Asthma and Mindfulness-based Stress Reduction (MBSR)

描述（由申请人提供）：哮喘是一种慢性呼吸道疾病，在美国影响7%或1400万成年人。它是成年人中最常见的四种慢性疾病之一，估计花费了79亿美元的医疗费用和53亿美元的失业或失学费用。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）方法来帮助减轻他们的哮喘症状，但几乎没有证据表明其有效性。包括瑜伽在内的呼吸和放松技巧似乎最有希望。正念减压（MBSR）是马萨诸塞大学医学院（UMMS）开发的一个以团体为基础的项目，重点是通过正式的冥想练习培养正念，并将正念融入日常生活，作为应对身体症状、慢性疾病和困难情绪状况的应对资源。正念减压已被证明是一种有效的辅助干预，可以减轻各种压力相关疾病和慢性疾病的医学症状，减少心理困扰、焦虑和抑郁，并提高生活质量。我们的研究小组进行的一项小型初步研究发现，在完成正念减压课程后，生活质量、控制点、压力和焦虑的测量都得到了改善。

DESCRIPTION (provided by applicant): Asthma is a chronic respiratory disease that affects 7% or 14 million adults in the United States. It is one of the four most common chronic disorders in adults, costing an estimated 7.9 billion dollars in medical care and 5.3 billion dollars in lost work or school. Approximately 40% of asthmatics report using some form of complementary and alternative medicine (CAM) approach to help alleviate their asthma symptoms, but there is little evidence for their effectiveness. Breathing and relaxation techniques, including yoga appear most promising. Mindfulness-based stress reduction (MBSR) is a group-based program developed at the University of Massachusetts Medical School (UMMS) that focuses on the cultivation of mindfulness through formal meditation practices and the integration of mindfulness into everyday life as a coping resource to deal with physical symptoms, chronic medical conditions, and difficult emotional situations. MBSR has been shown to be an effective adjunctive intervention in reducing medical symptoms for a broad range of stress- related disorders and chronic diseases, reducing psychological distress anxiety and depression, and improving quality of life. A small preliminary study conducted by our research team found improvements in measures of quality of life, locus of control, stress, and anxiety immediately following the completion of the MBSR program. The overall goal of the proposed two year exploratory study is to conduct a randomized controlled trial (RCT) to test and optimize recruitment and data collection procedures and to collect preliminary data on the effect of MBSR on behavioral and psychological aspects of asthma and lung function to support justification for a larger clinical trial should the results of this study be promising. Seventy-eight adults ages 21 and older with a physician-documented diagnosis of asthma classified as either mild or moderate documented will be recruited for seventy participants at final follow-up. Participants will be randomly assigned to one of two conditions stratified by asthma severity: (1) MBSR, or (2) Healthy Living Course (HLC) attention control condition. Participant assessments will occur at study entry (baseline) and at 10-week, 6- and 12-month follow-up. The primary aim of the project is to evaluate the efficacy of the MBSR program in improving quality of life and lung function as assessed by change from baseline to two-week average morning peak expiratory flow (PEF) compared to HLC participants. Secondary aims are to evaluate the effect of the MBSR program on reducing asthma rescue medication use, frequency of asthma exacerbations (prednisone therapy), asthma symptoms, healthcare utilization, number of days of work or school missed, peak expiratory flow (PEF) variation, and psychological distress, and in improving asthma control, asthma-related internal locus of control, and lung function as assessed by spirometry (FEV1).