Asthma Symptom Management Through Mindfulness Training

通过正念训练控制哮喘症状

• 批准号: 9110132
• 负责人: JAMES F CARMODY
• 金额: $ 66.23万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-03 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9110132
• 关键词: Address; Adoption; Adult; Adverse effects; Adverse event; Affect; Affective; Anxiety; Asthma; Attention; Behavioral; Biological Markers; Chronic Disease; Clinical; Clinical Management; Controlled Study; Cost utility; Deterioration; Discrimination; Disease; Disease Management; Distress; Education; Educational process of instructing; Emergency department visit; Emotions; Employee Strikes; Esthesia; Exhalation; Feeling; Funding; Future; Goals; Gold; Guidelines; Health; Health Care Costs; Hospitals; Intervention; Knowledge; Lead; Life Cycle Stages; Maintenance; Measures; Mediating; Medical; Medicine; National Center for Complementary and Alternative Medicine; Nitric Oxide; Outcome; Participant; Patients; Peak Expiratory Flow; Perception; Pharmaceutical Preparations; Pilot Projects; Play; Process; Productivity; Psyche structure; Psychosocial Factor; Pulmonary Function Test/Forced Expiratory Volume 1; Quality of life; Quality-Adjusted Life Years; Recruitment Activity; Reporting; Resistance; Respiratory Signs and Symptoms; Respiratory physiology; Risk; Role; Self Management; Services; Spirometry; Stress; Symptoms; Tactile; Testing; Thinking; Third-Party Payer; Time; Training; Training Programs; Visit; active control; airway inflammation; arm; asthmatic; asthmatic patient; base; body-mind; clinically significant; cost; cost effectiveness; design; emotional factor; experience; follow-up; group support; improved; interest; mindfulness; mindfulness-based stress reduction; negative affect; physical conditioning; post intervention; programs; psychologic; pulmonary function; respiratory; standard measure; stress symptom; symptom management; symptomatic improvement; symptomatology

DESCRIPTION (provided by applicant): Asthma is one of the four most common adult chronic disorders. It affects 7.3% (16.4 million) U.S. adults and costs $18 billion in direct healthcare costs and lost productivity. Control of symptoms and improving patient's quality of life (QOL) are the goals in asthma management and require patients to accurately identify their symptoms. But the low congruence between patients' symptom reports and their pulmonary function leads to disease management errors. The accuracy with which asthma patients recognize their symptoms is affected by emotional factors, and because high negative affectivity is related to low interoceptive accuracy and worse asthma symptoms and asthma physical health, the frequent mental distress prevalent among asthmatics is thought to result in difficulty in distinguishing symptoms of stress/distress from those of asthma. Mindfulness training teaches people to recognize and distinguish among the components of experience (thoughts, feelings, sensations/symptoms) and is associated with increased perceptual accuracy of respiratory resistance, and reduced affective negativity. It thus has the potential to improve patient's discrimination between asthma symptoms and stress/distress, resulting in improved asthma management, control and QOL. A pilot RCT (N=84) of a widely-available mindfulness training program (Mindfulness-Based Stress Reduction (MBSR)) to explore this hypothesis in adults with mild, moderate or severe persistent asthma. Intent to treat analyses comparing MBSR to an active control program showed clinically significant improvements in overall QOL (p=0.01), as well as important improvements in asthma symptoms (p=0.009), reduced use of asthma rescue medication (p=0.001), anxiety (p=0.05), perceived stress (p=0.01), and mindfulness (p=0.01). Promising improvements in the percentage of patients with well-controlled asthma also were found. All improvements were sustained 10 months post-intervention. Widespread adoption of this promising adjunct intervention will require sharper evidence regarding asthma control and symptoms. The primary aim of the proposed RCT is therefore to test MBSR against an active control on the key clinical outcomes of asthma control and symptoms using gold standard measures with 256 adults with mild, moderate or severe asthma. Secondary aims evaluate the program's effect on asthma QOL, lung function, cost-effectiveness, and the mediating effect of respiratory interoceptive accuracy on asthma control, QOL, and medication use. Assessments are at baseline, 6-, 12-, and 18-month follow-up. MBSR is available nationwide and covered by many third-party payers. If sustained and credible improvements in asthma control and symptoms are found, MBSR could be a useful adjunct to traditional medical treatment and would have the potential for improving the lives of people with asthma. By examining the mediating effects of psychosocial variables on asthma control, the study also generates new knowledge on mechanisms of change and maintenance in mind-body and behavioral programs in medicine.

描述（由申请人提供）：哮喘是四种最常见的成人慢性疾病之一。它影响了 7.3%（1640 万）美国成年人，造成了 180 亿美元的直接医疗费用和生产力损失。控制症状和改善患者的生活质量（QOL）是哮喘管理的目标，需要患者准确识别自己的症状。但患者的症状报告与其肺功能之间的一致性较低，导致疾病管理错误。哮喘患者识别症状的准确性受到情绪因素的影响，并且由于较高的负面情感与较低的内感受准确性以及较差的哮喘症状和哮喘身体健康有关，因此哮喘患者中普遍存在的频繁精神困扰被认为导致难以区分压力/痛苦症状与哮喘症状。正念训练教会人们识别和区分经验的组成部分（思想、感觉、感觉/症状），并与提高呼吸阻力的感知准确性和减少情感消极性相关。因此，它有可能改善患者对哮喘症状和压力/痛苦的辨别力，从而改善哮喘管理、控制和生活质量。一项广泛使用的正念训练计划（基于正念的减压（MBSR））的试点随机对照试验（N = 84），旨在在患有轻度、中度或重度持续性哮喘的成人中探索这一假设。比较MBSR与主动控制计划的意向治疗分析显示，整体生活质量有临床显着改善（p=0.01），哮喘症状也有显着改善（p=0.009），哮喘救援药物的使用减少（p=0.001），焦虑（p=0.05），感知压力（p=0.01）和正念（p=0.01）。哮喘控制良好的患者比例也有希望改善。所有改善均在干预后持续 10 个月。这种有前景的辅助干预措施的广泛采用需要有关哮喘控制和症状的更清晰的证据。因此，拟议的 RCT 的主要目的是使用金标准措施对 256 名患有轻度、中度或重度哮喘的成人进行测试，以测试 MBSR 与主动控制对哮喘控制和症状的关键临床结果的影响。次要目标是评估该计划对哮喘生活质量、肺功能、成本效益的影响，以及呼吸内感受准确性对哮喘控制、生活质量和药物使用的中介作用。评估在基线、6、12 和 18 个月的随访中进行。 MBSR 在全国范围内提供，并由许多第三方付款人承保。如果发现哮喘控制和症状持续可靠的改善，MBSR可能成为传统医学治疗的有用辅助手段，并有可能改善哮喘患者的生活。通过研究心理社会变量对哮喘控制的中介作用，该研究还产生了关于医学中身心和行为计划的变化和维持机制的新知识。