Clinical Review

Psychological Stress Interventions and Asthma: Therapeutic Considerations

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

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The Future for Stress Management as a Fundamental Component of Asthma Care

Historically, avoidance of known triggers and use of pharmacologic maintenance and treatment modalities has been the cornerstone of asthma care. The recognition of excess psychological stress as a recognized trigger and treatment target is continuing to evolve in our therapeutic armamentarium. Our understanding of the effects of stress management in asthma patients provides clinical support for the neuroendocrine immune link between the bronchial inflammatory response characteristic in asthma and that of the human stress response. Understanding the relationships of psychological stress in asthma physiology, clinical morbidity, and therapeutic options is imperative, as the changing health care environment increasingly demands preventive, practical, cost-effective, evidence-based medicine. Some psychological stressors will no doubt be more difficult to address than others, but implementation of nonpharmacologic stress management paradigms should help improve effective asthma management across all patient demographics and should hopefully lead to decreased population health care costs, fewer days of work lost, and improved quality of life. Despite a clear molecular link between asthma, inflammation and stress and a clinical trend toward benefit, the heterogeneity of studies and poor quality evidence for each stress reduction modality make it difficult to draw any firm conclusions on the comparative efficacy of specific psychological interventions in asthma management programs. Mindfulness-based stress reduction has the highest quality evidence and shows the most promise thus far. Further research employing methodically sound RCTs that use standardized physiologic and nonphysiologic outcome measures is needed to elucidate the role for stress reduction interventions in routine clinical practice.

Corresponding author: Gailen D. Marshall Jr, MD, PhD, Div. of Clinical Immunology and Allergy, Dept. of Medicine, The University of Mississippi Medical Ctr., 2500 N. State St. N416 Jackson, MS 39216, gmarshall@umc.edu.

Financial disclosures: None.

Author contributions: conception and design, CRP, AMW, GDM; drafting of article, CRP, AMW, GDM; critical revision of the article, CRP, AMW, GDM; administrative or technical support, GDM.