Asthma and Mindfulness-based Stress Reduction (MBSR)

描述（由申请人提供）：哮喘影响了美国约7%或大约1400万成年人，估计花费了79亿美元的医疗费用，53亿美元的失业或失学费用。尽管大约40%的哮喘患者报告使用某种形式的补充和替代医学（CAM）来帮助缓解他们的症状，但很少有证据表明CAM对哮喘的有效性。有相当多的流行病学和实验证据表明，心理因素，包括压力，在哮喘发病率中起作用，并导致了减少压力的行为方案可能影响哮喘症状及其管理的建议。我们小组进行的一项小型初步研究发现，在完成正念减压（MBSR）项目后，哮喘相关的生活质量、控制点、压力和焦虑都得到了改善，我们现在已经获得了一项为期两年的随机试验的资助，该试验将MBSR用于肺功能以及哮喘的行为和心理方面。这项试验目前正处于规划阶段。82名被诊断为轻度或中度哮喘的成年人将参加正念减压或健康生活课程的注意力控制条件。

DESCRIPTION (provided by applicant): Asthma affects about 7% or roughly 14 million adults in the United States and costs an estimated 7.9 billion dollars in medical care, and 5.3 billion dollars in lost work or school. Although approximately 40% of asthmatics report using some form of complementary and alternative medicine (CAM) to help alleviate their symptoms, there is little evidence for the effectiveness of CAM for asthma. There is considerable epidemiological and experimental evidence that psychological factors, including stress, play a role in asthma morbidity, and has led to the suggestion that behavioral programs known to reduce stress may affect asthma symptoms and their management. A small preliminary study by our group found improvements in asthma- related quality of life, locus of control, stress, and anxiety immediately following the completion of a Mindfulness-Based Stress Reduction (MBSR) program, and we have now been funded for a two-year randomized trial of MBSR for lung function and the behavioral and psychological aspects of asthma. This trial is presently in the planning stages. Eighty-two adults with a diagnosis of mild or moderate asthma will participate in either MBSR, or a Healthy Living Course attention control condition. Most of the immunological, endocrine and neuronal mediators and moderators of the stress response also play important roles in the initiation and perpetuation of the symptoms associated with asthma, but there has been only one small behavioral study of asthma-related immune markers. Given NCCAM's recently stated interest in supporting studies of immune mechanisms, we are submitting this competitive supplement in order to take advantage of the valuable scientific opportunity provided by the parent study to investigate immune markers as well as clinically-relevant biomarkers. Asthma is an immunoregulatory disease and there is evidence that a change in Th1 - Th2 cytokine balance toward a Th2 environment may play an important role in its pathogenesis. The aims of this application are to investigate possible biological mediators of any observed differences in lung function (two-week average morning peak expiratory flow) in subjects participating in the two arms, by evaluating changes in Th1 - Th2 cytokine balance and levels of circulating regulatory Tcells, over a 12-month period. We will also evaluate changes in serum IgE, a marker of clinical relevance in asthma. Also, the sample size is sufficient for exploratory analyses for possible psychological mediators/moderators by examining associations between any changes in immunological markers, clinical symptoms and psychosocial variables. Blood will be collected from each of the participants at each of the four assessment points: study entry (baseline), 10-week (post-intervention), 6- and 12-month follow-up. Supplemental funds will be applied to the institutional and subject-related expenses in obtaining and shipping the blood samples, the immunological assays by flow cytometry, and the entering, management and analysis of the data obtained. Public Health Relevance: Although approximately 40% of asthmatics report using some form of complementary and alternative medicine (CAM) to help alleviate their symptoms, and studies show that relaxation improves their respiratory function, there is no evidence to show that there are accompanying changes in their immune systems. The presence of such changes would indicate the level that these CAM programs operate at in the body and the mind. This study will examine whether there are immune system changes associated with any improvements in patients' lung function and their self-reports of asthma symptoms as a result of participating in a well-known stress reduction program. This information is important for people to know so that they can make sound decisions about whether programs such as this one are right for their circumstances.