalpaklıoğlu Turkish Thoracic Society Meeting , Apr 6, 2013, Antalya.

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Life Style in Asthma Management ; Stress , home / workplace , and intellectual state

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  1. Life Style in AsthmaManagement; Stress, home/workplace, andintellectualstate Prof. Dr. A. Füsun Kalpaklıoğlu TurkishThoracicSocietyMeeting, Apr 6, 2013, Antalya

  2. ”Stress“ is the organism’s response to stressfulconditions or stressors, consisting of a pattern ofphysiological and psychological reactions. “StresS”

  3. ”Vagal-Bias” • 171 children ,age 2 to17 yr; • evaluated in ED forasthma • attack • 11 preselected film stressors • Correlationbetweendepression, vagalbias, airwayresistance Miller BD, et al. JACI 2009;124:66-73

  4. Social Networks as a newsource of psychologicalstress? • 18 y. M (fluticasone 250 mg BID, montelukast 10 mg ) “Facebookfriend” “Friending” “Facebook profile” “Post-Facebook PEF” “Facebook: a newtriggerforasthma?” D’Amato G, et al. Lancet 2010; 376: 1740

  5. Social Networks andAsthma • Facebookusers 800 million (since 2011 increasing 30%) • Twittersurpassed 500 million • 65% online adults , 83% of 18-29 y. usesocialnetworks ”VirtualRelationship” • Self-esteem • Facebookdepression & loneliness “Cyberostracism” “Cyberbullying” D’Amato G, et al. CurrOpin 2013; 1: 87-91

  6. Web-Based vs Standart Asthma Self-Management PortalforAssessmentand Self-Management of Asthma P’ASMA (www.pasma.med.up.pt) PiKo: FEV1/PEF Araujo L, et al. J InvestAllClinImm 2012; 22: 22-34

  7. CorticosteroidInsensitivity Haczku A, et al. JACı 2010;125: 550-8

  8. Relationship of socialsupporttostress, copingand health • 28 Canadianadolescents • 3 months of weekly online chatsessions Hypotesis 1: Increasesupport-seekingcoping Hypothesis 2: Increasesupportsatisfaction/ reducesupportneeds Hypothesis 3: Increasesupport network size Hypothesis 4: Decreaseloneliness/socialisolation Hypothesis 5: Increase self-efficacy InterveningProcessesSociallearning Socialcomparing Socialexchange COPING Supportseeking Letourneau N, et al. J Pediatr Nursing 2012; 27: 65-73

  9. BIOBEHAVIORAL Famiy Model EmotionalClimate FAMILY Parentalrelationship Quality/Conflict PARENT CHILD RelationSecurity Parenting BiobehavioralReactivity EmotionalDysregulation/ Depression PATIENT PSYCHOBIOLOGICAL MECHANISMS DiseaseSeverity Woodet al. 2000, 2008

  10. StressManagement in Asthma • 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. • PFT • PerceivedStressScale (PSS) F(1.54)=1.48,p=.23 Hockemeyer J, et al. BehavioralMed 2002; 27:161-72

  11. AttitudeforAsthmaManagement • 180 patients, • 84% F • M age 43 y, PositiveAttitude Self- Efficacy Knowledge Mancuso C, et al. J Asthma 2010; 47: 883-8

  12. 3/11 Disaster in Fukushima&AsthmaControl Fukuhara A, et al. AJRCCM 2012; 186: 1309

  13. POOR ADHERENCE • POOR COGNITION • SSRIs • Anxiolytics • Cognitive- • behavioraltx THERAPY • Reducestressors • Exercise • Delegateresponsibility • Relaxationexercises; • ie.musclerelaxation • breathing

  14. IdentifyingNonadherence Extraversion F>M Adherence F<M Adherence not correlated w personalitytraits Kalkan IK, Baccioglu A, Kalpaklioglu AF. InvestAllergolClinImmunol (accepted)

  15. Asthma & Yoga • (33M/24F) mild-to-moderateasthma YOGA Group (29) CONTROL Group (28) 4 hr/d/2 wk Asanas (postures) Prayanamas (breathingtechs) Kriyas (cleansingtechs) Meditation Shavasana (relaxation) Vempati R, et al. BMC PulmMed 2009; 9: 37

  16. Asthma & Yoga ”Breath is central to yoga because it is central to life” T. Krishnamacharya Vempati R, et al. BMC PulmMed 2009; 9: 37

  17. Ashma/AllergyAwareness Kalpaklioglu AF, et al. WAO J 2011; 4: 170

  18. Ashma/AllergyAwareness SYMPTOMS N (%) Nasal • Hay fever 142 (56.1) • Itchynose 176 (69.6) • Runnynose 141 (55.7) • Nasalcongestion 130 (51.4 • Postnasaldrip 119 (47) • Sneezing 196 (77.5 • Poor sense of smell 96 (37.9) • Itchyeyes 183 (72.3) • Watery/redeyes 157 (62.1) Chest • Cough 156 (61.3) • Wheezing 131 (51.8) • Chesttightness 119 (47) • Shorthness of breath 130 (51.4) Kalpaklioglu AF, et al. WAO J 2011; 4: 170

  19. Asthma & Sept 11, 2001 Disaster in WTC Brackbill RM, et al. JAMA 2009; 302: 502-16

  20. Asthma & Sept 11, 2001 Disaster in WTC Brackbill RM, et al. JAMA 2009; 302: 502-16

  21. Clinicaldeterioration -Sept 11, 2001 Disaster in WTC Clinicalvisits & Asthmaprescriptions ,P<0.05 Rescueinhaler Oral steroiduse, P>0.05 Szema AM, et al. JACI 2004; 113: 420-6

  22. EpigeneticRegulation Martino and Prescott. Chest 2011;139:640-7

  23. Gene silencingby DNA methylation DNA methylationis an epigenetic mechanism that canresult in gene silencing • Environmentalexposures alter DNA methylation • Examples of epigenetic-environmentalinteraction: – Diet – Allergens – Cigarettesmoke – Airpollution – Ageing This interaction has implications possibly for the asthmaclinic, in thefuture. Bowman et al. Expert OpinTher Targets 2009;13:625-40, Yang I, AAAAI 2013

  24. Secondhandsmokeandambientairpollution - CpGmethylationandexpression of IFN- in T cells • Fresno (n=62, high air pollution), Stanford (n=40, low air pollution) • Secondhand smoke exposure (SHS); verified by urinary cotinine IFN- in CD4+CD25 T effectorcells AAP  SHS + 0 + 0 AAP=ambient air pollution (PM2.5, PM10, PAH, ozone) Kohliet al.ClinicalEpigenetics 2012;4:17, Yang L,. AAAI 2013

  25. Asthma & Smoking Thenon-neuronal cholinergic system as novel drug target in the airways Pieper MR, et al. Life Sci 2012; 91: 1113-8

  26. Depression/QoL/IntellectualState Mancuso C, et al. J Gen InternMed 2000; 15: 301-10

  27. QOL in Asthma & IntellectualState • 316 ptswithasthma w/worhinitis • Correlation of HRQoL(SF-36 ) iwithsociodemographic data, educationalstate Kalpaklioglu AF, et al. J InvestAllergolClinImmunol 2008; 18: 168-173

  28. QOL in Asthma & IntellectualState Patients with asthma (w/worhinitis)experiencephysical and mentalimpairment Kalpaklioglu AF, et al. J InvestAllergolClinImmunol 2008; 18: 168-173

  29. Factorsinfluencingquality of life in Asthma VAS Gonzales-Barcala, et al. MultiRespMed 2012; 7: 32

  30. InnerCity Risk Factors in Asthma CR Busse W. JACı 2010;125: 529-37

  31. NOT “one size fitsall”

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