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Biopsychological effects of Asthma
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Class notes college 6: Biopsychological effects of Asthma
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BIOPSYCHOSOCIAL ASPECTS IN ASTHMAINTRODUCTION ASTHMA: PATHOPHYSIOLOGY AND FACTS
Definition:
- “Asthma is a heterogeneous disease, usually characterized by chronic airway
inflammation.
- It is defined by the history of respiratory symptoms such as wheeze, shortness of
breath, chest tightness and cough that vary over time and in intensity, together with
variable expiratory airflow limitation.”
o infectie/ontsteking in luchtwegen
o wheeze: geluid v longen
o chest tightness: gevoel dat je borstkast niet kan uitzetten
o kunnen niet zoveel uitademen als ze wilen (variable expiratory airflow
limitation)
Facts:
- Asthma is a common and potentially serious chronic disease that can be controlled
but not cured
- Symptoms are associated with variable expiratory airflow, i.e. difficulty breathing air
out of the lungs due to
à variable: kan veranderen, bv over een jaar
à 3 processen waardoor in-/uitademen moeilijk w:
o Bronchoconstriction (airway narrowing)
o Airway wall thickening (longwanden w dikker)
o Increased mucus (meer sticky slijm wat moeilijk weggaat)
- Symptoms may be triggered or worsened by factors such as viral infections,
allergens, tobacco smoke, exercise and stress.
- Symptoms and airflow limitation may resolve spontaneously or in response to
medication, and may sometimes be absent for weeks or months at a time. On the
other hand, patients can experience episodic flare-ups (exacerbations) of asthma
that may be life-threatening and carry a significant burden to patients and the
community.
à flare-ups: ineens w symptomen erger of komen ze op
- Asthma is usually associated with airway hyperresponsiveness to direct or indirect
stimuli, and with chronic airway inflammation. These features usually persist, even
when symptoms are absent or lung function is normal, but may normalize with
treatment.
à airway hyperresponsiveness: overreactie v luchtwegen op stimuli (direct of
indirect)
, - Veel patienten hebben een normaal leven, zeker buiten allergieenseizoen
dat zorgt ervoor dat ze soms minderen/stoppen met medicatie (terwijl ze het wel
moeten nemen om ontsteking laag te houden), hierdoor wordt het weer erger
Asthma phenotypes:
- Allergic asthma (often in childhood/family history of allergy, good ICS response)
à ICS = inhaled corticol steroids = main treatment om ontsteking te verminderen
naar een laag level
- Non-Allergic asthma (in adults, less ICS responses)
- Late-onset asthma (often women/usually non-allergic, less ICS responses)
à early onset allergic astma: meer bij jongens
à late onset: meer vrouwen, geen idee waarom
- Asthma with fixed airflow limitation (in long-lasting asthma, airway wall changes)
à normaal w wanden dunner v longen om terug normaal kunnen adem te halen
- maar bij fixed airflow blijven ze dik
- Asthma with obesity (obese patients with asthma, prominent symptoms but less
eosinophilic inflammation)
à andere soort ontsteking, maar niet geweten waarom dat zo is
- ...more research needed
à veel discussie over welke subklassen er zijn (bv ook genetisch?)
à belangrijk omdat ze anders reageren op medicatie/behandeling
- Also common:
o Exercise-induced asthma
à veel wielrenners hebben asthma (maar medicatie ertegen is ook klein
beetje doping, niet duidelijk waarvoor er dan medicatie w ingenomen)
o Occupational asthma and work-aggravated asthma
§ Occupational asthma: bv bakkerij: veel stof v meel: als je dat inhaleert
voor 20 jaar, kan asthma ontwikkelen
§ Work-aggravated asthma: asthma bestaat al maar het w erger door
het werk (bv asthma hebben en in kantoor werken waar veel
schimmels zijn à kan erger w maar is niet oorzaak)
Asthma burden:
- Worldwide: 300 millions of affected patients
- Worldwide: prevalence range across whole population(s): 1-16%
o Germany (children: 9-14%, adults: 4-5%)
o Belgium (children 12-13 years: 4.2%)
o children: most common chronic disease
o adults: one of the most common chronic diseases
- Worldwide: 346.000 deaths/year due to asthma
- High direct (treatments) and indirect (productivity loss) costs
, o Germany (costs per case/year)
§ Moderate asthma: EUR 2200 – 2270
§ Severe asthma: EUR 7900 – 9300
- Difficult to obtain exact/comparable numbers!
Physiology of asthma:
Parasympathisch: nevus vagus innerveert luchtwegen en is verantwoordelijke voor
spiertonus ervan
à hogere vagale activteit: activeert spieren om samen te trekken
Sympathisch: bronchodilatatie
Medicatie werkt vaak in op sympathisch AZS: om dat te vergroten en de luchtwegen te
verbreden
à Ook verbonden met limbisch systeem: emoties en stress interageren ermee en kunnen
leiden tot symptomen v luchtwegen
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