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BACKGROUND: Patients may find it difficult to distinguish between the symptoms of anxiety and those of asthma. Findings are equivocal on whether there is a specific link between anxiety and asthma. The aims of this study were to i) to identify the prevalence of anxiety, depression and panic fear in adults with asthma compared with that of the general population ii) to investigate whether there is a specific relationship between asthma and anxiety. METHODS: An epidemiological survey of 872 adults with a diagnosis of asthma identified from six General Practices in Sheffield, England. Community postal survey using self-completion questionnaire. RESULTS: The response rate was 59%. People with asthma had higher mean Hospital Anxiety and Depression Scale (HADS) anxiety scores than UK norms with a higher proportion above the clinical cut-off. Mean HADS depression scores were significantly higher than UK norms and norms for a general population sample of people registered with the same practice. These effects were age-related with the relationship between asthma and psychological distress most marked over the age of 45. The prevalence of asthma-specific panic fear was 15.7%. CONCLUSION: A significant minority of people have high levels of panic fear (as measured by the Asthma Symptom Checklist) associated with asthma. However, in adults with asthma there is also high prevalence of both generalised anxiety and depression (as measured by the HADS), suggesting that the link of anxiety to asthma may be part of a broader relationship between psychological distress and chronic disease rather than a specific one. [ABSTRACT FROM AUTHOR]

Background: High levels of asthma-related fear and panic exacerbate asthma symptoms and complicate the management of asthma. Asthma-specific fear may be reduced by a cognitive behavioural intervention. We aimed to test if there is a reduction in asthma-specific fear after cognitive behavioural intervention compared with routine treatment., Methods: Adults with asthma registered with family doctors in Sheffield UK were screened for anxiety and 94 highly anxious patients were randomly allocated to receive either a cognitive behavioural intervention to improve self-management of their anxiety (n = 50) or routine clinical care (n = 44). Asthma-specific fear at the end of treatment and at six month follow up were the primary endpoints. Service usage in the six months prior to and six months following the intervention was monitored to allow estimation of costs. Data were analysed by intention to treat., Findings: At the end of treatment, there was a significantly greater reduction in asthma-specific fear for people in the CBT group compared with controls. At six months after treatment the reduction in asthma-specific fear in the CBT group was increased and the difference between treatment and control group was statistically significant. Service use costs were not reduced in the CBT group., Interpretation: A brief cognitive behavioural intervention was found to have efficacy in reducing asthma-specific panic fear immediately after treatment and at 6 months follow up. There was no cost advantage to cognitive behavioural treatment., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

This study describes sensitization to a diazonium salt intermediate, diazonium tetrafluoroborate (DTFB), produced during the manufacture of a fluorine polymer precursor. Most of the workers exposed to DTFB powder complained of respiratory and mucosal irritation. However, some of these individuals had symptoms typical of occupational asthma. Clinical and immunologic studies, including bronchial provocation testing and specific IgE measurements, were performed on two individuals with asthmatic symptoms associated with exposure to DTFB. These studies confirmed a diagnosis of occupational asthma. In an investigation of 43 other exposed workers in two separate factories handling the diazonium compound, specific IgE antibodies to DTFB-human serum albumin conjugate were found in 20% of individuals. There was a good correlation between specific IgE and exposure-related respiratory symptoms, which suggests an IgE-mediated pathogenesis. DTFB-human serum albumin conjugates were characterized by electrophoretic techniques, and it was found that conjugates prepared at pH 10 elicited optimum IgE binding in RAST. In vitro cross-linking of albumin by DTFB was demonstrated but had no effect on RAST binding. Our findings on the effect of pH and polymerization on IgE binding support proposed mechanisms for in vivo conjugation and provide information on the antigenic determinants important in IgE recognition of hapten-carrier protein conjugates.

The levels of circulating complement components C3 and C4, total haemolytic complement, CH50, as well as evidence of complement activation, have been studied in peripheral blood samples during allergen-induced asthma. No evidence of activation of the complement system was detected in these studies.

Calcium deprivation inhibits the formation and subsequent release of SRS-A as well as histamine from passively sensitized human lung fragments challenged with antigen. Antimycin A inhibits the release of histamine and SRS-A in a dose dependant fashion, while causing a mild inhibition of SRS-A formation throughout the dose range studied. These data suggest that the influx of calcium is the critical event for the generation of SRS-A within the cell.

Immunological studies of forty-three patients with cystic fibrosis showed that positive prick tests to at least one common allergen were obtained in 70%, to multiple allergens in 28% and to A. fumigatus in 50%. Specific IgE antibodies against these allergens were found in the appropriate subjects. In spite of this evidence of type 1, IgE, sensitization none of the patients had a history of infantile eczema. Intracutaneous tests with A. fumigatus extract gave types 1 and 3 reactions in sixteen patients (37%), only seven of whom were among the sixteen (37%) who gave positive precipitin tests. Raised levels of total serum IgG and IgA were found as compared with healthy controls and asthmatic subjects. No differences were found in total serum IgM and IgD levels. The high incidence of allergy to A. fumigatus in cystic fibrosis is confirmed.

The effects of H1 and H2 receptor anatagonists on models of allergic reactions in monkey skin have been studied. Intradermal histamine is markedly inhibited by H1 receptor antagonists but not by H2 receptor antagonists in the doses used. However, the combination of both receptor antagonists gives greater inhibition than that seen with H1 receptor blockade alone. Reverse-type anaphylaxis is also markedly inhibited by H1 but not H2 receptor antagonists. Passive cutaneous anaphylaxis (PCA) is likewise inhibited by H1 receptor antagonism, but not by H2 receptor antagonism. The combination of the two inhibitors leads to a complete inhibition of this PCA response. The data suggest that the addition of an H2 receptor antagonist may potentiate the effect of H1 blockade alone.

In some allergic sera, 2-hr PCA responses can be due to IgE class antibody. In other sera where 2-hr PCA responses are not seen, removal of the IgG fracton allows expression of this 2-hr latency PCA response, suggesting an initial competition for binding sites between IgG and IgE, or that IgG can act as a blocking antibody, preventing antigen from reaching the cell-bound IgE.