A sunny outlook appeared to curb the course of disease over a six-month study.
How optimistic patients are about their asthma diagnosis may predict how their disease progresses, according to new research from Italy.
A study of 310 adults followed for six months from their diagnosis found that those with more negative explicit illness expectations had worse symptoms over time.
The researchers assessed asthma control with the Asthma Control Test (ACT) and respiratory function with forced expiratory volume in 1 second (FEV1) using spirometry, over three time points. Their explicit beliefs, which are conscious ones, and their implicit beliefs, or unconscious ones, were assessed at the beginning of the study.
Negative explicit beliefs, but not implicit ones, were associated with worse symptoms over time. Those with negative explicit expectations of symptom progression were also more likely to have greater declines in respiratory function, and the more negative the expectations, the greater the declines in respiratory function.
“These findings suggest that IEs [illness expectations] may be meaningfully associated with asthma outcomes, highlighting their potential relevance in understanding patient experiences and symptom perception,” the authors wrote.
“These results support further research into interventions targeting cognitive frameworks, with the aim of informing more personalised, patient‐centred approaches to asthma management.”
The authors said that there was a growing recognition of the importance of the complex interplay between psychological and social factors in health and disease.
“Beliefs significantly influence health outcomes through multiple pathways. Research highlights their critical role in guiding health‐related decisions and the powerful impact of anticipatory expectations on outcomes,” the authors wrote.
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“Similar to findings in pain management, where patient awareness of treatment can alter pain perception, studies in respiratory diseases have demonstrated that cognitive factors—such as emotional state and awareness—can significantly influence symptom perception.”
They described “illness expectation” as the cognitive framework individuals construct when diagnosed with a chronic illness. It included individual abilities, cognitive and emotional processing based on personal history and knowledge about the diagnosis and course of the condition.
“IE can exhibit varying degrees of rigidity, spanning from subtle expectations to a highly entrenched conception of the expected disease progression. IE is reflective of an individual characteristic, and persons with identical diagnoses and exposure to comparable information may harbour diverse IEs,” the authors wrote.
“The information received, particularly in the context of medical treatments, including placebos, can significantly influence IEs.”
These beliefs and mindsets could affect health either behaviourally, by changing adherence and lifestyle, for example, or non‐behaviourally, with physiological or psychological changes independent of obvious behavioural modifications.
“These insights suggest that fostering positive expectations in patients could be a useful strategy in asthma care, potentially improving treatment adherence and symptom control,” the authors wrote.
“Moreover, in the routine management of asthma, it might be relevant to use tools such as those we used in the study to make brief assessments of IEs during clinical consultations.”
