Indian Pediatrics 2001; 38: 1327-1328  

Psychosocial Aspects of Bronchial Asthma in Children and Adolescents: Further Contemplation

Malhi et al.(1) have presented and discussed about psychosocial problems in children and adolescents with asthma; a worthwhile effort as there is paucity of rele-vant research from India. This research report assumes further significance as psychosocial factors play a key role in the etiology of asthma(2) and 20% of this study sample manifested with psychological maladjust-ment. However, there are certain issues that merit contemplation and discussion.

Firstly, the sample comprised 44% patients with very good control (no coughing/wheezing episodes in the last one month), 44% with inadequate control, and 12% with very poor control (>10 coughing/wheezing episodes in the last one month). This shows that, despite regular medication, the sample was not homogenous as regards symptom-atolgy. Methodologically, assessing stable patients (in terms of either symptoms or dosage) would have been more helpful. This issue becomes additionally important if we look at the statement "poor control..... children with asthma" (page 528, col 1, para 2, line 8-13). "Poor control" can only be commented upon if the prophylactic therapy was adequate - this does not appear to be the case for some patients here. This, hence, does pose limitation on the generalizability of results. Secondly, 20% of the target popula-tion demonstrated psychological maladjust-ment in the form of both externalising and internalising symptoms. As bronchial asthma has been conceptualised historically to be an internalizing psychosomatic illness(3), it would have been helpful if the authors had additionally shown whether these patients had predominantly internalizing or externalizing constellation of symptoms. Thirdly, patients were on regular medications. But the nature, distribution, dosage and duration of medi-cines have not been alluded to. Many oral or inhaled medications for treating asthma produce adverse effects, viz., agitation, insomnia, emotional ability, depression, dysphoria/irritability, hypomania, etc.(3). Hence, it is essential to try to differentiate between psychological symptoms related to asthma or as being an adverse manifestation of the medications. Lastly, the authors have carried out a correlation exercise and comment on the need to "identify potentially modifiable correlates of psychological and social functioning of children with asthma". A correlational analysis amongst variables of self-concept, adjustment and psycho-pathology can be additionally carried out. This should: (a) shed more light on role of these important psychosocial variables related to asthma, and (b) provide information on the role of internal (self concept) and external (adjustment) variables as possible predisposing factors towards manifest psychopathology.

Further in-depth analysis and inter-pretation can enhance the utility of this study as the information provided in text-books(2) elucidates to psychological factors in etiology of asthma (but not to the consequences or related management issues).

Nitin Gupta,
Assistant Professor,
Department of Psychiatry,
Postgraduate Institute of Medical Education and Research,
Chandigarh 160 012, India.
E-mail: [email protected]

 

1. Malhi P, Kumar L, Singh M. Screening for psycholsocial problems in children and adolescents with asthma. Indian Pediatr 2001; 38: 524-530.

2. Sly MR. Asthma. In: Nelson Textbook of Pediatrics, 15th edn. Eds. Behrman RE, Kleigman RM, Arvin AM. Bangalore, Prism Books Pvt. Ltd., 1996; pp 628-640.

3. Moran MG. Respiratory disorder. In: Comprehensive Textbook of Psychiatry, 7th edn. Eds. Sadock BJ, Sadock V. Philadelphia, Lippincott Williams and Wilkins, 2000; pp 1803-1807.