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Meta-Analysis
. 2006 Jan 25;2006(1):CD002982.
doi: 10.1002/14651858.CD002982.pub3.

Psychological interventions for adults with asthma

J Yorke  1 , S L Fleming, C M Shuldham
Affiliations
Meta-Analysis

Psychological interventions for adults with asthma

J Yorke et al. Cochrane Database Syst Rev. .

Abstract

Background: Many people have asthma, and for some their symptoms may be triggered by psychological factors. In addition compliance with medical therapy may have a psychological dimension. Therefore, psychological interventions aim to reduce the burden of symptoms and improve management of the disease.

Objectives: To assess the effectiveness of psychological interventions for adults with asthma.

Search strategy: The Cochrane Airways Group Specialised Register and PsycINFO were searched with pre-defined terms up until August 2005.

Selection criteria: Randomised controlled trials published in any language assessing the effects of a psychological intervention compared with a form of control in adult participants were included in the review.

Data collection and analysis: Two reviewers assessed the relevance of abstracts identified by electronic searching and retrieved agreed studies for further scrutiny. The studies that met the inclusion criteria were assembled and data extracted.

Main results: Fourteen studies, involving 617 particpants, were included in the review, however study quality was poor and sample sizes were frequently small. However, some pooled effects were analysed. The use of 'as needed' medications was reduced in two studies, (47 patients), by relaxation therapy (OR 4.47, CI 1.22 to 16.44). There was no significant difference in FEV1 for relaxation therapy in four studies of 150 patients, (SMD -0.01, CI -0.41 to 0.40). Quality of life, measured using the Asthma Quality of Life Questionnaire in two studies, (48 patients), showed a positive effect following CBT (WMD 0.71, CI 0.23 to 1.19). Peak Expiratory Flow outcome data in two studies, (51 patients), indicated a significant difference in favour of bio-feedback therapy (SMD 0.66, CI 0.09 to 1.23). The remainder of the findings between studies were conflicting. This may have been due to the different types of interventions used and the deficiencies in trial design.

Authors' conclusions: This review was unable to draw firm conclusions for the role of psychological interventions in asthma due to the absence of an adequate evidence base. Larger, well-conducted and reported randomised trials are required in this area, in order to determine the effects of these techniques in the treatment of asthma in adults.

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Conflict of interest statement

None known.

Figures

1
1
Based on the findings of this review this image shows that when relaxation/autogenic therapy is given to 100 patients, on average 3 would need to be treated in order to induce a reduction in the amount of bronchodilator used. The data analysed showed that 22/100 people would be able to do this anyway, but that an additional 34/100 people could achieve this with treatment.
1.1
1.1. Analysis
Comparison 1 Bio‐feedback therapy versus control, Outcome 1 FEV1 (% predicted).
1.2
1.2. Analysis
Comparison 1 Bio‐feedback therapy versus control, Outcome 2 Medication use.
1.3
1.3. Analysis
Comparison 1 Bio‐feedback therapy versus control, Outcome 3 Withdrawals.
1.4
1.4. Analysis
Comparison 1 Bio‐feedback therapy versus control, Outcome 4 PEF.
1.5
1.5. Analysis
Comparison 1 Bio‐feedback therapy versus control, Outcome 5 Exacerbations (use of oral corticosteroids).
1.6
1.6. Analysis
Comparison 1 Bio‐feedback therapy versus control, Outcome 6 Symptoms.
2.1
2.1. Analysis
Comparison 2 Cognitive behavioural therapy versus control, Outcome 1 Asthma quality of life questionnaire.
2.2
2.2. Analysis
Comparison 2 Cognitive behavioural therapy versus control, Outcome 2 Asthma symptoms checklist.
2.3
2.3. Analysis
Comparison 2 Cognitive behavioural therapy versus control, Outcome 3 Diurnal PEF (Litres/min).
2.4
2.4. Analysis
Comparison 2 Cognitive behavioural therapy versus control, Outcome 4 Nocturnal PEF (Litres/min).
2.5
2.5. Analysis
Comparison 2 Cognitive behavioural therapy versus control, Outcome 5 Negative emotional score (NEM).
2.6
2.6. Analysis
Comparison 2 Cognitive behavioural therapy versus control, Outcome 6 Adherence scale.
2.7
2.7. Analysis
Comparison 2 Cognitive behavioural therapy versus control, Outcome 7 Trait anxiety scale.
2.8
2.8. Analysis
Comparison 2 Cognitive behavioural therapy versus control, Outcome 8 Psychophysiological disorder.
2.9
2.9. Analysis
Comparison 2 Cognitive behavioural therapy versus control, Outcome 9 Depressive symptoms.
2.10
2.10. Analysis
Comparison 2 Cognitive behavioural therapy versus control, Outcome 10 Asthma Quality of Life Questionnaire ‐ Total.
2.11
2.11. Analysis
Comparison 2 Cognitive behavioural therapy versus control, Outcome 11 Peak flow variabilty.
2.12
2.12. Analysis
Comparison 2 Cognitive behavioural therapy versus control, Outcome 12 Withdrawals.
2.13
2.13. Analysis
Comparison 2 Cognitive behavioural therapy versus control, Outcome 13 Health locus of control.
2.14
2.14. Analysis
Comparison 2 Cognitive behavioural therapy versus control, Outcome 14 Symptom free days.
2.15
2.15. Analysis
Comparison 2 Cognitive behavioural therapy versus control, Outcome 15 Sheehan patient rated anxiety scale.
3.1
3.1. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 1 Increase in medication usage.
3.2
3.2. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 2 Decrease/discontinuation of medication.
3.3
3.3. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 3 FVC.
3.4
3.4. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 4 Withdrawals.
3.5
3.5. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 5 FEV1.
3.6
3.6. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 6 PEF (Litres/min).
3.7
3.7. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 7 Airway resistance (cm H2O/Litre/second).
3.8
3.8. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 8 Medication usage (puffs/day).
3.9
3.9. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 9 Spielberger's Trait Anxiety score.
3.10
3.10. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 10 Spielberger's State Anxiety score.
3.11
3.11. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 11 Depression.
3.12
3.12. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 12 Asthma Quality of Life Questionnaire.
3.13
3.13. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 13 Symptoms ‐ wheeze.
3.14
3.14. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 14 FEV1%.
3.15
3.15. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 15 Symptoms ‐ attacks.
3.16
3.16. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 16 Symptoms ‐ cough.
3.17
3.17. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 17 Anxiety.
3.18
3.18. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 18 Attitude.
3.19
3.19. Analysis
Comparison 3 Relaxation/hypnosis/autogenic therapy versus control, Outcome 19 Self‐efficacy.
See this image and copyright information in PMC

Update of

References

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References to ongoing studies

Harrison {published data only (unpublished sought but not used)}
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References to other published versions of this review

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