The Placebo Effect in Asthma

Abstract

The placebo effect is a complex phenomenon occurring across a variety of clinical conditions. While much placebo research has been conducted in diseases defined by self-report such as depression, chronic pain, and irritable bowel syndrome (IBS), asthma has been proposed as a useful model because of its easily measured objective outcomes. Studies examining the placebo response in asthma have not only contributed to an understanding of the mechanisms behind the placebo response but also shed an interesting light on the current treatment and diagnosis of asthma. This paper will review current literature on placebos in general and specifically on the placebo response in asthma. It focuses on what we know about the mechanisms behind the placebo effect, whether there is a specific portion of the population who responds to placebos, which patient outcomes are influenced by the placebo effect, and whether the effect can be augmented.

Relationship Between Benralizumab Exposure and Efficacy for Patients With Severe Eosinophilic Asthma

“…There was a strong placebo effect for reduced exacerbations and improved FEV 1 observed in the SIROCCO and CALIMA trials, 7,8 which is a common observation in clinical trials for patients with asthma. 13,14 The placebo effect on FEV 1 is usually a result of better patient adherence to maintenance therapy because of the active monitoring that accompanies controlled clinical trial enrollment. However, we did not observe a placebo effect for patients aged > 65 years, and we saw the strongest placebo effect in the adolescent group.…”

Heterogeneity in Clinical, Endoscopic, and Histologic Outcome Measures and Placebo Response Rates in Clinical Trials of Eosinophilic Esophagitis: A Systematic Review

“…Potential determinants of the histologic placebo response in EoE RCTs include (1) inclusion of patients with PPI-responsive EoE who derive both clinical and histologic benefits from concomitant PPI therapy 41 ; (2) sampling of histologically normal mucosa in the context of patchy eosinophilic infiltration in EoE; (3) regression to the mean; and (4) spontaneous changes in disease activity in the natural history of EoE, possibly as a response to fluctuations in allergen or dietary exposures. Although symptomatic placebo rates in EoE tend to be lower than in other allergic and gastrointestinal disorders, 42,43 they still remain higher and more variable compared with histologic placebo response. Some EoE studies report greater than one-third to one-half of Figure 2.…”

The placebo response of injectable GLP‐1 receptor agonists vs. oral DPP‐4 inhibitors and SGLT‐2 inhibitors: a systematic review and meta‐analysis

“…We chose weight, and indirectly HbA1c, as a focus of research, as appetite and satiety are also relatively subjective endpoints. For objective endpoints, contradictory results have been obtained, with some describing placebo as being powerless , whilst others showed significant placebo effects, for example in the treatment of hypertension , asthma and glaucoma . As suggestions made by caregivers and patients' expectations are very important for treatment outcome , suggestion towards treatment effects might explain the clear relationship between the response to placebo and its active comparator, a connection that has been described previously .…”