Skip Navigation LinksHome > February/March 2014 - Volume 35 - Issue 2 > Anxiety Associated with Asthma Exacerbations and Overuse of...
Journal of Developmental & Behavioral Pediatrics:
doi: 10.1097/DBP.0000000000000029
Challenging Case

Anxiety Associated with Asthma Exacerbations and Overuse of Medication: The Role of Cultural Competency

Horikawa, Yousuke T. MD, PhD*; Udaka, Tina Y. MD*; Crow, Janet K. MD*; Takayama, John I. MD; Stein, Martin T. MD*



The Editors of the Journal of Developmental and Behavioral Pediatrics acknowledge the work of our reviewers for 2013. Many of our reviewers have reviewed multiple manuscripts. We are extremely grateful for their commitment and dedication to the peer review process and to our journal.

Diane Abatemarco

Jennifer Accardo

Veronica Accornero

Emma Adam

Richard Adams

Abbey Alkon

Carla Allan

Thomas Anders

Kristen Anderson

Julia Anixt

Kevin Antshel

Don Bailey

Diane Baker

Jeffrey Baker

Angela Ballantyne

Gerard Banez

Andrew Barnes

Ben Barton

Nerissa Bauer

Amy Baughcum

Rebecca Baum

Barbara Baumgardner

David Bellinger

Forrest C. Bennett

David Bennett

Amanda Bennett

Brad Berman

Christina Bethell

Jeffrey L. Black

Jennifer Blackford

Gregory Blaschke

Richard Boles

Dina Borzekowski

Denise Bothe

Robert Bradley

Catherine Bradley

Joshua Breslau

David Bridgett

Rahil Briggs

Jeffrey Brosco

Mariana Brussoni

Christopher Burant

Arlene Butz

Kelly Byars

Melissa Carson

Lawrence Charnas

Ira Chasnoff

Maida Chen

HeeCheong Chon

Roula Choueiri

Peter Chung

Samuele Cortese

Daniel Coury

Genevieve Creighton

Mario Cruz

Ann Davis

Deborah Davis

Natacha De Genna

Robert Dempster

Lesley Deprey

Laura Dietz

Benard P. Dreyer

Peggy Eicher

Leafar Espinoza

Pam Factor-Litvak

Jon Farber

Richard Ferber

Tiffany Field

Martin Fisher

Deborah A. Frank

Tanya Froehlich

Sheila Gahagan

Gwendolyn Gerner

Shuvo Ghosh

Meghan Gillen

Wendy Goldberg

Jenifer Goldman Fraser

Edward Goldson

Linda Grossman

Barbara Gueldner

Christian Guilleminault

Dagmar Haller

Elizabeth Harstad

Chantelle Hart

Rebeccca Hazen

Martha Hellems

Erin Hennessy

Peter Hepper

Susan Higman

Christopher Hodgman

Martin Hoffman

Marjorie Hogan

Diane Holditch-Davis

H. Eugene Hoyme

Sheryl Hughes

Susan L. Hyman

Abel Ickowicz

April Idalski Carcone

Joyce Javier

Renee R. Jenkins

Chad Jensen

Manuel Jimenez

Susan Johnson

Brian Johnston

Patricia Kavanagh

Kelly Kelleher

Jo Kim

Katarzyna Kordas

Maria Korth

Panagiotis Kratimenos

Rebecca Kronk

Brett Kuhn

Diane Langkamp

Garry Lapidus

Cynthia Larkby

Bryon Lauer

Kathleen L. Lemanek

Jack Levine

Chin-Shang Li

Thomas Lock

Caroline Magyar

David Mandelbaum

Francis McNesby

Robin McWilliam

Barbara Medoff-Cooper

Robyn Mehlenbeck

Klaus Minde

Daniel Moran

Cynthia Munoz

Cy Nadler

Robert E. Nickel

Britt Nielsen

Garey Noritz

Sarah Nyp

Lise Olsen

Joan Orrell-Valente

Kathryn Ostermaier

John M. Pascoe

Sarah Paterson

Heather Patrick

Laura Payne

Eleni Petridou

Randall Phelps

Sheridan Phillips

Joy Pieper

Penny Pivalizza

Thomas Power

Laura Prager

Suzanne Prior

Lisa Ramirez

John Rausch

Jennifer Reiter-Purtill

Colleen Reuland

Kyung Rhee

Gehan Roberts

Kenneth Robey

Donald Robin

Nancy Roizen

Kristine Rork

Peter Rosenbaum

Erin Ross

Amy Salisbury

Melissa Santos

Amy Sato

Kimberly Saudino

Jeffrey Schatz

Joann Schulte, DO, MPH

Daniel Schulteis

Gregg Selke

Radley Sheldrick

Diana Shellmer

Nancy Sherwood

Lisa Shulman

Ellen J. Silver

Mark D. Simms

Kevin Smith

Nicola Smith

Sarah Soden

Earl Soileau

Karen Sokal-Gutierrez

Adiaha Spinks-Franklin

Jane Squires

Ian St James Roberts

Martin Stein

Marilyn Stern

Caron Strahlendorf

Scott Stuart

Mariann Suarez

Hanes Swingle

Nicole Talge

Brian Tang

Audrey Thurm

Martha Tingen

Jane Tuttle

William Tynan

Jeanne Van Cleave

Annette van Maanen

Robert Voigt

Ludwig von Hahn

Janelle Wagner

Melissa Wake

Teresa Ward

Wendy Ward

Zachary Warren

William Warzak

Sarah Watamura

Michael Weitzman

Carol Weitzman

Anne Wheeler

Marian Williams

P. Gail Williams

Lawrence Wissow

Manisha Witmans

John Worobey

Melissa Xanthopoulos

Yvette Yatchmink

Jin You

Aisha Yousafzai

Samuel Zinner

Journal of Developmental & Behavioral Pediatrics. 35(3):237, April 2014.

The article does not include the affiliation of one of the authors, John Takayama. His affiliation should have read as follows: Department of Pediatrics, University of California San Francisco.

Journal of Developmental & Behavioral Pediatrics. 35(3):227, April 2014.

Collapse Box


CASE: Toshi, a 14-year-old Japanese boy, had uncontrolled asthma after relocating from Japan with his family 1 year ago. In Japan, he was diagnosed with moderate, persistent asthma, which was controlled with salmeterol and albuterol on an as needed basis. Since moving to the United States, Toshi complained of frequent dyspnea.Initially, he was seen by a Japanese physician who prescribed 200 mg of fluticasone 3 times a day and albuterol nebulization as needed. When Toshi came to the Pediatric Primary Care Clinic, he reported using his nebulizer up to 25 times daily. A physical examination revealed a thin, anxious, jittery, hypertensive, and tachycardic adolescent with hyperreflexia and dysmetria. Toshi complained of difficulty breathing, in the absence of wheezing or respiratory distress; peak flow recordings in the office were normal. Furthermore, he had a history of “panic attacks,” being a “worrier,” and stopped attending school, playing sports, and socializing over the past 6 months due to his “breathing difficulties.”Citalopram was prescribed for anxiety, but the family's apprehension about mental health disorders led to resistance to treatment recommendations. With motivational interviewing and negotiation, Toshi and his family agreed to a trial of citalopram. Three months later, he no longer took fluticasone or albuterol. The tachycardia, hypertension, and neurological symptoms improved. As he gained weight and improved his strength, he attended classes and participated in sports.A few months later, with improvement of his health, Toshi and his parents decided to discontinue citalopram. He then developed behaviors consistent with generalized anxiety and obsessive-compulsive disorder. Currently, his symptoms associated with anxiety have worsened, but he and his family are resistant to medication or initiating cognitive behavioral therapy due to their cultural beliefs regarding mental health disorders.

Copyright © 2014 by Lippincott Williams & Wilkins

Follow Us



Article Tools


Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.