Stabil astım hastalarında bilişsel esneklik ve ilişkili faktörler: tedavi uyumunun aracı rolü

Year 2026, Volume: 9 Issue: 1, 39 - 44, 05.01.2026

Büşra Durak , Ayşe Erdoğan Kaya

https://doi.org/10.32322/jhsm.1796816

https://izlik.org/JA48GM57SK

Abstract

Hipoksi ve inflamasyon, astımda bilişsel işlevleri olumsuz etkileyebilir. Bu işlevlerden biri olan bilişsel esneklik, astım hastalarında yeterince çalışılmamıştır. Bu çalışma, stabil astım hastalarında bilişsel esneklik düzeylerini değerlendirmekte ve bu ilişkide tedavi uyumunun aracı rolünü araştırmaktadır. Çalışmaya 18–65 yaş arası, en az altı aydır astım tanısı almış ve stabil dönemde olan, göğüs hastalıkları polikliniğinde takip edilen toplam 74 hasta dahil edilmiştir. Katılımcılara sosyodemografik veri formu, Bilişsel Esneklik Ölçeği (CFS) ve Morisky 8 Maddelik İlaç Uyum Ölçeği (MMAS-8) uygulanmıştır. Veriler uygun istatistiksel yöntemlerle analiz edilmiştir. Katılımcıların %45,9’unda düşük tedavi uyumu saptanmış olup, bu bireylerde bilişsel esneklik puanlarının anlamlı düzeyde düşük olduğu bulunmuştur (p<0,001). Tedavi uyumu ile yaş, hastalık süresi veya gelir düzeyi arasında anlamlı bir ilişki bulunmamıştır. Sigaranın hem uyumu hem de bilişsel esnekliği olumsuz etkilediği görülmüştür. Regresyon analizi, sigaranın bilişsel esneklik üzerinde negatif etkisi olduğunu, tedavi uyumunun ise pozitif etkisi olduğunu göstermiştir. Astım hastalarında tedavi uyumu ile bilişsel esneklik arasında anlamlı bir ilişki olduğu saptanmıştır. Bu bulgular, astım yönetiminde kişiselleştirilmiş yaklaşımların önemini vurgulamakta ve özellikle bilişsel esnekliği düşük bireylerde uyumu artırmaya yönelik destekleyici müdahalelere ihtiyaç olduğunu ortaya koymaktadır.

Keywords

Astım , Bilişsel Esneklik , İlaç Uyumu , Tedavi Uyumu , Solunum Hastalıkları

Ethical Statement

Çalışma için etik onay, Hitit Üniversitesi Klinik Araştırmalar Etik Kurulu’ndan alınmıştır (Karar numarası: 2023-167, tarih: 26/12/2023).

Supporting Institution

Bu çalışma için herhangi bir kurum veya kuruluştan mali destek alınmamıştır.

Thanks

Yok

Cognitive flexibility and associated factors in stable asthma patients: the mediating role of treatment adherence

https://izlik.org/JA48GM57SK

Abstract

Aims: Hypoxia and inflammation may negatively impact cognitive functions in asthma. One such function, cognitive flexibility, has not been sufficiently studied in asthma patients. This study evaluates cognitive flexibility levels in patients with stable asthma and investigates the mediating role of treatment adherence in this relationship.
Methods: A total of 74 patients aged 18 to 65, diagnosed with asthma for at least six months and in a stable phase, followed in a pulmonology outpatient clinic, were included.
Results: Participants completed a sociodemographic data form, the Cognitive Flexibility Scale (CFS), and the Morisky 8-Item Medication Adherence Scale (MMAS-8). Data were analyzed using appropriate statistical methods. Low treatment adherence was observed in 45.9% of participants, and these individuals had significantly lower cognitive flexibility scores (p<0.001).
Conclusion: No significant relationship was found between treatment adherence and age, disease duration, or income level. Smoking was found to negatively affect both adherence and cognitive flexibility. Regression analysis showed a negative effect of smoking and a positive effect of adherence on cognitive flexibility. A significant relationship was found between treatment adherence and cognitive flexibility in asthma patients. These findings emphasize the importance of personalized approaches in asthma management and highlight the need for supportive interventions to improve adherence, particularly in individuals with low cognitive flexibility.

Keywords

Asthma , cognitive flexibility , medication adherence , treatment adherence , respiratory disease

Ethical Statement

Ethical approval for the study was obtained from the Clinical Research Ethics Committee of Hitit University (Decision number: 2023-167, dated 26/12/2023).

Supporting Institution

The authors received no financial support from any institution or organization for this study.

Thanks

None

References

• Lambrecht BN, Hammad H. The immunology of asthma. Nature Immunology. 2015;16(1):45-56.
• Ren M, Feng M, Long Z, Ma J, Peng X, He G. Allergic asthma-induced cognitive impairment is alleviated by dexamethasone. Frontiers in Pharmacology. 2021;12:680815. doi:10.3389/fphar.2021.680815
• Caldera-Alvarado G, Khan D, Defina L, Pieper A, Brown E. Relationship between asthma and cognition: the cooper center longitudinal study. Allergy. 2013;68(4):545-8. doi:10.1111/all.12125
• Yii AC, Koh MS. A review of psychological dysfunction in asthma: affective, behavioral and cognitive factors. J Asthma. 2013;50 (9):915-921. doi:10.3109/02770903.2013.819887
• Tattersall MC, Jarjour NN, Busse PJ. Systemic Inflammation in asthma: what are the risks and impacts outside the airway? J Allergy Clin Immunol Pract. 2024;12(4):849-862. doi:10.1016/j.jaip.2024.02.004
• Hu J, Ma H, Ning Z, Xu Q, Luo J, Jiang X, et al. Asthma and cognitive dysfunction in older adults: the mediating role of systemic immune-inflammation index. Sci Rep. 2024;14(1):27194. doi:10.1038/s41598-024-76393-y
• Canas JJ, Fajardo I, Salmeron L. Cognitive flexibility. Informa Healthcare, Karwowski W (eds). International Encyclopedia of Ergonomics and Human Factors. Vol 1. 2nd Edition, CRC Press. Taylor & Francis, London, England. 2016;1(3):297-301.
• Nooyens AC, Baan CA, Spijkerman AM, Verschuren WM. Type 2 diabetes and cognitive decline in middle-aged men and women: the doetinchem cohort study. Diabetes Care. 2010;33(9):1964-1969. doi:10. 2337/dc09-2038
• Muller M, Van Raamt F, Visseren FL, et al. Metabolic syndrome and cognition in patients with manifest atherosclerotic disease: the smart study. Neuroepidemiology. 2010;34(2):83-89. doi:10.1159/000264825
• Zhu C, Kwok NT-k, Chan TC-w, Chan GH-k, So SH-w. Inflexibility in reasoning: comparisons of cognitive flexibility, explanatory flexibility, and belief flexibility between schizophrenia and major depressive disorder. Frontiers in Psychiatry. 2021;11:609569. doi:10.3389/fpsyt.20 20.609569
• Wang X, Cui L, Ji X. Cognitive impairment caused by hypoxia: from clinical evidences to molecular mechanisms. Metabolic Brain Disease. 2022;37(1):51-66. doi:10.1007/s11011-021-00796-3
• Rajabi S, Keshavarz Eq, Dehghani Y, Keshavarz M, AliMoradi K. Comparing executive functions between patients with chronic asthma and healthy subjects. J Asthma. 2018;55(4):452-459. doi:10.1080/02770903.2017.1337786
• Taha H. Poor executive functions among children with moderate-into-severe asthma: evidence from WCST performance. Frontiers in Psychology. 2017;8:234021. doi:10.3389/fpsyg.2017.00793
• Hussain S, Khawar R, Amin R, Hamdani A, Majeed A. Psychological flexibility, cognitive emotion regulation and mental health outcomes among patients with asthma in Pakistan. PeerJ. 2023;11:e15506. doi:10. 7717/peerj.15506
• Irani F, Barbone JM, Beausoleil J, Gerald L. Is asthma associated with cognitive impairments? a meta-analytic review. JCEN. 2017;39(10):965-978. doi:10.1080/13803395.2017.1288802
• Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention 2024. Updated May 20242024.
• Çelikkaleli Ö. Bilişsel Esneklik ölçeği'nin geçerlik ve güvenirliği. Eğitim ve Bilim. 2014;39(176):339-346.
• Martin MM, Rubin RB. A new measure of cognitive flexibility. psychological reports. Psychological Reports. 1995;76(2):623-626. doi:10. 2466/pr0.1995.76.2.623
• Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10(5):348-354. doi:10.1111/j.1751-7176.2008.07572.x
• Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24 (1):67-74. doi:10.1097/00005650-198601000-00007
• Morisky DE, Malotte CK, Choi P, et al. A patient education program to improve adherence rates with antituberculosis drug regimens. Health Educ Q. 1990;17(3):253-267. doi:10.1177/109019819001700303
• Oğuzülgen IK, Köktürk N, Işikdoğan Z. Turkish validation study of Morisky 8-item medication adherence questionnaire (MMAS-8) in patients with asthma and chronic obstructive pulmonary disease. Tuberk Toraks. 2014;62(2):101-107. doi:10.5578/tt.7401
• Caldera-Alvarado G, Khan DA, Defina LF, Pieper A, Brown ES. Relationship between asthma and cognition: the cooper center longitudinal Study. Allergy. 2013;68(4):545-548. doi:10.1111/all.12125
• Creer TL. Behavioral and cognitive processes in the self-management of asthma. J Asthma. 2008;45(2):81-94. doi:10.1080/02770900701247236
• Hu J, Ma H, Ning Z, et al. Asthma and cognitive dysfunction in older adults: the mediating role of systemic immune-inflammation index. Sci Rep. 2024;14(1):27194. doi:10.1038/s41598-024-76393-y
• Rhyou HI, Nam YH. Association between cognitive function and asthma in adults. Ann Allergy Asthma Immunol. 2021;126(1):69-74. doi: 10.1016/j.anai.2020.08.022
• O'Brien LM. The neurocognitive effects of sleep disruption in children and adolescents. Child Adolesc Psychiatr Clin N Am. 2009;18(4):813-823. doi:10.1016/j.chc.2009.04.008
• Soones TN, Lin JL, Wolf MS, et al. Pathways linking health literacy, health beliefs, and cognition to medication adherence in older adults with asthma. J Allergy Clin Immunol. 2017;139(3):804-809. doi:10.1016/j.jaci.2016.05.043
• Smith D, Lovell J, Weller C, et al. A systematic review of medication non-adherence in persons with dementia or cognitive impairment. PLoS One. 2017;12(2):e0170651. doi:10.1371/journal.pone.0170651
• Insel K, Morrow D, Brewer B, Figueredo A. Executive function, working memory, and medication adherence among older adults. J Gerontol B Psychol Sci Soc Sci. 2006;61(2):P102-P107. doi:10.1093/geronb/61.2.p102
• Rajabi S, Keshavarz E, Dehghani Y, Keshavarz M, AliMoradi K. Comparing executive functions between patients with chronic asthma and healthy subjects. J Asthma. 2018;55(4):452-459. doi:10.1080/02770903.2017.1337786
• Sonney J, Insel KC. Exploring the intersection of executive function and medication adherence in school-age children with asthma. J Asthma. 2019;56(2):179-189. doi:10.1080/02770903.2018.1441870
• Becker JH, Feldman JM, Arora A, Busse PJ, Wisnivesky JP, Federman AD. Cognition, symptom perception, and medication non-adherence in older adults with asthma. J Asthma. 2022;59(3):607-615. doi:10.1080/02770903.2020.1856867
• Stilley CS, Bender CM, Dunbar-Jacob J, Sereika S, Ryan CM. The impact of cognitive function on medication management: three studies. Health Psychol. 2010;29(1):50-55. doi:10.1037/a0016940
• Apter AJ, Boston RC, George M, et al. Modifiable barriers to adherence to inhaled steroids among adults with asthma: it's not just black and white. J Allergy Clin Immunol. 2003;111(6):1219-1226. doi:10.1067/mai. 2003.1479
• Apter AJ, Wan F, Reisine S, et al. The association of health literacy with adherence and outcomes in moderate-severe asthma. J Allergy Clin Immunol. 2013;132(2):321-327. doi:10.1016/j.jaci.2013.02.014
• Dou JK, Liu H, Mei Y, et al. Factors affecting medication adherence in middle-aged and elderly patients in China: a cross-sectional study. Med Sci Monit. 2025;31:e945805. doi:10.12659/MSM.945805
• Dahlén E, Bergström A, Ödling M, Ekström S, Melén E, Kull I. Non-adherence and sub-optimal treatment with asthma medications in young adults: a population-based cohort study. J Asthma. 2022;59(8):1661-1669. doi:10.1080/02770903.2021.1941092
• Dima AL, Hernandez G, Cunillera O, Ferrer M, de Bruin M. Asthma inhaler adherence determinants in adults: systematic review of observational data. Eur Respir J. 2015;45(4):994-1018. doi:10.1183/090319 36.00172114
• Erdoğan Kaya A, Durak B. smokers versus non-smokers: comparing cognitive flexibility and dyspnea symptoms in medical students. European Journal of Therapeutics. 2024;30(4):428-34.
• Chamberlain SR, Odlaug BL, Schreiber LR, Grant JE. Association between tobacco smoking and cognitive functioning in young adults. Am J Addict. 2012;21(1):S14-S19. doi:10.1111/j.1521-0391.2012.00290.x
• Maurer C, Raherison-Semjen C, Lemaire B. et al. Severe adult asthma and treatment adherence: results of the FASE-CPHG study. Rev Mal Respir. 2021;38(10):962-971. doi:10.1016/j.rmr.2021.08.006
• Vanoverschelde A, van der Wel P, Putman B, Lahousse L. Determinants of poor inhaler technique and poor therapy adherence in obstructive lung diseases: a cross-sectional study in community pharmacies. BMJ Open Respir Res. 2021;8(1):e000823. doi:10.1136/bmjresp-2020-000823
• Cao Q, Koh MS, Yii AC, Chan AK, Ong TH, Low SY. Factors influencing medication adherence amongst difficult-to-treat asthma patients. Eur Respir J. 2017 doi:10.1183/1393003.congress-2017.PA4031
• Wang W, Luan W, Zhang Z, Mei Y. Association between medication literacy and medication adherence and the mediating effect of self-efficacy in older people with multimorbidity. BMC Geriatr. 2023;23(1): 378. doi:10.1186/s12877-023-04072-0