Illness expectations play a crucial role in asthma progression and patient-reported outcomes

Individual expectations about one's health can influence him/her future condition and the speed of the progression of a disease: in fact, a research conducted by researchers of psychology at the Università Cattolica del Sacro Cuore, Milan campus, shows that, after a diagnosis of asthma, people who are optimistic about their health will have a slower progression of the disease.

The study was published in the journal Health Expectations (Wiley) and conducted by full Professor Francesco Pagnini of the Department of Psychology at the Università Cattolica and colleagues.

Professor Pagnini explains: "this study was developed in response to the difficulties reported by patients in managing asthma. Patients helped identify key areas of concern, and their perspectives influenced the choice of outcomes and tools". Although direct involvement in recruitment and dissemination was limited due to the pandemic, the design and focus of the study were guided by patient priorities, with potential applications in clinical consultations and future co-designed interventions.

Background

After receiving a diagnosis, people often develop expectations about how their condition will evolve, Professor Pagnini explains. This cognitive framework, known as "illness expectations" (IE), comprises future-oriented beliefs about the course of the disease and its symptoms. In chronic conditions such as asthma, IEs can play a crucial role in determining patient-reported outcomes and also variations in clinical markers indicative of disease progression. "In this study, we empirically assessed the impact of IEs on asthma symptoms and respiratory function in patients," Pagnini affirms.

The study

'We involved a group of 310 people diagnosed with asthma who were followed for a period of 6 months, with three assessment points, measuring the level of asthma control with the Asthma Control Test (ACT), while respiratory function was assessed through forced expiratory volume in 1 second (FEV1) using spirometry,' he explains. At the beginning of the study, we assessed each person's IE using the validated Illness Expectation Test (IET), which captures both explicit (conscious) and implicit (unconscious) expectations.

It emerged that people with more negative explicit IE about their asthma reported worse symptoms over time. Explicit IE about symptom progression was also associated with changes in lung function, with more negative expectations predicting greater decline in respiratory performance, the professor adds.

These findings suggest that IE may be significantly associated with asthma outcomes, highlighting their potential relevance in understanding patient experiences and symptom perception. "In experiments with patients affected by other diseases, such as multiple sclerosis, we obtained similar results", the expert continues.

The hypothesis suggested to explain these results is that, as with the placebo effect, what happens is that if I have an idea about the world and the future that awaits me, that idea will prevail, largely influencing behaviour and thus, for example, modifying adherence to therapies and clinical recommendations, he concludes.