The impact of health beliefs and family asthma management on biological outcomes in youth with asthma

• Main Author: Walker, Hope Alayne
• Language: English
• Published: University of British Columbia 2010
• Online Access: http://hdl.handle.net/2429/22481

Childhood asthma is a chronic inflammatory disease, with symptoms likely affected by physical, environmental and social factors. With regard to social factors, previous research has linked asthma management and beliefs to morbidity outcomes in children with asthma. In two studies, it was tested whether beliefs about and management of one’s illness would predict biological outcomes cross-sectionally (in Study 1), and longitudinally over 18 months (in Study 2) in a sample of children with asthma. Associations of asthma management-related beliefs and behaviors with immune markers and clinical outcomes were examined in a sample of 66 children with asthma (ages 9-18) in Study 1, and longitudinal associations of asthma management-related beliefs and behaviors with changes in asthma-relevant biological markers in a subsample of 40 children with asthma in Study 2. Children and parents were interviewed about asthma management beliefs and behaviors. In Study 1, immune measures included stimulated production of cytokines implicated in asthmatic airway inflammation, eosinophil counts, and IgE levels. Clinical outcomes included pulmonary function, symptoms, beta agonist use, and physician contacts. In Study 2, asthma outcomes included lung function (FEV ₁%), eosinophil counts, and daily cortisol measured at two time points, 18 months apart. In Study 1, children’s reports of greater conceptual understanding of asthma, parents’ reports of quicker responses to asthma symptoms, and children’s and parents’ reports of more balanced integration of asthma into daily life were all associated with reduced inflammatory profiles. Inflammatory profiles were found to be a statistically significant pathway linking asthma beliefs and behaviors to clinical outcomes. In Study 2, children with a less sophisticated disease belief (the “no symptoms, no asthma” belief) displayed eosinophil counts that increased over time, controlling for baseline levels. Poorer family asthma management was associated with increasing eosinophil counts over time. Poorer child asthma management was associated with cortisol output that declined over time. Families who reported poorer collaboration with their physician had children who displayed worsening lung function over time. These findings suggest that interventions aimed at teaching families better asthma management approaches and more accurate disease beliefs may have the potential to alter biological profiles in children with asthma.