Living with Asthma: The Psychosocial Effects

Evidence-based research points to an underlying psychosocial component of asthma that affects patient coping, disease outcomes, treatment adherence, and patient behavior. During a session at the 2018 AAAAI Annual Meeting, Melissa T. Korenblat-Hanin, ACSW, LCSW, of the St. Louis Children’s Hospital in Missouri, discussed the psychosocial dynamics of asthma.

Anxiety, depression, and low social support can work against successful management of asthma, impact functional status, and interfere with effective adherence to therapy, said Ms. Korenblat-Hanin. A 2004 report from the Lung Association found that patients with asthma can fall into a cycle of poor disease management, fear, and symptoms. This is caused by low expectations of disease control, a lack of understanding of the daily need to manage the disease, and misperceptions about what it means to have controlled asthma.

“The psychosocial construct helps us understand, assess, and treat the patient,” said Ms. Korenblat-Hanin. The psychosocial framework includes work or school, peers, life events, family, neighborhood, caregiver, mental health, and the disease itself. By identifying coping mechanisms, behaviors, barriers, challenges, and strengths, healthcare providers can understand the patient’s emotional climate and determine whether a psychological intervention is necessary.

She then cited Richard S. Farr, MD, a past president of AAAAI and former head of the Division of Allergy, Immunology, and Rheumatology at Scripps. Dr. Farr was a practitioner who, in the early 1960s, recognized certain behavior patterns and coping styles in people. By defining these “coping styles,” Dr. Farr helped physicians learn to recognize patterns and address them to help patients achieve better asthma control.

Comprehensive and sustainable care requires a multidisciplinary approach, including awareness, assessment, communication, resource connection, and ongoing monitoring. A psychosocial assessment should include history forms, standardized questionnaires, assessment guidelines, formal interview/encounter, collaboration with the medical team, and chart review.

Psychological dimensions include cognitive processes, perception of quality of life, personality style, psychologic functioning, family dynamics, behavior management, coping mechanisms, and grieving processes. Social components that physicians should discuss with patients include relationships, social support and stressors, financial barriers, poverty, trauma, and loss, to name a few.

Ms. Korenblat-Hanin discussed some intervention strategies as well, including strengthening patient knowledge of adherence, attending to any barriers, building vigilance, increasing resourcefulness, enhancing communication, and normalizing patient experiences.

She talked about Asthma Explorers Club (asthmaeclub.com), an online resource for children with asthma. She also provided community resources such as counseling, suicide prevention hotlines, in-home services, and more, including:

• Annie’s Hope
• Wings on Wheels
• Crisis Nursery
• Life Crisis
• Children’s Division
• Healthy Start Clinic
• The SPOT
• 40 Winks Foundation
• Pediatric Outreach Project

She also stressed the need to close the communication loop with ongoing follow-up that includes phone check-ins, social media, texting, emails, and case management.

Discovering and uncovering psychosocial pieces of information helps the healthcare team, patient, and family. “Understand risk, determine resources, and connect and collaborate,” Ms. Korinblat-Hanin concluded.

Presentation 1101: AH: Advanced Practice Update