An Extension of the Reed and Townley Conception of the Pathogenesis of Asthma: The Role of Behavioral and Psychological Stimuli and Responses

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Abstract
This article describes behavioral stimuli and responses correlated with the pathogenesis and course of asthma. In particular, the stimuli and responses are reviewed in order to extend a classification system for asthma proposed by Reed and Townley. There are three components to this system: (1) stimuli correlated with the pathogenesis of asthma, (2) responses that constitute the asthmatic attack, and (3) variables that link the stimuli to the responses. In the present discussion, it is noted that behavioral stimuli may trigger an attack by themselves, although they often are correlated with other stimuli that precipitate the attack. Behavioral responses, on the other hand, are viewed as contributing to the severity of asthma by influencing either the variables linking the stimuli to the respiratory responses or the respiratory responses per se. Specific behavioral stimuli described include emotional behaviors, personality and psychological variables, and patient behaviors, such as medication compliance. Specific behavioral stimuli that enhance physical factors described by Reed and Townley include those involved in exercise-induced asthma. Behaviors that may contribute to the severity of an asthma attack also are described. These include behavioral deficits and excesses, cognitive deficits, and motivational factors. Incorporating behavioral and psychological variables within the conceptual framework provided by Reed and Townley, it is argued, expands a common system that can be of value to medical, biological, and behavioral scientists in the acquisition of knowledge about asthma and its treatment.

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