RESUMEN
OBJECTIVE: Asthma self-management programs are effective but often time-consuming.We evaluated the effects of a shortened asthma self-management program on asthma knowledge, morbidity and asthma-related behaviour in a group of moderate to severe adult asthmatics. METHODS: The effects of the program were evaluated with a one year prospective trial in a group of 55 asthmatics (mean age 45 yrs, 42% males, N=26 in intervention group, N=29 in control group) by administering questionnaires and diary exercises at baseline, immediately, 3 and 12 months after the end of the program. RESULTS: Asthma-related knowledge and hyperventilation symptoms improved more in the intervention than in the control group and this effect was maintained until 3 months after participation. General asthma symptoms improved significantly, but substantial symptom improvements were also found in the control group. The original effects in the intervention group persisted partly but not significantly 1 year after participation. No significant effects were found on pulmonary function. CONCLUSIONS: Based on our preliminary results, we conclude that our shortened asthma self-management program had an impact on knowledge and asthma symptoms, especially hyperventilation symptoms, until 3 months after the end of the program. Continuous reinforcement and specifying the program content are essential aspects to obtain more robust and long-lasting effects when administering shortened asthma self-management programs.
Asunto(s)
Asma/terapia , Autocuidado , Adulto , Análisis de Varianza , Distribución de Chi-Cuadrado , Femenino , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Pruebas de Función Respiratoria , Encuestas y CuestionariosRESUMEN
BACKGROUND: Medically unexplained dyspnea occurs commonly in medical settings and remains poorly understood. This study was conducted to investigate the psychophysiological characteristics of medically unexplained dyspnea and the efficacy of breathing retraining for these patients. METHODS: A group of patients with medically unexplained dyspnea were compared to patients with a variety of organic lung diseases and healthy subjects. In another group of patients, the influence of breathing therapy on complaints, anxiety, and breath-holding was evaluated for an average of 1.5 years. RESULTS: Patients with medically unexplained dyspnea reported more intense dyspnea than patients with a variety of organic lung diseases. Additionally, they were anxious and presented a broad range of symptoms in daily life and under challenge, for instance voluntary hyperventilation. More than one third of them qualified for panic disorder. They had shorter breath-holding time at rest, less increase in breath-holding time and higher chances of showing a "paradoxical" decrease of breath-holding time after hyperventilation. A combination of PaO2, forced expiratory volume in one second (FEV1), and anxiety measures distinguished them from organic dyspnea. Breathing retraining profoundly improved their symptoms and decreased the level of state and trait anxiety. Moreover, they better tolerated the voluntary hyperventilation and the symptoms induced were also markedly decreased after therapy. Breath-holding time was prolonged and PetCO2 in a representative group of patients increased. CONCLUSIONS: Patients with medically unexplained dyspnea appear to have the feature of a "psychosomatic" patient: an anxious patient with a wide variety of symptoms of different organ systems that do not have an organic basis. They can be distinguished from organic dyspnea using a small set of physiological and psychological measures. Breathing retraining turns out to be an effective therapy for those "difficult to treat patients".