psychological factors in asthma心理因素在哮喘.pdf

ORIGINAL ARTICLE Psychological Factors in Asthma Ryan J. Van Lieshout, MD and Glenda MacQueen, 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 suggests that the relation between asthma and psychological factors may be more complex than that, however. Central cognitive processes may influence not only the interpretation of asthma symptoms but also the manifestation of measurable changes in immune and physiologic markers of asthma. Furthermore, asthma and major depressive disorder share several risk factors and have similar patterns of dysregulation in key biologic systems, including the neuroendocrine stress response, cytokines, and neuropeptides. Despite the evidence that depression is common in people with asthma and exerts a negative impact on outcome, few treatment studies have examined whether improving symptoms of depression do, in fact, result in better control of asthma symptoms or improved quality of life in patients with asthma. Key words: asthma, depression, pathophysiology, treatment P sychological factors may influence the symptoms and chronic illness on the other. More provocatively, perhaps, management of asthma, and numerous pathways may there may be components of central or peripheral nervous contribute to the links between asthma and psychiatric system dysfunction that predispose people to asthma or disease states such as depression. The notion that worsen the course of asthma independent of behavioural emotional stress can precipitate or exacerbate acute and