Psychological Factors in Asthma 英文参考文献.docVIP

ORIGINAL ARTICLE PsychologicalFactorsinAsthma RyanJ.VanLieshout,MDandGlendaMacQueen,MD,PhD,FRCPC Asthma has long been considered a condition in which psychological factors have a role. As in many illnesses, psychological variables may affect outcome in asthma via their effects on treatment adherence and symptom reporting. Emerging evidence suggeststhattherelationbetweenasthmaandpsychologicalfactorsmaybemorecomplexthanthat,however.Centralcognitive processes may influence not only the interpretation of asthma symptoms but also the manifestation of measurable changes in immuneandphysiologicmarkersofasthma.Furthermore,asthmaandmajordepressivedisordershareseveralriskfactorsandhave similar patterns of dysregulation in key biologic systems, including the neuroendocrine stress response, cytokines, and neuropeptides.Despitetheevidencethatdepressioniscommoninpeoplewithasthmaandexertsanegativeimpactonoutcome, few treatment studies have examined whether improving symptoms of depression do, in fact, result in better control of asthma symptomsorimprovedqualityoflifeinpatientswithasthma. Keywords: asthma,depression,pathophysiology,treatment P sychological factors mayinfluence thesymptoms and managementofasthma,andnumerouspathwaysmay chronic illness on the other. More provocatively, perhaps, theremaybecomponents ofcentralorperipheralnervous system dysfunction that predispose people to asthma or worsen the course of asthma independent of behavioural response style or the experience of illness-related stress or depression. contribute to the links between asthma and psychiatric disease states such as depression. The notion that emotional stress can precipitate or exacerbate acute and chronic asthma1 has been recognized anecdotally for many years. Psychological barriers, such as faulty symptom attribution, adoption or rejection of the sick role, and low self-esteem, may negatively impact treat- ment adherence. Conversely, the presence of a chronic and potentially life-thre