Trachea-noise biofeedback in asthma: A comparison of the effect of trachea-noise biofeedback, a bronchodilator, and no treatment on the rate of recovery from exercise- and eucapnic hyperventilation-induced asthma

Abstract

We review some of the evidence that supports the existence of psychosomatic triggers to bronchospasm in asthmatics, and hypothesize that it may also be possible to consciously reverse bronchospasm using trachea-noise biofeedback. We precipitated significant levels of bronchospasm in 16 asthmatics using exercise or eucapnic-hyperventilation challenges on five occasions, and administered four different treatments and a no-treatment control. The treatments were trachea-noise biofeedback (TNBF), wrong-information TNBF, an inhaled adrenergic bronchodilator, and a placebo inhaler, all given double blind. Half of the subjects had 3 training days in the use of the TNBF device before study. Our results show that TNBF, in the trained subjects only, is associated with a detectable, but not statistically significant, increase in the rate of recovery from bronchospasm over that found with no treatment. We conclude that, although asthmatics seem to have a strong ability to consciously induce bronchospasm, conscious reversal of a full asthma attack using TNBF is limited. Despite contrary conclusions by other investigators, we believe that this study demonstrated little TNBF-assisted recovery from bronchospasm. We suggest that this is because its effect may be inhibited by humoral mechanisms that sustain the attack, but we believe further work is required to support this.

Stress management techniques: Are they all equivalent, or do they have specific effects?

“…These include Peper's technique of trapezius EMG biofeedback for thoracic relaxation, combined with biofeedback training to increase inspiratory air flow (Peper, Smith, & Waddell, 1987;Tibbetts & Peper, 1989), controlled breathing (Hibbert & Pilsbury, 1988), decreased vagal tone (Harding & Maher, 1982), trachea noise biofeedback (Mussell & Hartley, 1988), and biofeedback of respiratory resistance (Janson-Bjerklie & Clark, 1982;Steptoe, Phillips, & Harling, 1981). Of these, it should be noted that, strictly speaking, the latter two methods are not "stress management" methods, and that decreases in vagal tone tend to be associated with increases in the fight-or-flight reaction.…”

Establishing a role for psychology in respiratory medicine.

“…Although asthma-education programs increase knowledge about asthma and its appropriate care, evidence that education intervention alone significantly alters health care behavior is at best mixed. Some support can be found for the effect of asthma education on reducing health care use (Bolton, Tilley, Kuder, Reeves, & Schultz, 1991;Osman et al, 1994) behavior. In one study, 53 high-risk asthmatic children with histories of repeated emergency room visits and hospitalizations were enrolled in an intensive self-management program (Greineder et al, 1995).…”

Psychological approaches to the treatment of asthma.

“…Subjects receiving biofeedback showed an ability to produce phasic increases in heart rate, accompanied by significant increases in peak expiratory flow rate, as well to reduce the incidence of asthma attacks and to decrease the use of medication. Mussell and Hartley (1988) used trachea-noise biofeedback. In their study, bronchoconstriction was deliberately induced by exercise and eucapnic hyperventilation challenges.…”