Clinical Review

Psychological Stress Interventions and Asthma: Therapeutic Considerations

Journal of Clinical Outcomes Management. 2014 December;21(12)

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Psychological Stress and Asthma

Research regarding the relationships between asthma and chronic stress has been conducted in a variety of populations, using both cross-sectional and prospective designs [12,13]. It has been found that perceived stress negatively affects quality of life of patients with asthma and is associated with reduced medication compliance [14,15] and symptom perception [14,16]. Stress has been linked to both the onset of allergic asthma [17,18] and to enhanced skin test reactivity in response to allergens [19].Oh et al [12] suggested a dose-dependent relationship, with individuals who report increasingly higher levels of stress being more likely to report symptoms of asthma.

People with asthma who are exposed to various types of chronic stress tend to have worse severity and poorer control of their asthma symptoms [20,21]. Interventions to help manage stress in people with asthma are needed at the individual, family, and community levels; all levels are known to influence asthma and asthma morbidity [20,22].

If stress is associated with increased disease incidence and severity, then stress modulation could be expected to have beneficial effects. Advice to work fewer hours, get more sleep, and optimize relaxation can be unproductive and even frustrating to busy persons striving to meet all the demands of life. More realistic are interventions based upon helping people manage stress. Studies have reported benefit from stress management for a number of chronic diseases, including hypertension [23], obesity [24], diabetes [25], and HIV [26]. Given the associations noted above, stress intervention as a therapeutic modality for asthma management is a valid option that should be explored [27].

We performed a systematic literature review using the Cochrane, Medline, and PubMed electronic databases of studies published in the English language that address whether stress intervention (both direct and indirect methods) helps patients who have asthma, focusing on randomized controlled trials (RCTs). Because of the limited number of relevant studies, we also included higher quality meta-analysis and systematic reviews. We searched the topics “stress and asthma,” “psychological interventions and asthma,” “yoga and asthma,” “music therapy and asthma,” “art therapy and asthma,” and “relaxation methods and asthma.” We also searched for anxiety and depression medications in asthma, focusing on “selective serotonin uptake inhibitors and asthma,” and “anxiolytics and asthma.” Studies are summarized in the Table.

Psychologically Focused Interventions

Mindfulness-based stress reduction (MBSR) has been recognized as an important modality for treatment of many chronic diseases, including chronic pain [28], cardiovascular disease [29], type 2 diabetes mellitus [29], cancer [30], and fibromyalgia [28]. MBSR teaches patients to recognize disease symptoms and personal reactions to these symptoms, and to develop a nonreactive awareness of these elements [14]. It is an individual or group-based therapeutic approach that uses education, discussion, and various meditation techniques to reduce perceived general and disease-associated stress [14,31]. Pbert et al performed an RCT comparing a MBSR program with a traditional education program in adults with mild, moderate, or severe persistent asthma. The primary outcomes were centered on lung function as measured by peak expiratory flow (PEF) and quality of life using the Asthma Quality of Life Questionnaire (AQLQ). Secondary outcomes included changes in perceived stress as measured by the 10-question Perceived Stress Scale (PSS) and overall asthma control. At 12 months, results indicated that MBSR had positive effects on overall asthma control, with improvement in quality of life, a decrease in perceived stress, and a decrease in use of rescue therapies, but no significant effect on peak expiratory flow [14].