Psychological interventions for adults with asthma

It is thought by some that psychological interventions can help people with asthma. Systematically, we searched the literature on psychological interventions to find valid studies that looked at the effects of providing mainly psychological interventions for adults with asthma. The studies found examined many different therapies and measured different physical and psychological outcomes; for these reasons, their results could not be easily combined. However, meta-analyses could be performed to determine the effect of Cognitive Behavioural Therapy (CBT) on quality of life, bio-feedback on PEF, and relaxation therapy on PEF and FEV1 and medication use. The available studies were completed with small numbers of people and the way the studies were conducted could be improved. More research with larger numbers of people and improved design needs to be done before it is known whether psychological interventions are effective in improving health outcomes for adults with asthma.

Authors' conclusions: 

This review was unable to draw firm conclusions for the role of psychological interventions in asthma due to the absence of an adequate evidence base. Larger, well-conducted and reported randomised trials are required in this area, in order to determine the effects of these techniques in the treatment of asthma in adults.

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Background: 

Many people have asthma, and for some their symptoms may be triggered by psychological factors. In addition, compliance with medical therapy may have a psychological dimension. Therefore, psychological interventions aim to reduce the burden of symptoms and improve management of the disease.

Objectives: 

To assess the effectiveness of psychological interventions for adults with asthma.

Search strategy: 

The Cochrane Airways Group Specialised Register and PsycINFO were searched with pre-defined terms up until May 2007.

Selection criteria: 

Randomised controlled trials published in any language assessing the effects of a psychological intervention compared with a form of control in adult participants were included in the review. Our primary outcome was healthcare resource defined as: hospitalisation, emergency room visits and/or GP visits

Data collection and analysis: 

Two reviewers assessed the relevance of abstracts identified by electronic searching and retrieved agreed studies for further scrutiny. The studies that met the inclusion criteria were assembled and data extracted.

Main results: 

Fifteen studies, involving 687 participants, were included in the review. Study quality was poor and sample sizes were frequently small. However, some pooled effects were analysed. Three studies measured our primary outcome but individually did not report significant differences between treatment and control. The use of 'as needed' medications was reduced in two studies, (47 patients), by relaxation therapy (OR 4.47, CI 1.22 to 16.44). There was no significant difference in FEV1 for relaxation therapy in four studies of 150 patients, (SMD -0.01, CI -0.41 to 0.40). Quality of life, measured using the Asthma Quality of Life Questionnaire in two studies, (48 patients), showed a positive effect following CBT (WMD 0.71, CI 0.23 to 1.19). Peak Expiratory Flow outcome data in two studies, (51 patients), indicated a significant difference in favour of bio-feedback therapy (SMD 0.66, CI 0.09 to 1.23) but no significant difference following relaxation therapy (WMD 43 L/min, CI -5 to 92 L/min). There was no statistically significant improvement in depression levels following relaxation therapy (SMD 0.17, CI -0.25 to 0.59). The remainder of the findings between studies were conflicting. This may have been due to the different types of interventions used and the deficiencies in trial design.

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