title: Asthma Trigger Reports Are Associated with Low Quality of Life, Exacerbations, and Emergency Treatments.
abstract: BACKGROUND
  Despite the importance of trigger perceptions for asthma diagnosis and management, associations among asthma triggers, affective disorders, and asthma outcome have received little attention.
  
  
  OBJECTIVE
  Because anxiety and depression are known to influence patients' health reports, we measured and controlled for these affective disorders in analyzing associations among patient perceptions of asthma triggers and asthma treatment outcomes.
  
  
  METHODS
  Patients from a nationally representative sample of respiratory specialist practices (N = 459) were assessed for clinically significant anxiety and depression and completed questionnaires on asthma triggers, quality of life, and asthma control. Physicians recorded exacerbation and emergency treatment frequencies in the prior year, spirometric lung function, and allergy test results. Hierarchical multiple regressions examined associations among reported trigger factors, anxiety, depression, and asthma outcomes, including quality of life, asthma control, exacerbations, emergencies, and spirometry.
  
  
  RESULTS
  Patients across asthma severity levels were well represented. Anxiety and depression were associated with more frequent nonallergic, in particular psychological, triggers. Controlling for demographics, asthma severity, anxiety, and depression, nonallergic asthma triggers (including psychological triggers) explained substantial portions of variance in asthma control (total of 19.5%, odds ratios [ORs] = 2.07-1.37 for individual triggers), asthma-related quality of life (total of 27.5%, ORs = 3.21-1.49), and general quality of life (total of 11.3%, ORs = 1.93-1.55). Psychological triggers were consistently associated with exacerbations and emergency treatments (ORs = 1.96-2.04) over and above other triggers and affective disorders. Spirometric lung function was largely unrelated to perceived asthma triggers.
  
  
  CONCLUSIONS
  Patients' perceptions of asthma triggers are important determinants of asthma outcomes, which can help identify individuals at risk for suboptimal asthma management.
authors.affiliation: 1 Department of Psychology, Southern Methodist University, Dallas, Texas.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ritz
authors.affiliation: 2 Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Wittchen
authors.affiliation: 3 Deutsches Rheumaforschungszentrum, Ein Leibniz-Zentrum, Berlin, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Klotsche
authors.affiliation: 4 Chemnitz University of Technology, Department of Psychology, Chemnitz, Germany; and.
authors.forename: Stephan
authors.initials: S
authors.lastname: Mühlig
authors.affiliation: 2 Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.|5 Leibniz-Institute for Prevention Research and Epidemiology, Bremen, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Riedel
mesh_terms: D000328:Adult; D000397:Air Pollution / Q000009:adverse effects; D001008:Anxiety Disorders / Q000523:psychology*; D001249:Asthma / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000523:psychology*; D018450:Disease Progression; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology; D016017:Odds Ratio; D010465:Perception; D011058:Pollen / Q000009:adverse effects; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D013147:Spirometry; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: anxiety; asthma; depression; perceived asthma triggers; quality of life