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Original Research: ASTHMA |

Psychologic Distress and Maladaptive Coping Styles in Patients With Severe vs Moderate Asthma

Kim L. Lavoie, PhD; Donald Bouthillier, PhD; Simon L. Bacon, PhD; Catherine Lemière, MD; James Martin, MD; Qutayba Hamid, MD, PhD; Mara Ludwig, MD; Ron Olivenstein, MD; Pierre Ernst, MD
Author and Funding Information

From the Department of Psychology (Dr Lavoie), University of Quebec at Montreal; the Division of Chest Medicine, Hôpital du Sacré-Cœur de Montréal (Drs Lavoie, Bacon, and Lemière), the Research Center, Montreal Heart Institute (Drs Lavoie and Bacon), and the Department of Psychosomatic Medicine, Hôpital du Sacré-Cœur de Montréal (Dr Bouthillier), University of Montreal; the Department of Exercise Science (Dr Bacon), Concordia University; the Meakins Christie Laboratories, Department of Medicine (Drs Martin, Hamid, and Ludwig), and the Department of Epidemiology, Biostatistics, and Occupational Health (Dr Ernst), McGill University; and the Respiratory Epidemiology and Clinical Research Unit (Dr Olivenstein), Montreal Chest Institute, Montreal, QC, Canada.

Correspondence to: Kim L. Lavoie, PhD, Hôpital du Sacré-Cœur de Montréal, Research Center, Department of Chest Medicine, J-3190, 5400 Gouin West, Montreal, QC, Canada H4J 1C5; e-mail: k-lavoie@crhsc.rtss.qc.ca


Funding/Support: Funding support for this study was provided by the Fonds de la recherche en santé du Québec (Drs Lavoie and Bacon) and the Richard and Edith Strauss Canada Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(6):1324-1331. doi:10.1378/chest.09-1979
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Background:  Though several biologic factors have been suggested to play a role in the development and persistence of severe asthma, those associated with psychologic factors remain poorly understood. This study assessed levels of psychologic distress and a range of disease-relevant emotional and behavioral coping styles in patients with severe vs moderate asthma.

Methods:  Eighty-four patients (50% women, mean [M] age 46 years) with severe (n = 42) and moderate (n = 42) asthma were recruited. Severe asthma was defined according to American Thoracic Society criteria. Patients underwent demographic and medical history interviews and pulmonary function and allergy testing. Patients also completed questionnaires measuring asthma symptoms and the Millon Behavioral Medicine Diagnostic Inventory, which assesses psychologic distress and emotional/behavioral coping factors that influence disease progression and treatment.

Results:  After adjustment for covariates and applying a correction factor that reduced the significant P level to < .01, patients with severe vs moderate asthma reported experiencing more psychologic distress, including worse cognitive dysfunction (F = 6.72, P < .01) and marginally worse anxiety-tension (F = 4.02, P < .05). They also reported worse emotional coping (higher illness apprehension [F = 9.57, P < .01], pain sensitivity [F = 10.65, P < .01], future pessimism [F= 8.53, P < .01], and interventional fragility [F = 7.18, P < .01]), and marginally worse behavioral coping (more functional deficits [F = 5.48, P < .05] and problematic compliance [F = 4.32, P < .05]).

Conclusions:  Patients with severe asthma have more psychologic distress and difficulty coping with their disease, both emotionally and behaviorally, relative to patients with moderate asthma. Future treatment studies should focus on helping patients with severe asthma manage distress and cope more effectively with their illness, which may improve outcomes in these high-risk patients.


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