Psychological Interventions in Asthma

Abstract

Asthma is a multifactorial chronic respiratory disease characterised by recurrent episodes of airway obstruction. The current management of asthma focuses principally on pharmacological treatments, which have a strong evidence base underlying their use. However, in clinical practice, poor symptom control remains a common problem for patients with asthma. Living with asthma has been linked with psychological co-morbidity including anxiety, depression, panic attacks and behavioural factors such as poor adherence and suboptimal self-management. Psychological disorders have a higher-than-expected prevalence in patients with difficult-to-control asthma. As psychological considerations play an important role in the management of people with asthma, it is not surprising that many psychological therapies have been applied in the management of asthma. There are case reports which support their use as an adjunct to pharmacological therapy in selected individuals, and in some clinical trials, benefit is demonstrated, but the evidence is not consistent. When findings are quantitatively synthesised in meta-analyses, no firm conclusions are able to be drawn and no guidelines recommend psychological interventions. These inconsistencies in findings may in part be due to poor study design, the combining of results of studies using different interventions and the diversity of ways patient benefit is assessed. Despite this weak evidence base, the rationale for psychological therapies is plausible, and this therapeutic modality is appealing to both patients and their clinicians as an adjunct to conventional pharmacological treatments. What are urgently required are rigorous evaluations of psychological therapies in asthma, on a par to the quality of pharmaceutical trials. From this evidence base, we can then determine which interventions are beneficial for our patients with asthma management and more specifically which psychological therapy is best suited for each patient. Key points• Asthma is a condition in which psychological factors play a major role and psychological co-morbidities can co-exist. The rationale for including psychological therapies to improve health outcomes for patients with asthma seems logical.• Because of poor methodological quality and small sample sizes, it is impossible to draw conclusions as to the effectiveness of psychological therapies in the management of adults or children with asthma.• There are some promising results for specific therapies on isolated outcomes, for example, in adults CBT on quality of life, biofeedback on peak flow and relaxation therapies on medication use.• The trials evaluating this clinical area are small, with heterogeneous interventions, poor quality study design and diversity of outcome measures that preclude the provision of guidance for clinical practice.• This potentially important area of patient care needs the development of a rigorous research program where future work is influenced and improves upon existing studies.

Sex and intimacy in people with severe asthma: a qualitative study

“… 25 The recurrence of poor self- further supports a recognised need for increased psychology input to assess patients and support HCPs. NHS England 26 have recently recommended health psychology as an essential component of the severe asthma team. Adequate psychology support is underfunded in an increasingly financially constrained health economy and provision for demand remains very limited.…”

Dysfunctional Breathing in Children and Adults With Asthma

“…Whilst there is a good scientific rationale for psychological interventions to treat dysfunctional breathing, it is difficult to carry out well-designed studies in this area and there is little supporting evidence for this approach in any age group (57, 58). Suggestion therapy has been shown to be highly effective in young children with habit cough using a bed sheet as a bandage to strap and heal the chest, but a similar device has not been used for dysfunctional breathing in asthma (59).…”

Posttraumatic stress disorder following asthma attack: the role of agency beliefs in mediating psychiatric morbidity

“…Biofeedback therapy and psycho-education are also likely to be beneficial, through empowering experiences of effective coping, stress management, and relaxation (Pope et al, 2014;Smith et al, 2007), which may lead to increased self-efficacy (and reduced psychiatric morbidity). Systematic reviews on psychological interventions for asthma found that these methods may be effective, but were inconclusive due to small sample sizes and differing outcome measures (see Smith & Jones, 2015;Yorke et al, 2007). Future studies on interventions should more explicitly incorporate efficacy building and longitudinally measure changes in self-efficacy to further support the importance of self-efficacy for people with asthma, PTSD, and co-morbid disorders (Battersby et al, 2010;Marks et al, 2005;Taylor et al, 2014).…”

“…Still, preliminary evidence points toward wellbeing and quality of life benefits from a range of psychological interventions for chronic health conditions. These include cognitive and behavioural approaches, relaxation, bio-feedback, and psychoeducation (Smith & Jones, 2015). However, the three systematic reviews in the past decade failed to find firm evidence for any one intervention due to small studies and suboptimal methods (see Smith and Jones, 2015).…”