Training patients with asthma in mindfulness-based stress reduction (MBSR) improves clinically relevant outcomes and may therefore enhance asthma management, especially among those with comorbid psychopathology, according to study findings published in Brain, Behavior, and Immunity – Health.
Asthma exacerbation risk is elevated in individuals with psychological distress and comorbid psychopathology. MBSR training is designed to improve emotion regulation and reduce stress. Investigators hypothesized that undergoing MBSR training would reduce the effect of psychological distress on asthma control and inflammation, along with exacerbation risk. They therefore conducted a randomized controlled trial (ClinicalTrials.gov identifier: NCT02157766) to explore the effects of MBSR training on asthma control and airway inflammation among adults with asthma.
A total of 73 voluntary participants (aged 18 to 65 years, 43 female) recruited from the Madison, Wisconsin, area were randomized to either an 8-week MBSR training group (n=35) or to a wait-list control group (n=34, comprising individuals who were to receive free MBSR at the end of the study). All participants had a been diagnosed with asthma by a physician; individuals with experience in MBSR or other mind-body techniques were excluded, as were those with neurological disorders, traumatic brain injury, and bipolar or psychotic disorders.
Asthma control was evaluated with use of the Asthma Control Questionnaire 6-item version (ACQ-6). The ACQ-6 comprises 5 Likert-scale questions regarding symptoms, including night awakenings, symptom frequency/severity, and disease-associated activity limitations, as well as 1 question about medication use. Ratings on the ACQ-6 are based on a 7-point scale that indicates the degree of symptom-related impairment experienced during the prior week, then averaged for a total score of 6. The Composite Asthma Severity Index (CASI) quantifies asthma severity via use of a combination of impairment, future risk for exacerbation, and treatment needed to achieve current levels of disease control.
Clinically relevant asthma evaluations, including ACQ-6 and inflammatory biomarkers, were obtained at baseline and at 6 other visits that occurred at approximately 1-month intervals. The initial visit (month 0) took place at baseline, prior to randomization to the MBSR or wait-list group. The second visit (month 1) occurred at the intervention midpoint. The third visit (month 2) reflects the initial postintervention evaluation. The remaining visits took place approximately monthly until the final visit (month 6), which occurred at approximately 4 months postintervention. Self-reported mindfulness, psychological distress, anxiety, and depression symptoms were evaluated at baseline, postintervention, and at study completion. The patient’s chronic level of stress was established at baseline only.
Results of the study showed that asthma control improved significantly in individuals who were randomized to MBSR, compared with those in the control group (P =.01), with improvement maintained at the 4-month postintervention. Overall, 32.26% of those in the MBSR arm attained the minimally important difference (ie, change in ACQ-6 of ≥0.5) from baseline to final visit, compared with 12.50% of wait-list participants (P =.059). No significant effects were revealed when total CASI scores were used as the outcome.
MBSR-related improvement in asthma control was associated with a significant decrease in distress (P =.043), with the MBSR intervention most effective in those with the highest baseline depressive symptoms (P =.023). Additionally, MBSR also decreased levels of exhaled nitric oxide — a known biomarker of airway inflammation — compared with levels in the control group (P <.05).
A key limitation of the current study is the absence of an active control group. Although a wait-list control arm was used to control for variation in outcome measures over time, the possibility exists that the effects reported in this study were driven by factors that are not specific to training in mindfulness, including social support or expectancy effects.
The investigators concluded that “as incorporation of the concept of treatable traits into asthma management grows, MBSR may prove to be an effective intervention to reduce the contribution of psychological factors to morbidity, and improve overall disease control.”
Disclosure: One of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.
Higgins ET, Davidson RJ, Busse WW, et al. Clinically relevant effects of Mindfulness-Based Stress Reduction in individuals with asthma. Brain Behav Immun Health. 2022;25:100509. doi:10.1016/j.bbih.2022.100509