T2 L17: Lifestyle factors and respiratory disease

• What is the mortality epidemiology of respiratory diseases?

  20% respiratory diseases
• Upper respiratory tract infections - colds and influenza - account for 50% of all acute illnesses

  Rinoviruses account for 30-50% of adult colds

  Only one-third of people exposed to cold virus develop a cold
• Is there a relationship between 'being cold' and the 'common cold'?

  scientific evidence dismisses a simple cause-effect link between cooling of the body surface and common cold

  • some studies appear to show a link e.g. acute chilling of feet causes onset of symptoms in ~10% of people
  • explanation: acute cooling of the body surface causes reflex vasoconstriction in nose and upper airways which inhibits respiratory defence onset of common cold symptoms caused by conversion of asymptomatic subclinical infection into a symptomatic infection
• Sleep: Less / worse sleep increases the risk of developing a cold - especially for lower SES.
• Chronic stress increases the risk of common cold

  Also related to:

  • smoking
  • lack of exercise
  • poor sleep efficiency
  • drinking more alcohol

  plus significant association between smoking and chronic stress
• Higher subjective socioeconomic status (SES) is associated with a lower risk of colds

  (independent of: objective SES or cognitive, affective and social factors)

  poor sleep and health behaviour among lower SES may mediate the link between subjective SES and colds
• What is the effect of preventative megadoses of vitamin C on the common cold?

  Prophylaxis and incidence: no significant reduction

  Prophylaxis and cold duration: significant reduction in both children and adults

  Therapy and cold duration: no significant difference

  so significantly reduces cold duration
• Systematic reviews show that psychosocial interventions to promote hand washing significantly reduce the risk of transmission

  but need more evidence of effectiveness and cost-effectiveness
• Asthma episodes incur large economic costs; medical treatment, lost productivity, social security costs
• What are the factors affecting the onset of respiratory disease?

  physical: genetic vulnerability

  demographic: sex (male), socioeconomic status (lower), ethnicity (minority), maternal age (younger)

  lifestyle: maternal smoking in pregnancy, maternal anxiety, smoking in the home

  psychosocial: childhood adversity / stress, violence in home
• What are the factors affecting the episodes of respiratory disease?

  physical: allergens, good allergies, chest infections, chemical fumes / pollution, cold weather

  lifestyle: smoking, intense exercise

  psychosocial: acute stress, anxiety
• What are the psychosocial factors in asthma?

  asthma symptoms are exacerbated by stress

  acute stress makes it worse

  anxiety, pessimism, and perceived stigma affect perception of symptoms and medical outcomes

  
  

  Likelihood of hospitalisation and duration of stay are influenced more by psychological factors than objective symptoms of asthma

  psychological interventions are effective
• Anxiety disorders exacerbate asthma symptoms

  Exposure to inter-personal conflict worsens asthma symptoms in children/adolescents
• What are the problems with how people with asthma are expected to monitor themselves?

  most are unable to detect changes in lung function

  and self-rated asthma does not match peak expiratory flow
• What are some psychological interventions to reduce the impact of psychosocial factors on people with asthma?

  self-management education, simplified regimens, electronic trackers/reminders:

  improve medication adherence

  improve clinical markers of asthma control

  reduce use of healthcare

  reduce hospitalisation

  reduce abstenteeism from employment / education
• Smoking and lung cancer

  over 90% of cases of lung cancer can be attributed to smoking tobacco

  other causes include exposure to: asbestos, radon, other radioactive substances

  dose-response effects link greater risk of lung cancer to # of cigarettes, depth of inhalation, etc.

  declines in smoking prevalence are reflected in declines in lung cancer incidence
• Decline in smoking prevalence individual behaviour change (psychological) and structural change (social) prevalence of smoking is around 15%

  more common among young adults and lower SES groups
• What is the prevalence of e-cigarettes?

  Rise in prevalence of electronic nicotine delivery systems (ENDS) / e-cigarettes / vapes

  more common among younger people high variability in use of cigarettes and ENDS over time = many people report dual use and/or switch between cigarettes and ENDS
• What is the use of ENDS and switches to/from cigarettes reflect?

  perceived risk / harm

  but not always accurate

  interventions focused on risk/harm may be effective for reducing ENDS use
• Relapse

  note that relapse is common:

  • plan how to manage triggers / temptations - e.g. dual-process model
  • boost skills and confidence
  • plan alternative responses
  • note how negative emotions affect - and are affected by - relapse* respond appropriately to relapse
  • framing of relapse
  • learning from relapse