Психологические дисфункции у женщин с бронхиальной астмой

Background. The importance of psychosocial factors in the management of bronchial asthma (BA) is discussed in clinical guidelines, including in international and national clinical guidelines. However, a specific evaluation of their role as a cause of poor asthma control in susceptible patients is required. Aim. Assessment of psychological health of women with different levels of asthma control.Materials and methods. The study included 108 women with asthma observed in Saratov center for Allergology who were stratified into 3 groups according to the control level (good, partial, uncontrolled, according to GINA). In establishing a diagnosis of asthma, standard methods were used (medical history, symptoms, spirography). To assess the level of control, ACQ-5 (Asthma Control Questionnaire 5 items-self-administered) was used, to assess the quality of life, questionnaires AQLQ-S (Asthma Quality of Life Questionnaire S); SF-36 (36-ltem MOS Short-Form Health Survey), a standardized and validated Russian version of the women’s health questionnaire WHQ (Women’s Health Questionnaire) were used; for psychological diagnosis and evaluation of social and personal competencies that contribute to the preservation and improvement of human health (the intellectual, personal, emotional, physical, social, creative, spiritual aspects), integrated multimodal questionnaire was used. The comparison was conducted with a control group of men with bronchial asthma, comparable in age and level of control.Results. Women with poorly controlled asthma had worse performance of AQLQ-S (combined median score of 3,43 instead of 5,13 in the group of good control; p < 0,05); all scales of the SF-36, including the general condition (43,48 against 55,07), role of physical (25,93 against 57,76) and emotional problems (43,83 against 64,37); at p < 0.05. According to the WHQ questionnaire (the inverse relationship: the higher the score, the lower the quality of life) in the group with poor control there is a high level of depression (mean 0,36 versus 0,24; p < 0,05); physical health problems are marked (0,47 against 0,27; p < 0,05). There is a very low selfestimation of their attractiveness in BA (0,71 and 0,64 for bad and good control, respectively). According to the integrated multimodal questionnaire, in both men and women with asthma almost identical results were obtained on the scales sensitive to manifestations of anxiety-depressive symptoms, emotional balance, scales of emotional skills, correlating with severe alexithymia and low capacity for reflection. Among women the proportion of individuals with high scores of intellectual functioning, strong-willed competence, goal-setting, and ability of making contacts was higher.Conclusion. The severity of asthma and disease control are closely linked with the psychological condition of the patient. Psychological dysfunctions are correlated with suboptimal BA control. It is important to understand psychological differences in women and to educate patients in both effective BA control and in establishing individualized asthma management strategies.There is a need for a multidisciplinary approach aimed at the identification and effective correction of asthma. The study of the psychological characteristics of personality and motivational sphere of the patient can help to optimize therapy, improve monitoring and prognosis of the disease. Введение. Важность психосоциальных факторов в управлении бронхиальной астмой (БА) обсуждается в клинических руководствах, включая международные и национальные клинические рекомендации, однако требуется конкретная оценка их роли в качестве причин плохого контроля астмы в уязвимых группах пациентов.Цель исследования. Оценка психологического здоровья женщин с разным уровнем контроля бронхиальной астмы.Материал и методы. В исследование включены 108 женщин с бронхиальной астмой, наблюдающихся в Саратовском аллергологическом центре, которые были стратифицированы на три группы в соответствии с уровнем контроля (хороший, частичный, неконтролируемый (GINA)). При постановке диагноза бронхиальной астмы использованы стандартные методы (анамнез, симптомы, спирография). Для оценки уровня контроля использовались Asthma Control Questionnaire 5 items-self-administered (ACQ-5), качества жизни – опросники Asthma Quality of Life Questionnaire S (AQLQ-S), 36-ltem MOS Short-Form Health Survey (SF-36), стандартизированная и валидизированная русскоязычная версия опросника женского здоровья Women’s Health Questionnaire (WHQ). Для психологической диагностики и оценки социально-личностных компетенций, способствующих сохранению и развитию здоровья человека (интеллектуальный, личностный, эмоциональный, физический, социальный, творческий, духовный аспекты), применялся мультимодальный интегрированный опросник (МИО). Сравнение проводилось с контрольной группой мужчин с бронхиальной астмой, сопоставимых по возрасту и уровню контроля.Результаты. Женщины с плохо контролируемой астмой имели худшие показатели AQLQ-S (суммарная медиана баллов 3,43 вместо 5,13 в группе хорошего контроля; p < 0,05); всех шкал SF-36, включая общее состояние (43,48 против 55,07), роль физических (25,93 против 57,76) и эмоциональных проблем (43,83 против 64,37); р < 0,05. По опроснику WHQ (обратная зависимость: чем выше балл, тем ниже качество жизни) при плохом контроле отмечается высокая выраженность депрессии (среднее значение 0,36 против 0,24; p < 0,05), проблем физического здоровья (0,47 против 0,27; p < 0,05). Отмечена чрезвычайно низкая оценка собственной привлекательности при БА (0,71 и 0,64 соответственно при плохом и хорошем контроле). По опроснику МИО у мужчин и женщин с БА получены практически одинаковые показатели по шкалам, чувствительным к проявлениям тревожно-депрессивной симптоматики, эмоциональной уравновешенности, шкалам эмотивных навыков, коррелирующих с выраженной алекситимией и низкой способностью к рефлексии. Среди женщин была выше доля индивидуумов с высокими шкалами интеллектуального функционирования, волевой компетенции, целеполагания, контактности.Заключение. Тяжесть астмы, контроль заболевания тесно связаны с психологическим состоянием больного. Существует необходимость в междисциплинарном подходе, направленном на выявление и эффективную коррекцию психофункциональных расстройств при БА. Изучение психологических особенностей личности и мотивационной сферы пациента может способствовать оптимизации терапии, улучшению контроля и прогноза заболевания.

Место фиксированной комбинации будесонид / формотерол в лечении хронической обструктивной болезни легких стабильного течения. Заключение совета экспертов Приволжского федерального округа Российской Федерации

Late diagnosis of chronic obstructive pulmonary disease (COPD) at advanced stage, high risk of exacerbations, low compliance of patients, and adverse effects of treatment have been still unresolved problems in the treatment of COPD despite the development of new drugs. The personalized medicine rneeds distinct indications and predictors of efficacy and safety of treatment. Budesonide/formoterol fixed combination is recommended for patients with asthma – COPD overlap syndrome and bronchitis phenotype, blood eosinophilia > 300 cells/mm3, if other causes were excluded, post-bronchodilator forced expiratory volume in 1 second (FEV1) < 50% pred.; and ≥ 2 exacerbations or ≥ 1 hospitalization related to exacerbation during the previous year. Budesonide/formoterol fixed combination is not recommended for regular use in patients with emphysema phenotype of COPD and rare exacerbations (< 2 exacerbations and without hospitalizations in the previous year).Несмотря на появление новых препаратов для лечения пациентов с хронической обструктивной болезнью легких (ХОБЛ), в настоящее время нерешенными проблемами в терапии этого заболевания остаются поздняя диагностика и выявление ХОБЛ уже на стадии тяжело протекающего заболевания, высокий риск обострений, низкая комплаентность пациентов, побочное действие лекарственных средств. Персонализированная медицина требует четких показаний, предикторов эффективности и безопасности лечения. Терапия фиксированной комбинацией будесонид / формотерол рекомендована пациентам с сочетанием бронхиальной астмы (БА) и ХОБЛ; высоким уровнем эозинофилов в периферической крови (> 300 клеток в 1 мкл крови) при исключении других причин (гельминты, лямблии и т. п.) и с постбронходилатационным объемом форсированного выдоха за 1-ю секунду (ОФВ1) < 50 %долж.; бронхитическим фенотипом; ≥ 2 обострениями в предшествующий год; ≥ 1 госпитализацией по поводу обострения в течение 1 года при наличии постбронходилатационного ОФВ1 < 50 %долж. Фиксированная комбинация будесонид / формотерол не рекомендуется к регулярному назначению при эмфизематозном фенотипе ХОБЛ у больных с редкими обострениями (< 2 / без госпитализаций за предшествующий год)

FLORISTIC FINDINGS IN THE BAIKALSKY RESERVE

The article contains data about 18 new species and subspecies of vascular plants for Baikalsky Reserve. Two оf these species are new for Buryatiya republic, 4 species are new records for the Khamar-Daban mountain range. The distribution of Carex laevissima Nakai и Chaenorhinum minus (L.) Lange is clarified

Psychological dysfunctions in women with bronchial asthma

Background. The importance of psychosocial factors in the management of bronchial asthma (BA) is discussed in clinical guidelines, including in international and national clinical guidelines. However, a specific evaluation of their role as a cause of poor asthma control in susceptible patients is required. Aim. Assessment of psychological health of women with different levels of asthma control.Materials and methods. The study included 108 women with asthma observed in Saratov center for Allergology who were stratified into 3 groups according to the control level (good, partial, uncontrolled, according to GINA). In establishing a diagnosis of asthma, standard methods were used (medical history, symptoms, spirography). To assess the level of control, ACQ-5 (Asthma Control Questionnaire 5 items-self-administered) was used, to assess the quality of life, questionnaires AQLQ-S (Asthma Quality of Life Questionnaire S); SF-36 (36-ltem MOS Short-Form Health Survey), a standardized and validated Russian version of the women’s health questionnaire WHQ (Women’s Health Questionnaire) were used; for psychological diagnosis and evaluation of social and personal competencies that contribute to the preservation and improvement of human health (the intellectual, personal, emotional, physical, social, creative, spiritual aspects), integrated multimodal questionnaire was used. The comparison was conducted with a control group of men with bronchial asthma, comparable in age and level of control.Results. Women with poorly controlled asthma had worse performance of AQLQ-S (combined median score of 3,43 instead of 5,13 in the group of good control; p < 0,05); all scales of the SF-36, including the general condition (43,48 against 55,07), role of physical (25,93 against 57,76) and emotional problems (43,83 against 64,37); at p < 0.05. According to the WHQ questionnaire (the inverse relationship: the higher the score, the lower the quality of life) in the group with poor control there is a high level of depression (mean 0,36 versus 0,24; p < 0,05); physical health problems are marked (0,47 against 0,27; p < 0,05). There is a very low selfestimation of their attractiveness in BA (0,71 and 0,64 for bad and good control, respectively). According to the integrated multimodal questionnaire, in both men and women with asthma almost identical results were obtained on the scales sensitive to manifestations of anxiety-depressive symptoms, emotional balance, scales of emotional skills, correlating with severe alexithymia and low capacity for reflection. Among women the proportion of individuals with high scores of intellectual functioning, strong-willed competence, goal-setting, and ability of making contacts was higher.Conclusion. The severity of asthma and disease control are closely linked with the psychological condition of the patient. Psychological dysfunctions are correlated with suboptimal BA control. It is important to understand psychological differences in women and to educate patients in both effective BA control and in establishing individualized asthma management strategies.There is a need for a multidisciplinary approach aimed at the identification and effective correction of asthma. The study of the psychological characteristics of personality and motivational sphere of the patient can help to optimize therapy, improve monitoring and prognosis of the disease

Psychological dysfunctions in women with bronchial asthma

Background. The importance of psychosocial factors in the management of bronchial asthma (BA) is discussed in clinical guidelines, including in international and national clinical guidelines. However, a specific evaluation of their role as a cause of poor asthma control in susceptible patients is required. Aim. Assessment of psychological health of women with different levels of asthma control.Materials and methods. The study included 108 women with asthma observed in Saratov center for Allergology who were stratified into 3 groups according to the control level (good, partial, uncontrolled, according to GINA). In establishing a diagnosis of asthma, standard methods were used (medical history, symptoms, spirography). To assess the level of control, ACQ-5 (Asthma Control Questionnaire 5 items-self-administered) was used, to assess the quality of life, questionnaires AQLQ-S (Asthma Quality of Life Questionnaire S); SF-36 (36-ltem MOS Short-Form Health Survey), a standardized and validated Russian version of the women’s health questionnaire WHQ (Women’s Health Questionnaire) were used; for psychological diagnosis and evaluation of social and personal competencies that contribute to the preservation and improvement of human health (the intellectual, personal, emotional, physical, social, creative, spiritual aspects), integrated multimodal questionnaire was used. The comparison was conducted with a control group of men with bronchial asthma, comparable in age and level of control.Results. Women with poorly controlled asthma had worse performance of AQLQ-S (combined median score of 3,43 instead of 5,13 in the group of good control; p < 0,05); all scales of the SF-36, including the general condition (43,48 against 55,07), role of physical (25,93 against 57,76) and emotional problems (43,83 against 64,37); at p < 0.05. According to the WHQ questionnaire (the inverse relationship: the higher the score, the lower the quality of life) in the group with poor control there is a high level of depression (mean 0,36 versus 0,24; p < 0,05); physical health problems are marked (0,47 against 0,27; p < 0,05). There is a very low selfestimation of their attractiveness in BA (0,71 and 0,64 for bad and good control, respectively). According to the integrated multimodal questionnaire, in both men and women with asthma almost identical results were obtained on the scales sensitive to manifestations of anxiety-depressive symptoms, emotional balance, scales of emotional skills, correlating with severe alexithymia and low capacity for reflection. Among women the proportion of individuals with high scores of intellectual functioning, strong-willed competence, goal-setting, and ability of making contacts was higher.Conclusion. The severity of asthma and disease control are closely linked with the psychological condition of the patient. Psychological dysfunctions are correlated with suboptimal BA control. It is important to understand psychological differences in women and to educate patients in both effective BA control and in establishing individualized asthma management strategies.There is a need for a multidisciplinary approach aimed at the identification and effective correction of asthma. The study of the psychological characteristics of personality and motivational sphere of the patient can help to optimize therapy, improve monitoring and prognosis of the disease