Asthma

This is the start of a series on chronic medical conditions. 

Health psychologists started working with several chronic illnesses, stress, pain, weight loss, headaches, physical conditioning back in the 1970's.  In the past 40 years the knowledge of those illnesses and conditions have grown exponentially.

Asthma is a chronic illness that impacts breathing.  About 1.8 million people have been diagnosed with asthma.  Asthma causes breathing difficulty by constricting the airways in the lungs and by causing swelling or inflammation in the airways.  This causes difficulty with being able to exhale without wheezing, gasping, feeling short of breath or coughing.

Medical treatment involves relieving the constriction and decreasing the inflammation of the airways and getting the symptoms manageable.  There are short acting medication, anti-inflammatory medications, vasodilators, and some other types of medications used to both relieve symptoms rapidly and to prevent symptoms from returning.

Psychological treatment involves managing the complexities of the illness, the side effects of medication, identifying triggers, and managing depression, anxiety and stress which accompanies the illness.

Let me give an example of a woman I'll call Sara.  She's had breathing problems for the past 25 years.  She is on two types of medication.  She has a rescue inhaler she uses four times a day.  She has a preventive inhaler she uses as directed twice a day.  She smokes cigarettes 2 to 3 times a week.  She has a nebulizer at home for breathing treatments but it's been broken for years.  She gets her primary treatment in emergency rooms.  She has no idea about what causes her asthma.  She's afraid to go anywhere or do anything.  The asthma attacks both frighten and embarrass her.  She thinks people will believe she is sick and contagious, so she avoids people.

She and I chatted about her rescue inhaler.  She knows she's supposed to inhale deeply twice each time she uses it.  But she's frightened and inhales only shallowly and uses the second inhalation very little.  So she ends up using a rescue inhaler far too frequently, getting signs of toxicity, and feeling poorly when she uses it.  She has never heard of a peak flow meter.  When I described the plastic tube that measures breathing on exhalation, she had seen that in her doctor's office and in the emergency room but didn't have one.  Her use of her rescue inhaler or visits to the emergency room were based on her feeling short of breath not on any information about how her breathing was.  So she started a list for her doctor.  Item one:  Can I get a Peak flow meter?

She has no idea about what triggers her asthma attacks.  They seem to come at random.  So she has homework:  Keep a list of where you are when you feel short of breath, time of day, and what you are doing at the time.  Single sheet of paper, three columns, one week work of data.

Her nebulizer is broken.  Item two for her doctor:  Can I get a new nebulizer?  That's likely to stop the need for frequent trips to emergency rooms for routine health care.  She's never been hospitalized overnight for asthma.  She's never been intubated.  She's getting routine home health care or outpatient care that's needed on an urgent basis from an emergency room that provides the most expensive type of care available.  She's exposed to bacterial and viral illnesses unnecessarily.  Her condition doesn't need to be treated in an emergency room. She requires urgent care, not emergency care.

Her physician doesn't take time with her.  She's chronically ill.  She's not understanding her health care.  She returns frequently not getting better.  Her doctor spends less and less time with her.  She's changed doctors often.  They are all the same to her.  Both she and her doctor are frustrated.  Health psychologists spend between 40 and 60 minutes at a visit on average.  A primary care physician spends 15 to 30 minutes on average.  On follow up, primary care doctors spend less time.

She smokes.  Her asthma makes her anxious.  She smokes because paradoxically, smoking decreases anxiety.  Unfortunately, smoking is a common trigger for asthma attacks.  Even if she's only smoking 3 to 5 cigarettes a day she needs to stop.  She needs a stop smoking plan, a stress reduction plan, and a better way to manage anxiety.

She's overweight.  She doesn't exercise because she's afraid of getting an asthma attack.  Asthma can be triggered by exercise.  It can be triggered by foods.  It can be triggered by the environment.  She doesn't know what's causing her asthma to be triggered.  That list will help her determine her triggers.  She can exercise in her home, or outside carefully, monitoring her chest constriction.  She may need to premedicate with her inhaler prior to exercise.  She may need to change her diet.  Someone like me can help with both of those.

Because I provide boutique services I can go to people's homes.  I help them set up the lists.  I can assist with setting up support services.  I can go with them to their medical doctor's appointments.  I can go with them if they need to go to an emergency room.  Treatment is expensive for that amount of personalization.  It's not covered by insurance.  It's time consuming.  But she stops needing frequent doctor visits.  She gets better control over her asthma.  She loses weight and stops smoking.  She stops paying for cigarettes.  She's not seeing her doctors as much, so co-pays for her physician are reduced.  Her medication use is lessened and those expenses are reduced.   Boutique health psychology is offered in some large cities.  I live in Los Angeles.  It's not uncommon in this area, but it's still not that common.  For most people, getting control over a chronic illness is well worth the expense and the time.