Patients with asthma-like symptoms but negative asthma tests and patients with bronchial asthma

Abstract: Patients with asthma-like symptoms but with negative results in asthma tests have recently been identified. The symptoms are mainly triggered by strong odours, physical exercise and mental stress. These patients are often misdiagnosed and mistreated. They mostly have to find coping strategies by themselves. Patients with diagnosed bronchial asthma sometimes are 'educated in their own disease' by health care professionals in order to increase their compliance and to help them to find coping strategies.The overall aim of this thesis was to identify and describe patients with asthma-like symptoms but negative asthma tests and to find diagnostic instruments to differentiate these patients from patients with bronchial asthma and healthy subjects and to investigate some possible mechanisms behind the disorder. A further aim was to describe the effects of a cognitive and affective treatment of patients with diagnosed bronchial asthma and to discuss if this model might also be applicable to patients with asthma-like symptoms but negative asthma tests.Altogether 24 patients with asthma-like symptoms but negative asthma: tests, 28 patients with bronchial asthma and 10 healthy controls participated in four studies. Only women aged 18-60 years were included. They were investigated with psychological tests, questionnaires and provocation with physical exercise, voluntary hyperventilation and mental stress. In-depth interviews were also performed. In a fifth study, the effects of a cognitive and affective model for treating patients with bronchial asthma, an "asthma school'', were studied by means of different questionnaires and lung function testo;, Althogether 38 patients with bronchial asthma, women and men aged· 18-70 yrs, participated.The results showed that the patients with asthma-like symptoms suffered more frequently from a greater variety of symptoms compared to the patients with asthma and healthy contJ:ols. They were more depressed, less hedonic, more hypochondriac and had lower trust in others than the patients of the astluna group. They had a higher health care consumption compared to the patients with asthma The physical exercise test did not provoke any bronchoconstriction in the patients with asthma-like symptoms. Neither could the symptoms be explained by physical unfitness. The provocations with voluntary hyperventilation and mental stress revealed that hyperventilation might be present in these patients and that mental stress might be one trigger factor. In a qualitative study, the patients stated that they felt dejected, confused and non confirmed by health care professionals, family and friends. Their subjective hyperreactivity limited them socially. They lacked adequate coping strategies. The findings were characterised by numerous self-reinforcing vicious circles where the circles comprised subjective hyperreactivity, social limitations and non confinnation. Patients with bronchial asthma benefit from being treated in an "asthma-school''. After having attended an "asthma-school", the patients increased their knowledge of the disease slightly more than a control group. They also increased their quality of life and decreased their health care conswnption.In summary, no evidence was found for the diagnosis of asthma in the patients with asthmalike symptoms but negative asthma tests. It is possible to separate them from patients with bronchial asthma by using different lung function tests, and different provocation tests. Patients with bronchial asthma benefit from taking part in an "asthma school". A similar treatment, with both a cognitive and an affective approach, might also be applicable in patients with asthma-like symptoms but negative asthma tests. A multidisciplinary approach and confirmation of these patients is important.