Japanese Journal of Psychosomatic Medicine

Psychosomatic respiratory disease is defined as a specific pathological condition that psychosocial factors are closely related to its pathogenesis or progression and is associated with respiratory disorders. Recent researches on psychosomatic respiratory diseases in Japan have focused on chronic obstructive pulmonary disease, chronic respiratory failure, sleep apnea syndrome and lung cancer, as well as bronchial asthma and hyperventilation syndrome. The studies focused on bronchial asthma have shown that psychosomatic approach can improve asthma symptom more effectively than medical treatment, bronchial asthma may be associated with mental disorders defined by DSM-IV, and asthma attack can be triggered by PTSD. It is also worth noting that studies on hyperventilation syndrome suggested that it is important to make sure whether the subject under study is acute hyperventilation or subacute/chronic hyperventilation.

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Worldwide rapid development of bronchial asthma's treatment has driven the recent sharp decrease of asthmatic patients' hospitalization, however, there are some difficult-to-control asthmatic patients who have admitted in hospital repeatedly. One of these possible reasons might be deterioration of asthmatic attacks due to psychosocial stress. However, these stresses are made up of many complicated factors and also are difficult to analyze. We exploit a self-administered questionnaire for psychosomatic patients with asthma that is named "Psychosomatic Questionnaire related to Asthmatic Occurrence and Progression" in the Japanese Guideline for the Diagnosis and Treatment of Psychosomatic Diseases published in 2006. This questionnaire consists of 25 items with 5 subscales and evaluates psychosomatic factors such as 1) asthmatic occurrence and progression, 2) emotion and asthmatic attacks, 3) characters and behaviors, 4) daily life and QOL, and 5) family history, by which scores we could speculate a possible treatment's strategy for psychosomatic factors. We also performed a research using this questionnaire in 2009 for physician-diagnosed asthmatics in a respiratory hospital and concluded that about one quarter of patients with asthma could be classified into the psychosomatic type. Further study is required to establish simple and plain medical cares for the psychosomatic type of people with asthma in primary care clinics.

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Allergic asthma is associated with exposure to both allergens and non-allergenic components of the environment. In particular, non-allergenic components, such as bacterial products, air pollution, and tobacco smoke can act as adjuvants to promote allergic sensitization to innocuous inhaled antigens. Epigenetics caused by environmental factors and psychosocial stress has been reported to modulate allergic immune responses. Although many studies have been performed so far, little is known about the mechanism by which how psychosocial stress enhances allergic inflammation in the airway. In this paper, we review several papers in terms of current mechanisms of asthma related to environmental factors and discuss how psychological stress affects the severity and prevalence of asthma.

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Obstructive sleep apnea syndrome (OSAS) is associated with lifestyle-related diseases, including hypertension, obesity, and diabetes. OSAS itself is also one of lifestyle-related diseases because its worsening has an association with lifestyle factors such as overeating, lack of exercise and overdrinking. It is necessary to modify these lifestyle factors in order to treat OSAS patients effectively. In addition, OSAS patients have many problems related to chronic illness, such as poor adherence and depression. The psychosomatic approach based on the biopsychosocial model is more useful to manage such problems linked to lifestyle and chronic illness than conventional medical approaches. We here focus mainly on psychosomatic aspects of OSAS.

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