Asthma has not declined in morbidity and mortality despite significant advances in medical treatment. A literature review was conducted and a program of research was devised with the goal of improving understanding of why many appropriately treated and educated asthmatics are unable to gain adequate control of their asthma. A review of the literature found that psychological stress was a poorly understood trigger for asthmatic symptoms and a possible factor in poor asthma control. A clinic visit study of adult asthmatics found: (1) life event stress was associated with asthma quality of life but not ventilatory function, (2) asthma self-efficacy was strongly related to asthma quality of life and ventilatory function, (3) style of coping with stress appeared to buffer the effects of stress on asthma, and (4) evidence for a stress-responsive asthmatic subgroup. A subsequent longitudinal daily diary study found: (1) concurrent stress and daily asthma symptoms were strongly associated, (2) daily bronchodilator use appeared to be determined by pre-diary beliefs about disease severity and controllability, (3) stress could precede (within one day) increases in asthma symptoms and decreases in airflow, and (4) clinically significant decreases in peak flow were often preceded by large increases in perceived stress. A laboratory study found: (1) exposure of asthmatics to specific passive and asthma-related stressors resulted in decreased airflow and that these decreases are associated with a concurrent increase in vagal (parasympathetic) tone, (2) an active stressor that resulted in increased sympathetic arousal did not result in decreased airflow, (3) relaxation resulted in parasympathetic arousal and decreased airflow, and (4) asthma self-efficacy was associated with parasympathetic reactivity. In sum, the program of research has generated findings that help explain how stress, coping and self-efficacy contribute to asthma control led to concrete suggestions to improve c

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The Self-Regulation Model (Leventhal, Nerenz & Steele, 1984) highlights the roles of patients' illness representations, coping, emotional reactions and appraisal of coping in the progression of chronic disease. This thesis incorporates previous literature on adherence, panic-fear and selfmanagement interventions into the model in order to (a) investigate coping with asthma and (b) develop an intervention aimed at improving asthmatic control. New measures of asthmatic control and illness representations of the consequences of having asthma were developed in order to operationalise the model. A cross-sectional study investigated factors influencing asthmatic control in a sample of 35 adult asthma sufferers recruited through a single general practice. Coping was poor, adherence being low and less than 50% of participants reporting current Peak Flow monitoring or medical contact during the previous 12 months. Good coping appeared to be a response to poor asthmatic control, rather than prophylactic. Good asthmatic control was associated with low perceived consequences, recent medical contact, moderate panic-fear and low general avoidance coping. These results imply that asthmatic control may be improved by encouraging sufferers to maintain regular contact with outpatient services and to implement prophylactic coping. Since epidemiological and clinical evidence suggested asthmatic control to be poor in young adults, an intervention was developed to improve asthmatic control in this group by modifying illness representations, coping and panic-fear. The intervention was evaluated in a randomised controlled study of 50 student asthma sufferers identified initially through an epidemiological screening of 2,979 students. It led to increased Preventer medication use and Peak Flow monitoring and decreased distress over the condition. However, the coping process changed and asthmatic control improved even in the control group, perhaps because self-monitoring of asthmatic control for the study constituted a change in coping. This unanticipated result was entirely compatible with the Self-Regulation Model. The thesis dearly demonstrates value of the Self-Regulation Model in understanding asthma self-management and developing clinical interventions.