Several studies have generated conflicting results in psychological and self-management variables between patients with a near-fatal asthma (NFA) attack and asthmatics without a NFA attack (non-NFA). The difference is probably due to the heterogeneity of the events studied and the selection of comparison groups. Vazquez and colleagues sought to determine whether NFA patients, in stable situations, have greater psychological morbidity and worse self-management behavior than non-NFA patients with similar sociodemographic and clinical characteristics. A sample of 44 NFA patients (mean=5.65 years after the NFA episode) and 44 non-NFA patients matched for age, sex, and asthma severity was assessed. All patients were in clinical stable situation. Information about sociodemographic, clinical, functional, and morbidity variables was collected for each patient, and the Cognitive Depression Inventory, the Trait-Anxiety Scale, the Toronto Alexithymia Scale, the Practical Knowledge of Self-management questionnaire, and the Medication Adherence scale were administered. In comparison with non-NFA patients, NFA patients showed higher levels of trait-anxiety (p=.001) and more difficulties describing and communicating feelings (P=.002). NFA and non-NFA patients did not differ in self-management variables. After adjustment in multivariate logistic regression analysis for age, sex, and asthma severity, significant differences were observed between NFA and control group patients in marital status, prescribed dose of inhaled corticoids, and trait-anxiety.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: NFA patients show higher psychological morbidity than non-NFA, even years after the NFA episode.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: These results support the need for tailoring self-management training for asthma. However, the fact those psychological factors, such as fear, can continue to haunt patients long after the fear-inducing event occurred is the strongest point made in the study. This is reason that patients should be taught relaxation skills, as well as instructors using behavioral cognitive methods to reduce any long-term fears patients may be experiencing.

L Vazquez et al. Psychological and self-management factors in near-fatal asthma. Journal of Psychosomatic Research, 2010:68:175-181.