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Sedentary lifestyle, obesity, depression and anxiety make asthma symptoms worse, a study shows

Publicado em 05 maio 2021

Sedentary lifestyle, obesity, depression, and anxiety are factors that make asthma symptoms worse and make it difficult to control. On the other hand, frequent aerobic exercise such as B. Moderate intensity walks at least five times a week will help reduce disease crises, especially in moderate and severe patients.

These are the conclusions of studies carried out at the University of São Paulo (USP), recently published in two articles – one in European Respiratory Journal and one more on Chest journal. Both had support gives FAPESP and the coordination of the teacher and physical therapist Celso Ricardo Fernandes de Carvalho, Faculty of Medicine (FM-USP).

The first study of 296 Brazilian and Australian patients identified four key extrapulmonary characteristics to consider when treating asthma: physical activity, obesity, depression, and anxiety.

The work showed that the patients formed groups with different characteristics: 1) participants with controlled and physically active asthma; 2) with uncontrolled asthma, physically inactive and sedentary; 3) having uncontrolled asthma, low physical activity, obesity and anxiety and / or symptoms of depression; and 4) with very uncontrolled asthma, physically inactive, sedentary, obese, and with symptoms of anxiety and / or depression.

Most of them (64%) had some complications (e.g. hospitalization) in the past 12 months. Fifteen comorbidities were found in the groups, the most common of which were gastroesophageal reflux, obesity, high blood pressure, mental disorders, sinusitis, and sleep disorders.

Researchers then performed a hierarchical cluster analysis to identify clinical asthma phenotypes based on extrapulmonary features and behavioral risk factors to describe the clinical features associated with these phenotypes. The study also showed that a sedentary lifestyle was the factor with the highest association with hospitalizations and asthma attacks.

“We identified four asthma phenotypes based on extrapulmonary characteristics: physical activity, obesity, depression, and symptoms of anxiety. Our data underscore the importance of evaluating these traits in clinical practice to individualize treatments and thereby improve outcomes in people with moderate to severe asthma, ”conclude the researchers in the lead author of the article Patrícia Duarte Freitas.

In the other study, which looked at 51 volunteers between the ages of 18 and 60 who attended the pulmonary outpatient department of the das Clínicas Hospital, it was concluded that frequent physical activity controlled the disease, sleep quality and anxiety symptoms improved.

In this case, the volunteers were divided into an intervention group, which underwent behavior modification for eight weeks to increase physical activity, and a control group only with the usual care.

Information was collected on clinical control of asthma, physical activity / inactivity, behavior, quality of life, symptoms of anxiety and depression, sleep quality, and anthropometric data.

Clinical control of asthma was measured using a tool called ACQ, which includes seven questions about disease symptoms, medications, and lung function. Participants kept a diary to report exacerbations of the condition during the intervention period. The levels of physical activity and physical inactivity were also measured using devices.

The researchers compared the data of the groups in a randomized and controlled study and analyzed the ratings before and after the intervention period. “The results suggest that a multidisciplinary approach to behavior modification can potentially be a complementary or alternative strategy that improves clinical control in adults with asthma,” the researchers write.

According to Carvalho, the work has been going on since 2007 when the research between exercise, asthma, and obesity began. In 2018, one of the group’s publications, the result of Freitas’ doctorate, was awarded by the European Respiratory Congress in Paris. The study at the time showed that obese people with asthma who had a balanced diet and routine of physical activity had significant improvements in lung function and the disease’s inflammation meters (Read more here agencia.FAPESP.br/28868/).

Asthma, which is characterized by inflammation of the airways, is considered one of the most common chronic diseases in the world, according to a report by the World Health Organization, affecting around 339 million people (WHO).

To raise awareness of the disease, World Asthma Day is held on the first Tuesday in May, sponsored by the Global Initiative for Asthma (GINA). This year, the theme “Uncovering Misconceptions About Asthma” was chosen to raise awareness of myths and misunderstandings, such as that the disease only affects children or is contagious.

The exact cause of asthma is not yet known, but a number of genetic factors, such as a family history of respiratory and environmental allergies, are thought to play a role. Some triggers can make bronchial symptoms or inflammation worse. These include allergy sufferers (household dust, mites, fungi, pollen, animal hair), irritants (cigarette smoke, air pollution, aerosols), climatic fluctuations and even emotional changes.

Although there is no cure, the disease can be controlled to reduce and prevent seizures, which are characterized by shortness of breath, coughing, and wheezing that can lead to death. Treatment is usually with drugs that relieve or control symptoms, especially inhaled corticosteroids alone or in combination with a bronchodilator.

Carvalho points out that multidisciplinary treatment is becoming increasingly important, mainly taking into account extrapulmonary factors, which are known to be treatable features.

These “characteristics” are phenotypic or endotypic characteristics that can include comorbidities (such as anxiety, vocal cord dysfunction, and reflux), risk factors (such as smoking and bone density), and self-care skills (such as adherence to therapy and inhalation technique). . They are taken into account as part of the treatment strategy for chronic respiratory diseases through personalized medicine.

On April 29, a consortium made up of doctors, researchers, and corporations started one Page? ? This is where information and studies on treatable traits are collected. Carvalho participates in the group and is the only representative researcher on the American continent.

“The idea of ??being treated with medication only is much less effective. We need to think about multi-professional treatment. In addition, the patient must begin to take on the commitment to exercise for himself. You don’t have to try to become an athlete, you just have to run, ”says Carvalho.

With the support of FAPESP by means of a Thematic project The professor is currently developing research aimed at evaluating the effects of new approaches and technologies to improve the treatment of patients with moderate and severe asthma. The role of behavioral changes in patients with other types of chronic respiratory disease, such as: B. chronic obstructive pulmonary disease (COPD) is also analyzed.

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