Various other psychological interventions have been studied as supplemental therapy to medications in the treatment of asthma. Yorke et al performed a systematic review of 14 RCTs evaluating various psychological interventions in asthma, including cognitive behavioral therapy (CBT), biofeedback, and various relaxation techniques [27]. Because there are no standardized outcomes measured across all studies, results are often conflicting. While CBT had a positive effect on asthma health care utilization, relaxation therapy had no significant effects; both did have positive effects on symptoms of depression and anxiety. Relaxation therapy had positive effects on relieving asthma symptoms such as cough and wheeze but CBT did not. Biofeedback and relaxation were the only interventions that had positive effect on improving lung function and decreasing medication usage [27].
In an RCT, Parry and colleagues evaluated the effects of CBT added to clinical care on asthma-specific fear when compared to standard clinical asthma care alone. They demonstrated a significant reduction in panic and fear related to asthma exacerbations using CBT [32].
Various other mind-body–based interventions, including meditation, yoga, and breathing techniques, have been evaluated as complementary asthma therapy. Several studies utilized the Buteyko breathing technique (BBT), which focuses on controlling breathing to restore normal levels of PaCo 2 in order to improve tissue oxygenation and reduce bronchospasm. Cooper et al performed an RCT that evaluated asthma symptom scores and methacholine sensitivity (concentration of bronchial irritant causing decline in FEV 1 > 20%) for the presence of bronchial hyperreactivity (BHR), a measure of asthma activity. The BBT group demonstrated a reduction in asthma symptoms and rescue inhaler use but no change in BHR [33]. Opat measured asthma QOL, asthma symptoms, rescue medication use, and lung function in patients who received instruction in BBT and patients in a sham control group. BBT was associated with improvement in asthma QOL and bronchodilator use but not in other outcome parameters [34]. Thomas et al demonstrated in an RCT involving asthma patients with symptoms of dysfunctional breathing that rebreathing-retraining physiotherapy improved asthma-related QOL compared with traditional nurse-provided education [35].
Physical Stress Management Interventions
Yoga, which involves various aspects of controlled breathing, stretching, and meditation techniques [36], aims to achieve synergy between the mind and body to produce a more relaxed psychophysiological state [37]. This popular modality is frequently used by patients, including those with asthma, for symptom control and disease management. Results from RCTs have varied in their reports of efficacy. The 2006 Allergic Rhinitis and Asthma (ARIA) work group performed a systematic review of 5 trials evaluating yoga and asthma. Though the quality of the trials varied greatly, the review demonstrated a possible benefit of yoga on asthma-related QOL but no other studied parameters [38]. QOL and hemodynamic improvement was also demonstrated in 1 RCT comparing yoga added to standard asthma therapy vs. standard therapy alone in female patients [37]. Cramer et al performed an extensive systematic review and meta-analysis of 14 RCTs evaluating the effects of yoga on all or some components of asthma-related QOL, asthma control, symptoms, and pulmonary function [39]. Though there may be some benefit of yoga breathing techniques on asthma-related QOL, the quality of these studies is very poor and reported results were highly variable. These limitations demonstrate the need for methodologically sound, standardized approaches to research in this field, which will be needed before definitive conclusions or treatment recommendations can be made [38,39].