Psychosocial factors and behavioral medicine interventions in asthma.

Abstract

Objective This review examines the evidence for psychosocial influences in asthma and behavioral medicine approaches to its treatment. Method We conducted a systematic review of the literature on psychosocial influences and the evidence for behavioral interventions in asthma with a focus on research in the past 10 years and clinical trials. Additional attention was directed at promising new developments in the field. Results Psychosocial factors can influence the pathogenesis and pathophysiology of asthma, either directly through autonomic, endocrine, immunological, and central nervous system mechanisms, or indirectly through lifestyle factors, health behaviors, illness cognitions, and disease management including medication adherence and trigger avoidance. The recent decade has witnessed surging interest in behavioral interventions that target the various pathways of influence. Among these, self-management training, breathing training, and exercise or physical activation programs have proven particularly useful, whereas other essential or promising interventions, such as smoking cessation, dietary programs, perception and biofeedback training, and suggestive or expressive psychotherapy, require further more rigorous evaluation. Given the high comorbidity with anxiety and mood disorders, further evaluation of illness-specific cognitive behavior therapy is of particular importance. Progress has also been made in devising community-based and culturally tailored intervention programs. Conclusion In concert with an essential medication treatment, behavioral medicine treatment of asthma is moving closer towards an integrated biopsychosocial approach to disease management.

Dyspnoea: a multidimensional and multidisciplinary approach

“…High anxiety/depression patients perceived increased dyspnoea [38][39][40][41] and may be associated with worst prognosis [42], while dyspnoea can cause increased anxiety and depression [43,44]. Unpleasant respiratory sensations can therefore be associated with significant psychological suffering (anxiety and depression), which in turn have a significant impact on daily functioning, treatment adherence, hospitalisation and mortality.…”

Co-morbid psychological dysfunction is associated with a higher risk of asthma exacerbations: a systematic review and meta-analysis

“…Published prospective cohort studies of the relation between PD and AE have conflicting results (10)(11)(12). The results of pooled analyses of the effectiveness of psychological interventions for individuals with asthma are also inconsistent (13)(14)(15). Therefore, we undertook a systematic review and metaanalysis of prospective cohort studies to explore the influence of co-morbid PD on AE, and to determine whether different kinds of PD differentially affect AE.…”

Breathing exercises for adults with asthma

“…assessment of expired CO 2 concentration, breathing rate and heart rate) is sometimes used with exercise training 4,16,17…”

“…Non-respiratory components may include advice on nutrition and use of medication, asthma education, aerobic exercise prescription, and psychological support to address the associated anxiety and depression that can accompany asthma 2,16. In clinical practice, instruction is usually delivered individually by an appropriately trained therapist.…”