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This research project aims to provide insights into the psychobiology of personality of individuals living with chronic asthma to inform treatment planning. Personal experience in observing emotional and social difficulties in an asthmatic child over years and an article on the effects of asthma medication on the cognitive and psychosocial functioning of asthmatic learners raised awareness of the problem. Medical illnesses, acute and chronic, are often accompanied by a number of disease-related stressors or events that produce stress. Stress-induced changes in the nerve and immune system affect cognitive and emotional functioning that adversely affect personality development and significantly decrease the individual’s quality of life, particularly if sustained over a long period of time. This project followed a quantitative mode of enquiry, and personality profiles were compiled at hand of the 16-PF Questionnaire. The research sample consisted of 11 Afrikaans speaking, 18-year-old asthmatic individuals from the same school. Significantly meaningful characteristics associated with chronic asthma were identified, i.e., a highly tense temperament, accompanied by low resilience, subjective anxiety, low self-worth, as well as surgency or uninhibited behaviour, tempered by moderate spontaneity and warmness. It is envisioned that these insights might significantly inform planning of treatment regimes and lifestyle modification programmes. Stress relief might improve neuroendocrine and immune functioning, delay disease progression, and reduce morbidity and mortality. The focus is thus on a general stress-coping model in order to improve quality of life. / Dissertation (MEd (Educational Psychology))--University of Pretoria, 2007. / Educational Psychology / unrestricted

Many respiratory patients misuse their inhaler. Although training improves their inhaler technique, patients do forget the correct inhaler use with time. In the current work, three clinical studies investigated novel tools designed with feedback mechanisms to ensure patients use the correct inhalation method when using their inhaler. Research Ethics Committee approval was obtained and all the participants signed an informed consent form. In the first study, the recruited asthmatic children (n=17) and adults (n=39) had their metered dose inhaler (MDI) technique assessed. Those who attained the recommended inhalation flow rate (IFR) of < 90 l/min through their MDI formed the control group. Whilst those who had a poor MDI technique with an IFR ≥ 90 l/min were randomized into either the verbal counselling (VC) group; or the 2ToneTrainer (2TT) group that, in addition to the verbal training, received the 2ToneTrainer MDI technique training device equipped with an audible feedback mechanism of correct inhalation flow. All the participants were assessed on two occasions (6 weeks apart) for their inhalation flow rate, asthma control and quality of life. The study showed that the 2ToneTrainer tool was as efficient as verbal training in improving and maintaining the asthmatic patients' MDI technique, particularly using the recommended slow inhalation flow through the MDI. Although statistically insignificant, potential improvement in quality of life was demonstrated. The 2ToneTrainer tool has the advantage of being available to the patients all the time to use when they are in doubt of their MDI technique. In the second research study, the inhalation profiles of asthmatic children (n=58) and adults (n=63), and of COPD patients (n=63) were obtained when they inhaled through the novel Spiromax dry powder inhaler (DPI) which was connected to an electronic pressure change recorder. From these inspiratory profiles; the peak inhalation flow, inhalation volume and inhalation acceleration rate were determined. The variability (23%-58%) found in these inhalation profile parameters among various patient groups would be expected in all DPIs. The effect of the inhalation acceleration rates and volumes on dose emission characteristics from DPIs should be investigated. Attention, though, should be paid to the patients' realistic inhalation profile parameters, rather than the recommended Pharmacopoeial optimal inhalation standard condition, when evaluating the in-vitro performance of DPIs. Finally, in preschool asthmatic children, the routine use of the current AeroChamber Plus spacer (n=9) was compared with that of a novel version; the AeroChamber Plus with Flow-Vu spacer (n=10) over a 12-week period. The Flow-Vu spacer has a visual feedback indicator confirming inhalation and tight mask-face seal. The study showed that the new AeroChamber Plus with Flow-Vu spacer provided the same asthma control as the AeroChamber Plus in preschool children and maintained the same asthma-related quality of life of their parents. However, the parents preferred the new Flow-Vu spacer because its visual feedback indicator of inhalation reassured them that their asthmatic children did take their inhaled medication sufficiently.

Many respiratory patients misuse their inhaler. Although training improves their inhaler technique, patients do forget the correct inhaler use with time. In the current work, three clinical studies investigated novel tools designed with feedback mechanisms to ensure patients use the correct inhalation method when using their inhaler. Research Ethics Committee approval was obtained and all the participants signed an informed consent form. In the first study, the recruited asthmatic children (n=17) and adults (n=39) had their metered dose inhaler (MDI) technique assessed. Those who attained the recommended inhalation flow rate (IFR) of < 90 l/min through their MDI formed the control group. Whilst those who had a poor MDI technique with an IFR ¿ 90 l/min were randomized into either the verbal counselling (VC) group; or the 2ToneTrainer (2TT) group that, in addition to the verbal training, received the 2ToneTrainer MDI technique training device equipped with an audible feedback mechanism of correct inhalation flow. All the participants were assessed on two occasions (6 weeks apart) for their inhalation flow rate, asthma control and quality of life. The study showed that the 2ToneTrainer tool was as efficient as verbal training in improving and maintaining the asthmatic patients¿ MDI technique, particularly using the recommended slow inhalation flow through the MDI. Although statistically insignificant, potential improvement in quality of life was demonstrated. The 2ToneTrainer tool has the advantage of being available to the patients all the time to use when they are in doubt of their MDI technique. In the second research study, the inhalation profiles of asthmatic children (n=58) and adults (n=63), and of COPD patients (n=63) were obtained when they inhaled through the novel Spiromax dry powder inhaler (DPI) which was connected to an electronic pressure change recorder. From these inspiratory profiles; the peak inhalation flow, inhalation volume and inhalation acceleration rate were determined. The variability (23% - 58%) found in these inhalation profile parameters among various patient groups would be expected in all DPIs. The effect of the inhalation acceleration rates and volumes on dose emission characteristics from DPIs should be investigated. Attention, though, should be paid to the patients¿ realistic inhalation profile parameters, rather than the recommended Pharmacopoeial optimal inhalation standard condition, when evaluating the in-vitro performance of DPIs. Finally, in preschool asthmatic children, the routine use of the current AeroChamber Plus spacer (n=9) was compared with that of a novel version; the AeroChamber Plus with Flow-Vu spacer (n=10) over a 12-week period. The Flow-Vu spacer has a visual feedback indicator confirming inhalation and tight mask-face seal. The study showed that the new AeroChamber Plus with Flow-Vu spacer provided the same asthma control as the AeroChamber Plus in preschool children and maintained the same asthma-related quality of life of their parents. However, the parents preferred the new Flow-Vu spacer because its visual feedback indicator of inhalation reassured them that their asthmatic children did take their inhaled medication sufficiently.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-19T18:00:13Z No. of bitstreams: 1 Maryjôse Carvalho Mello.pdf: 1188091 bytes, checksum: 04ca69726dabd228dc801e0754bbb389 (MD5) / Made available in DSpace on 2018-07-19T18:00:13Z (GMT). No. of bitstreams: 1 Maryjôse Carvalho Mello.pdf: 1188091 bytes, checksum: 04ca69726dabd228dc801e0754bbb389 (MD5) Previous issue date: 2017-12-18 / Asthma is a chronic inflammatory disease of the airways, such as children and adolescents. In this sense, active video games (VGA) and resistance exercise have been gaining prominence as a form of training in this age group, promoting adhesion, motivation, reduction of pulmonary inflammation, muscular strength gain and energy expenditure. Thus, the objective of this study was to evaluate whether the increase of aerobic (combined) exercise reduces a pulmonary inflammation and improves clinical control in children and adolescents as trainers more effectively than only aerobic training with VGA. This is a randomized, blinded clinical trial with no registry Clinical Trials.gov: NCT03014154, 30 children and adolescents were randomly assigned to a VGA group using XBOX 360 Kinect Adventure "Reflex Ridge" (VGA group) and unladen exercises and VGA group associated with resistance exercise (VGAR group) with intensity 3 sets of 15 repetitions, with 50% of 1 RM. The training period lasted 8 weeks and involved 2 weekly sessions of 1 hour and 10 minutes, 10 minutes. heating, 30 min. of VGA, 20 min. of exercises and 10 min. the elongation. Pulmonary inflammation, pulmonary function, peak flow, respiratory muscle strength, as anthropometric variables, clinical control questionnaires and quality of life, physical fitness and peripheral muscular strength of the participants before and after the training were evaluated. The results, involving 27 study participants (13 VGA and 14 VGAR) showed reduction in lung inflammation in both groups (clinically important) but the effect size (TE) for reduction of FeNO in the VGA group was 0 , 47 (small) and in the VGAR group was 0.68 (mean). In TCP it occurred in the test week, velocity, slope and distance traveled only in the VGA group. And in the VGAR group, improvement in physical fitness and rapid cardiovascular return to basal condition by HR recovery after the test (TE = 0.90) was higher in relation to the VGA group (TE = 0.41). Maximum load increase after 1RM test (MMSS from 2 kg to 4 kg (TE = 1,28) and MMII from 30 kg to 51 kg (TE = 1,09)) was also higher in the VGAR group. In both groups, there was improvement in quality of life and better clinical control of the disease, and no participants in both groups were not in exercise-induced bronchospasm during the sessions. These results allowed us to conclude that combined training is more effective in reducing pulmonary inflammation and allows an improvement in quality of life, clinical control of the disease, aerobic fitness, physical fitness and muscular strength in children and adolescents. / A asma é uma doença inflamatória crônica das vias aéreas, as crianças e os adolescentes asmáticos têm menor tolerância ao exercício físico. Neste sentido, os videogames ativos (VGA) e o exercício resistido vem ganhando destaque como forma de treinamento nesta faixa etária, promovendo adesão, motivação, redução da inflamação pulmonar, ganho de força muscular e gasto energético. Sendo assim, o objetivo deste estudo foi avaliar se o acréscimo do exercício resistido ao aeróbio (combinado) reduz a inflamação pulmonar e melhora o controle clínico em crianças e adolescentes asmáticos de forma mais eficaz do que apenas o treinamento aeróbio com VGA. Trata-se de um Ensaio clinico controlado, randomizado, cego, com registro no Clinical Trials.gov: NCT03014154, para tal, 30 crianças e adolescentes foram avaliados e alocados de forma randomizada, para um grupo de VGA utilizando o XBOX 360 Kinect Adventure “Reflex Ridge” (grupo VGA) e exercícios sem carga e um grupo de VGA associado a exercício resistido (grupo VGAR) com intensidade 3 séries de 15 repetições, com 50% de 1 RM. O período de treinamento durou 8 semanas e envolveu 2 sessões semanais de 1 hora e 10 minutos, sendo 10 min. de aquecimento, 30 min. de VGA, 20 min. de exercícios e 10 min. de alongamento. Foi avaliado a inflamação pulmonar, função pulmonar, peak flow, força muscular respiratória, as variáveis antropométricas, questionários de controle clinico e qualidade de vida, aptidão física e força muscular periférica dos participantes antes e após os treinamentos. Os resultados, provenientes de 27 participantes que completaram o estudo (13 VGA e 14 VGAR) mostraram redução na inflamação pulmonar em ambos os grupos (clinicamente importante) porém o tamanho do efeito (TE) para redução da FeNO no grupo VGA foi de 0,47 (pequeno) e no grupo VGAR foi de 0,68 (médio). No TCP houve aumento na duração do teste, velocidade, inclinação e distância percorrida apenas no grupo VGA. E no grupo VGAR, melhora do condicionamento físico e rápido retorno cardiovascular a condição basal pela recuperação da FC após o teste (TE=0,90) foi maior em relação ao grupo VGA (TE=0,41). O aumento da carga máxima após teste de 1RM (MMSS partindo de 2 kg para 4 kg (TE=1,28) e MMII de 30 kg para 51 kg (TE= 1,09)) também foi maior no grupo VGAR. Em ambos os grupos houve melhora da qualidade de vida e melhor controle clinico da doença, além de nenhum participante de ambos os grupos não apresentarem broncoespasmo induzido pelo exercício durante as sessões. Estes resultados permitiram concluir que o treinamento combinado é mais eficaz na redução da inflamação pulmonar e possibilita a melhora da qualidade de vida, controle clinico da doença, da aptidão aeróbia, condicionamento físico e aumenta da força muscular em crianças e adolescentes asmáticos.