1. 1 Asthma October 30, 2007

2. Weiss, Gergen, & Hodgson (1992)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)

3. 3 Respiratory System

4. 4 The Respiratory System

5. 5 Physiology of Asthma

6. 6 What is an Asthma Episode?

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

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

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

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

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

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

13. 13 Taking Inhaled Medications Spacer or chamber devices

14. 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. 15 Psychological Factors Affecting Asthma Stress Anxiety Depression

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

17. 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. 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. 19 Psychological Assessment Interviews, observation, & testing Parental functioning Marital status & satisfaction Employment status & functioning Social supports & stressors Understanding of asthma & its treatment

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

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

22. 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. 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. 24 Treating Medical Noncompliance Strategies fit into 3 categories Educational Organizational Behavioral

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

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

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

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