Asthma affects between 3 and 5 per cent of the population of the United States. The three hallmarks of the disease are airway inflammation, airway hyper-responsiveness, and a partially reversible airway obstruction. (3.9 The diagnosis is based on the presence of episodic dyspnoea and wheezing. Pulmonary function studies may be normal or can show the obstruction. Outpatient treatment is usually instituted with an inhaled b-adrenergic agent. If symptoms continue, an inhaled corticosteroid is added. If symptoms still do not respond, doses of inhaled agents are increased, cromolyn is added, or oral corticosteroids are prescribed. In addition to the psychiatric aspects of asthma symptoms, the treatments may produce significant psychiatric symptomatology.
Asthma is one of the classic 'psychosomatic diseases'. Emotional arousal causes changes in airway tone. The severity of an asthma attack is highly correlated with presence of major depressive disorder, panic attacks, and level of fear. Psycho-education, relaxation, biofeedback, and family therapy have each shown efficacy in the management of asthma/31 Particularly important in the management of asthma is education about the adverse effects of antiasthma medications, which include jitteriness, palpitations, and insomnia. These side-effects may require treatment with behavioural and/or psychopharmacological therapies.
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