Asthma Symptom Management Through Mindfulness Training

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）的美国成年人，造成了180亿美元的直接医疗成本和生产力损失。控制症状和改善患者的生活质量是哮喘管理的目标，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。哮喘患者识别其症状的准确性受情绪因素的影响，由于高负性情绪与低内感受准确性、更差的哮喘症状和哮喘身体健康有关，哮喘患者中普遍存在的频繁的精神困扰被认为导致难以区分压力/痛苦症状与哮喘症状。正念训练教人们识别和区分经验的组成部分（思想、感觉、感觉/症状），并与增加呼吸阻力的感知准确性和减少情感消极性有关。因此，它有可能改善患者对哮喘症状和压力/痛苦的区分，从而改善哮喘的管理、控制和生活质量。一项广泛使用的正念训练计划（正念减压（MBSR））的试点随机对照试验（N=84）在轻度、中度或重度持续性哮喘的成人中探索这一假设。意向治疗分析将正念减压疗法与主动对照方案进行比较，结果显示总体生活质量有临床显著改善（p=0.01），哮喘症状（p=0.009）、哮喘抢救药物使用（p=0.001）、焦虑（p=0.05）、感知压力（p=0.01）和正念（p=0.01）也有显著改善。研究还发现，哮喘控制良好的患者比例也有了可喜的改善。所有改善均在干预后10个月持续。这种有希望的辅助干预措施的广泛采用将需要关于哮喘控制和症状的更明确的证据。因此，建议的RCT的主要目的是使用金标准测量方法对256名患有轻度、中度或重度哮喘的成人进行哮喘控制和症状的关键临床结果和主动对照试验。次要目的是评估该项目对哮喘生活质量、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个月、12个月和18个月的随访中进行。MBSR在全国范围内可用，并由许多第三方支付者覆盖。如果在哮喘控制和症状方面发现持续和可靠的改善，正念减压疗法可能是传统医学治疗的有用辅助，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，该研究还对医学中身心和行为程序的变化和维持机制产生了新的认识。

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.