Asthma Symptom Management Through Mindfulness Training

通过正念训练控制哮喘症状

• 批准号: 9110132
• 负责人: JAMES F CARMODY
• 金额: $ 66.23万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-03 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9110132
• 关键词: Address; Adoption; Adult; Adverse effects; Adverse event; Affect; Affective; Anxiety; Asthma; Attention; Behavioral; Biological Markers; Chronic Disease; Clinical; Clinical Management; Controlled Study; Cost utility; Deterioration; Discrimination; Disease; Disease Management; Distress; Education; Educational process of instructing; Emergency department visit; Emotions; Employee Strikes; Esthesia; Exhalation; Feeling; Funding; Future; Goals; Gold; Guidelines; Health; Health Care Costs; Hospitals; Intervention; Knowledge; Lead; Life Cycle Stages; Maintenance; Measures; Mediating; Medical; Medicine; National Center for Complementary and Alternative Medicine; Nitric Oxide; Outcome; Participant; Patients; Peak Expiratory Flow; Perception; Pharmaceutical Preparations; Pilot Projects; Play; Process; Productivity; Psyche structure; Psychosocial Factor; Pulmonary Function Test/Forced Expiratory Volume 1; Quality of life; Quality-Adjusted Life Years; Recruitment Activity; Reporting; Resistance; Respiratory Signs and Symptoms; Respiratory physiology; Risk; Role; Self Management; Services; Spirometry; Stress; Symptoms; Tactile; Testing; Thinking; Third-Party Payer; Time; Training; Training Programs; Visit; active control; airway inflammation; arm; asthmatic; asthmatic patient; base; body-mind; clinically significant; cost; cost effectiveness; design; emotional factor; experience; follow-up; group support; improved; interest; mindfulness; mindfulness-based stress reduction; negative affect; physical conditioning; post intervention; programs; psychologic; pulmonary function; respiratory; standard measure; stress symptom; symptom management; symptomatic improvement; symptomatology

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.

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）美国成年人，直接医疗费用成本为180亿美元，生产力降低。控制症状并改善患者的生活质量（QOL）是哮喘管理的目标，要求患者准确识别症状。但是患者症状报告及其肺功能之间的一致性低导致疾病管理错误。哮喘患者识别症状的准确性受情绪因素的影响，并且由于高阴性情感与低感受的准确性和哮喘症状和哮喘的身体健康有关，因此哮喘患者频繁的精神困扰被认为会导致难以区分哮喘的压力/痛苦症状。正念训练教会人们认识并区分经验的组成部分（思想，感觉，感觉/症状），并与呼吸抵抗的感知准确性提高以及情感负面影响有关。因此，它有可能改善患者对哮喘症状和压力/困扰的区分，从而改善哮喘管理，控制和质量质量。一个广泛可用的正念训练计划（基于正念的压力减轻（MBSR））的试点RCT（n = 84），以探讨患有轻度，中度或严重持续性哮喘的成年人中的这一假设。治疗分析的意图将MBSR与主动控制程序进行比较，在整体QOL（p = 0.01）方面有显着改善（P = 0.01），以及哮喘症状的重要改善（P = 0.009），哮喘救援药物的使用减少（P = 0.001），焦虑症（P = 0.05），焦虑（P = 0.05），感知压力（P = 0.01）和p = 0.01，p = 0.01（P = 0.01）。还发现了良好控制哮喘患者百分比的有希望的改善。干预后所有改进均维持10个月。广泛采用这种有希望的辅助干预措施将需要有关哮喘控制和症状的更清晰的证据。因此，该提议的RCT的主要目的是使用256名患有轻度，中度或重度哮喘的成年人进行金标准措施测试MBSR，以对哮喘控制和症状的关键临床结局进行积极控制。次要目的评估该计划对哮喘质量，肺功能，成本效益以及呼吸道互感准确性对哮喘控制，QOL和药物使用的介导作用的影响。评估是基线，6个，12个月和18个月的随访。 MBSR在全国范围内可用，并由许多第三方付款人覆盖。如果发现哮喘控制和症状的持续且可靠的改善，MBSR可能是传统医疗的有用辅助手段，并有可能改善哮喘患者的生活。通过检查社会心理变量对哮喘控制的中介作用，该研究还为医学中的思维体和行为计划中的变化和维护机制提供了新的知识。