Difficult Asthma is a complex diagnosis relating to poor asthma control, but less related to severe clinical pathology. It is associated with medication non-adherence, poor psychosocial outcomes and high usage of health services. A number of psychological variables have been linked with the diagnosis. The systematic review examined the qualitative literature concerning patients’ experiences of self-managing asthma. A meta-ethnographic approach was used in order to add a layer of interpretive synthesis to the reciprocal translation of studies. A number of overarching themes were identified; Establishing Normality explored patients’ striving to achieve a balance between asthma symptoms, medication and quality of life. Beliefs about Medication identified common distrust of conventional medicine and the strategies used to find alternative ways to cope. Therapeutic Relationship gave voice to the frustrations of patients at being expected to self-manage asthma in a context of poor communication, unidirectional consultations and lack of access to quality information. Lack of policy implementation concerning shared models of care are considered. The empirical study extended the theme of patients managing asthma according to subjective beliefs. The self regulation model was used as a framework to understand the illness perceptions of adults attending a Difficult Asthma Clinic. The intention was to move discussion towards an understanding of illness perceptions as clusters or schemata of beliefs rather than individual dimensions. Four distinct clusters were established in this population based on their illness perceptions; these groups significantly varied on experiences of panic during asthma attacks and the strategies they used to cope with asthma, as well as clinical features such as age at diagnosis. Lung function did not differ between groups, suggesting there may be several potential routes to Difficult Asthma. The potential for tailored psychological interventions, care pathways and future research are discussed within a framework of mutual responsibility for disease management.

This study aimed to investigate the relationship between two different types of optimism, dispositional optimism and explanatory style, and negative affectivity, health status variables and self care behaviours, in a sample of individuals living with asthma. In order to investigate the nature of the relationship between the described optimism, negative affectivity and asthma variables, a non-experimental. cross-sectional design was employed, collecting quantitative data via the use of self report measures. The study recruited 59 adult participants, diagnosed with asthma. Participants completed measures to assess optimism, asthma health status, asthma self-care behaviours and negative affectivity. Participants were recruited via a General Practice surgery in Cromer and outpatient asthma clinic at the Norfolk and Norwich University Hospital. Participants had the option to complete the measures by attending an interview or via the post.

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This thesis examines the spatial and temporal variation in nitrogen dioxide (NO2) levels in Guernsey and the impacts on pre-existing asthmatics. Whilst air quality in Guernsey is generally good, the levels of NO2 exceed UK standards in several locations. The evidence indicates that people suffering from asthma have exacerbation of their symptoms if exposed to elevated levels of air pollutants including NO2, although this research has never been carried out in Guernsey before. In addition, exposure assessment of individuals is rarely carried out and research in this area is limited due to the complexity of undertaking such a study, which will include a combination of exposures in the home, the workplace and ambient exposures, which vary depending on the individual daily experience. For the first time in Guernsey, this research has examined NO2 levels in correlation with asthma patient admissions to hospital, assessment of NO2 exposures in typical homes and typical workplaces in Guernsey. The data showed a temporal correlation between NO2 levels and the number of hospital admissions and the trend from 2008-2012 was upwards. Statistical analysis of the data did not show a significant linear correlation due to the small size of the data sets. Exposure assessment of individuals showed a spatial variation in exposures in Guernsey and assessment in indoor environments showed that real-time analysis of NO2 levels needs to be undertaken if indoor micro environments for NO2 are the be assessed adequately. There was temporal and spatial variation in NO2 concentrations measured using diffusion tubes, which provide a monthly mean value, and analysers measuring NO2 concentrations in real time. The research shows that building layout and design are important factors for good air flow and ventilation and the dispersion of NO2 indoors. Environmental Health Officers have statutory responsibilities for ambient air quality, hygiene of buildings and workplace environments and this role needs to be co-ordinated with healthcare professionals to improve health outcomes for asthmatics. The outcome of the thesis was the development of a risk management framework for pre-existing asthmatics at work for use by regulators of workplaces and an information leaflet to assist in improving health outcomes for asthmatics in Guernsey.