From the Guidelines
Perpetuating factors are conditions or behaviors that maintain or worsen an existing problem or illness over time, and in the context of functional communication, swallowing, and cough disorders, these factors include hypersensitivity to subtle changes in air pressure, temperature, sensation in respiratory and vocal tract, fear-avoidance, and physiological arousal, as identified in the 2021 study published in the Journal of Neurology, Neurosurgery and Psychiatry 1. These factors prevent resolution and can create a cycle that's difficult to break. Common perpetuating factors in various conditions include:
- Poor sleep habits
- Medication overuse
- Psychological stress
- Maladaptive coping mechanisms
- Environmental triggers For example, in chronic pain, catastrophizing thoughts, physical deconditioning, and avoidance behaviors can all perpetuate the pain cycle. In insomnia, worry about not sleeping often becomes a perpetuating factor that maintains the sleep disturbance long after the initial cause has resolved. When treating any chronic condition, identifying and addressing these perpetuating factors is essential for successful management. This typically requires a multifaceted approach that might include cognitive behavioral therapy, lifestyle modifications, stress management techniques, and sometimes medication adjustments. Understanding these factors helps explain why some conditions persist despite treatment of the original cause and why comprehensive treatment approaches that address all contributing elements are often more successful than single-intervention strategies. In the context of health behavior interventions in schools and childcare services, perpetuating factors can also include barriers such as funding, staff motivation, and intervention adaptation, as well as facilitators like training, shared vision, and community-level factors, as discussed in the 2021 review published in Implementation Science 1. However, the most recent and highest quality study on perpetuating factors in functional communication, swallowing, and cough disorders is the 2021 study published in the Journal of Neurology, Neurosurgery and Psychiatry 1, which provides a comprehensive model of predisposing, precipitating, and perpetuating risk factors for these disorders. Key perpetuating factors identified in this study include:
- Hypersensitivity to subtle changes in air pressure, temperature, sensation in respiratory and vocal tract
- Fear-avoidance
- Physiological arousal
- Pain
- Tendency to ‘all or nothing’ or catastrophic thinking
- Perception that voice use or swallowing are dangerous, harmful, effortful
- Hypervigilance and excessive self-monitoring
- Belief that symptoms are due to damage or suspected or confirmed disease/illness; unusual illness beliefs
- Entrenched symptoms have become part of one’s sense of self or personal identity
- Litigation or disability compensation issues
- Medical uncertainty
- Excessive reliance on unreliable sources of information
- Stigma These factors can be addressed through a multifaceted approach that includes cognitive behavioral therapy, lifestyle modifications, stress management techniques, and sometimes medication adjustments, as well as addressing the underlying biological, psychological, and social factors that contribute to the development and maintenance of these disorders.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Perpetuating Factors
- Perpetuating factors refer to the elements that contribute to the maintenance or exacerbation of a disease or condition over time 2.
- In the context of hypertension, perpetuating factors may include factors such as sympathetic nervous system activity, prostaglandin synthesis, and the renin-angiotensin-aldosterone system 3.
- The 3P-Disease Model outlines the role of predisposing, precipitating, and perpetuating factors in disease states and conditions, and can be applied to various health-related diseases or disorders, including hypertension 2.
Treatment of Hypertension
- Angiotensin-converting enzyme (ACE) inhibitors are a class of drugs that have been used to treat hypertension, and work by inhibiting the renin-angiotensin-aldosterone system and modulating sympathetic nervous system activity 3, 4, 5, 6.
- However, ACE inhibitors have been associated with side effects such as cough and angioedema, and may not be the best choice for all patients 4, 5, 6.
- Alternative treatments, such as angiotensin receptor blockers (ARBs), may be preferred due to their similar efficacy and improved safety profile 4, 5.
Disease Management
- The management of hypertension and other diseases requires a multidisciplinary approach, taking into account biological, psychological, and socio-environmental factors 2.
- Understanding the perpetuating factors that contribute to a disease or condition is crucial for developing effective treatment strategies and improving patient outcomes 2.