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Asthma

Asthma. October 30, 2007. Pediatric Statistics . Prevalence increasing School absences Estimated as more than 10 million in 1990 for children between the ages of 5 and 17 Parental work absences Estimated to cost $726 million in 1990 Death rate = 1.9 per 100,000 (1980-89).

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Asthma

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  1. Asthma October 30, 2007

  2. Pediatric Statistics • Prevalence increasing • School absences • Estimated as more than 10 million in 1990 for children between the ages of 5 and 17 • Parental work absences • Estimated to cost $726 million in 1990 • Death rate = 1.9 per 100,000 (1980-89) Weiss, Gergen, & Hodgson (1992)

  3. Respiratory System

  4. The Respiratory System

  5. Physiology of Asthma

  6. What is an Asthma Episode?

  7. Characteristics of Asthma • Episodes are variable • Episodes are reversible • Airway hyper-responsiveness

  8. Triggers of Asthma Episodes • Viral respiratory infections • Exercise • Cold air or changes in weather • Irritants • Allergens • Emotional upsets

  9. Signs of Asthma Episode • Wheezing • Chest retractions (especially with infants) • Breathing is faster • Feeling chest tightness (or heaviness) • Coughing • “Status asthmaticus”

  10. Asthma Medications • Two types of medicine • Preventive or Controller = Anti-inflammatory • Rescue = Bronchodilators • Oral steroids • Preferred delivery = Inhalation

  11. Taking Inhaled Medications • Nebulizer (with or without face mask)

  12. Taking Inhaled Medications • Metered Dose Inhaler (MDI)

  13. Taking Inhaled Medications • Spacer or chamber devices

  14. 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

  15. Psychological Factors Affecting Asthma • Stress • Anxiety • Depression

  16. Psychological Factors Affecting Asthma • Family dysfunction • Attachment • Critical mothers • Purcell et al. (1969)

  17. 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

  18. 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

  19. Psychological Assessment • Interviews, observation, & testing • Parental functioning • Marital status & satisfaction • Employment status & functioning • Social supports & stressors • Understanding of asthma & its treatment

  20. Psychological Assessment • Child functioning • Developmental skills • Quality of peer interactions • School performance • Understanding of asthma & its treatment

  21. Psychological Assessment • Family functioning • Interaction patterns • Routines • Asthma management & family division of responsibility/supervision

  22. 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

  23. 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

  24. Treating Medical Noncompliance • Strategies fit into 3 categories • Educational • Organizational • Behavioral

  25. Other Approaches to Treatment • Operant procedures • Positive reinforcement • Satiation • Differential reinforcement of incompatible behavior (DRI) • Response cost • Extinction

  26. Other Behavioral Approaches to Treatment • Systematic desensitization • Biofeedback • Modeling

  27. Other Behavioral Approaches for Non-Adherence • Contracts • Family approaches

  28. Self-Management Programs • Patient education • Training in device techniques • Self-assessment of symptoms • Group & family therapy • Relaxation & stress reduction

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