From the Department of Medicine, The University of Mississippi Medical Center, Jackson, MS.
Abstract
- Objective: To review psychological stress interventions employed to improve asthma outcomes.
- Methods: Review of the literature.
- Results: In general, there are 2 approaches to managing stress in asthma patients—direct psychological interventions, and modalities where stress management is an indirect effect. The most direct approach involves mindfulness-based stress reduction, which has been shown to have a positive effect on asthma control. Cognitive behavioral therapy, biofeedback, music therapy, art therapy, and relaxation training also have been evaluated with varying results. Physical therapies, including yoga, chi gong, massage, reflexology, specific controlled breathing programs, and spinal manipulation have also been studied without consistent effectiveness demonstrated. Pharmacologic therapy for anxiety and depressive disorders has been shown to be associated with improvement in asthma symptoms and control.
- Conclusion: Although further research is needed to verify the beneficial role of specific stress intervention modalities for specific asthma populations, there is sufficient evidence of efficacy to validate the concept of stress management as a viable therapeutic approach for optimal asthma control.
The increasing levels of chronic psychological stress in the people’s everyday lives has been well recognized [1]. As technological advances continue to progress, the psychological and physical pressures associated with family- and work-role expectations, decreased free or “down” time, greater sleep deficits, increasing career-related pressures, social issues, and other factors have led to ever increasing levels of personal stress [2]. From an immune standpoint, these chronic stressors impact immune balance and may be at least partially responsible for the rise in incidence, prevalence, and severity of inflammatory diseases such as asthma [3]. As the factors responsible for increased levels of psychosocial stress in our society are not likely to decrease in the near future [4], the potential value of directed stress intervention therapies in the overall care plans for patients with asthma is an area of interest. Such stress management strategies must be evidence-based, pragmatic, and cost-effective. This review provides background, scientific and clinical rationale, and progress to date for various therapeutic approaches to stress management for asthma patients.
Asthma as Inflammatory Disease
Asthma is a breathlessness syndrome typically characterized by varying combinations of paroxysmal wheezing, cough, breathlessness, and chest tightness. The constellation of symptoms is often precipitated by exposure to volatile irritants, allergens, cold air, and exercise. Gastroesophageal reflux disease, respiratory viral infections, and pregnancy may also precipitate or worsen existing asthma [5,6]. Symptoms typically improve after appropriate asthma treatment.
While the role of IgE-mediated mechanisms in asthma has been questioned by some, studies have demonstrated the presence of IgE-mediated (“allergic”) mechanisms in most asthma cases [7]. Depending on the specific population, as many as 70% to 90% of asthma patients can be considered to have an allergic component to their asthma [8]. Such allergic sensitivities can be to seasonal pollens but even more commonly to perennial allergens such as dust mites, molds, cockroaches, and pet dander (especially cat) [9]. These associations have led to therapeutic approaches for many asthma patients based largely on those classically used for allergic rhinitis, including avoidance, environmental control, and even allergen immunotherapy [10]. Some of the newest and most promising pharmacotherapies for asthma are based on antagonism and/or prevention of the allergic cascade (production and activity of IgE) [11].