Asthma Symptom Management Through Mindfulness Training

描述(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，并造成了180亿美元的直接医疗成本和生产力损失。控制症状和提高患者的生活质量(QOL)是哮喘管理的目标，要求患者准确识别自己的症状。但患者的症状报告与他们的肺功能之间的低一致性导致了疾病管理的错误。哮喘患者识别症状的准确性受情绪因素的影响，由于较高的负性情感与较低的交互感受准确率和较差的哮喘症状和哮喘身体健康有关，因此哮喘患者普遍存在的频繁的精神痛苦导致很难区分应激/痛苦症状和哮喘症状。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负面有关。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。一项广泛可用的正念训练计划的试点随机对照试验(N=84)(基于正念的压力减轻(MBSR))，以探索患有轻度、中度或重度持续性哮喘的成年人的这一假设。治疗意向分析显示，与主动控制方案相比，在临床上总体生活质量有显著改善(p=0.009)，哮喘症状(p=0.009)、哮喘救治药物的使用减少(p=0.001)、焦虑(p=0.001)、感觉到的压力(p=0.01)和正念(p=0.01)也有重要的改善。控制良好的哮喘患者的百分比也得到了有希望的改善。所有的改善都在干预后10个月持续。广泛采用这种有希望的辅助干预措施将需要关于哮喘控制和症状的更敏锐的证据。因此，建议的随机对照试验的主要目的是使用金标准措施，在256名患有轻度、中度或重度哮喘的成年人中，测试MBSR对哮喘控制和症状的关键临床结果和症状的积极控制。次要目的是评估该计划对哮喘患者的生活质量、肺功能、成本效益的影响，以及呼吸间感觉准确性对哮喘控制、生活质量和用药的中介作用。评估处于基线、6个月、12个月和18个月的随访阶段。MBSR在全国范围内可用，并由许多第三方付款人覆盖。如果哮喘控制和症状得到持续和可靠的改善，MBSR可能是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，这项研究还产生了关于心身变化和维持机制的新知识，以及医学上的行为程序。

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.