Asthma and Mindfulness-based Stress Reduction (MBSR)

哮喘和正念减压 (MBSR)

• 批准号: 7298382
• 负责人: JAMES F CARMODY
• 金额: $ 13.24万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-30 至 2008-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7298382
• 关键词: Adherence; Adult; Affect; Anxiety; Asthma; Attention; Award; Behavior Therapy; Behavioral; Biological; Biological Assay; Biological Markers; Blood; Blood specimen; Caring; Cells; Chronic; Clinical; Clinical Markers; Complementary Medicine; Complementary and alternative medicine; Condition; Control Locus; Controlled Study; Cryopreservation; Data; Data Analyses; Diagnosis; Disease; Distress; Effectiveness; End Point; Endocrine; Environment; Equilibrium; Exhibits; Flow Cytometry; Funding; IgE; Immune; Immune System Diseases; Immune system; Immunity; Immunologic Markers; Interferon Type II; Interleukin-4; Interleukins; Intervention; Knowledge; Laboratories; Life Cycle Stages; Life Stress; Mediator of activation protein; Medical; Meditation; Mental Depression; Morbidity - disease rate; Nature; Neurons; Numbers; Parents; Participant; Pathogenesis; Patient Self-Report; Patients; Peak Expiratory Flow; Pharmaceutical Preparations; Pilot Projects; Play; Population; Process; Psychological Factors; Psychological Stress; Psychosocial Factor; Public Health; Publishing; Pulmonary Function Test/Forced Expiratory Volume 1; Quality of life; Randomized Controlled Clinical Trials; Regulation; Relaxation; Reporting; Respiratory physiology; Role; Sample Size; Sampling; Schools; Score; Serum; Severities; Shipping; Ships; Spirometry; Staging; State Interests; Stress; Suggestion; Symptoms; T-Lymphocyte; Time; United States; Upper arm; Variant; Week; Work; base; biological adaptation to stress; body-mind; clinically relevant; cost; cytokine; design; follow-up; improved; mindfulness-based stress reduction; peripheral blood; programs; psychologic; response; sound; transcription factor

DESCRIPTION (provided by applicant): Asthma affects about 7% or roughly 14 million adults in the United States and costs an estimated 7.9 billion dollars in medical care, and 5.3 billion dollars in lost work or school. Although approximately 40% of asthmatics report using some form of complementary and alternative medicine (CAM) to help alleviate their symptoms, there is little evidence for the effectiveness of CAM for asthma. There is considerable epidemiological and experimental evidence that psychological factors, including stress, play a role in asthma morbidity, and has led to the suggestion that behavioral programs known to reduce stress may affect asthma symptoms and their management. A small preliminary study by our group found improvements in asthma- related quality of life, locus of control, stress, and anxiety immediately following the completion of a Mindfulness-Based Stress Reduction (MBSR) program, and we have now been funded for a two-year randomized trial of MBSR for lung function and the behavioral and psychological aspects of asthma. This trial is presently in the planning stages. Eighty-two adults with a diagnosis of mild or moderate asthma will participate in either MBSR, or a Healthy Living Course attention control condition. Most of the immunological, endocrine and neuronal mediators and moderators of the stress response also play important roles in the initiation and perpetuation of the symptoms associated with asthma, but there has been only one small behavioral study of asthma-related immune markers. Given NCCAM's recently stated interest in supporting studies of immune mechanisms, we are submitting this competitive supplement in order to take advantage of the valuable scientific opportunity provided by the parent study to investigate immune markers as well as clinically-relevant biomarkers. Asthma is an immunoregulatory disease and there is evidence that a change in Th1 - Th2 cytokine balance toward a Th2 environment may play an important role in its pathogenesis. The aims of this application are to investigate possible biological mediators of any observed differences in lung function (two-week average morning peak expiratory flow) in subjects participating in the two arms, by evaluating changes in Th1 - Th2 cytokine balance and levels of circulating regulatory Tcells, over a 12-month period. We will also evaluate changes in serum IgE, a marker of clinical relevance in asthma. Also, the sample size is sufficient for exploratory analyses for possible psychological mediators/moderators by examining associations between any changes in immunological markers, clinical symptoms and psychosocial variables. Blood will be collected from each of the participants at each of the four assessment points: study entry (baseline), 10-week (post-intervention), 6- and 12-month follow-up. Supplemental funds will be applied to the institutional and subject-related expenses in obtaining and shipping the blood samples, the immunological assays by flow cytometry, and the entering, management and analysis of the data obtained. Public Health Relevance: Although approximately 40% of asthmatics report using some form of complementary and alternative medicine (CAM) to help alleviate their symptoms, and studies show that relaxation improves their respiratory function, there is no evidence to show that there are accompanying changes in their immune systems. The presence of such changes would indicate the level that these CAM programs operate at in the body and the mind. This study will examine whether there are immune system changes associated with any improvements in patients' lung function and their self-reports of asthma symptoms as a result of participating in a well-known stress reduction program. This information is important for people to know so that they can make sound decisions about whether programs such as this one are right for their circumstances.

描述（由申请人提供）：哮喘在美国影响约7％或大约1400万成年人，估计费用为79亿美元的医疗服务，损失的工作或学校损失了53亿美元。尽管大约40％的哮喘患者使用某种形式的互补和替代药物（CAM）报告来缓解症状，但几乎没有证据表明CAM对哮喘的有效性。有相当大的流行病学和实验证据表明，包括压力在内的心理因素在哮喘发病率中发挥作用，并提出了这样的建议，即已知减轻压力的行为计划可能会影响哮喘症状及其管理。我们小组的一项小型初步研究发现，在完成基于正念的压力（MBSR）计划后，立即在哮喘相关的生活质量，控制，压力和焦虑症的基因范围内有所改善，现在我们已经为MBSR的两年随机试验提供了资金，用于MBSR的肺功能以及肺部的行为和心理方面的肺部功能和心理方面。该试验目前处于计划阶段。诊断为轻度或中度哮喘的82名成年人将参与MBSR或健康的生活课程注意力控制条件。 压力反应的大多数免疫学，内分泌和神经元介质以及主持人在与哮喘相关的症状的启动和延续中也起着重要作用，但对哮喘相关的免疫标记物的行为研究只有一项小型行为研究。鉴于NCCAM最近对支持免疫机制的研究的兴趣，我们正在提交这种竞争性补充剂，以利用父母研究提供的宝贵科学机会来研究免疫标记物以及临床上与临床相关的生物标志物。哮喘是一种免疫调节性疾病，有证据表明，Th1 -Th2细胞因子对Th2环境的平衡发生变化可能在其发病机理中起重要作用。该应用的目的是通过评估参与两个ARM的受试者的肺功能差异（为期两周的平均早晨峰值流量）的可能生物学介体，通过评估在12个月内的TH1-TH2细胞因子平衡和循环调节性TCELL循环调节性TCELL的水平的变化。我们还将评估血清IgE的变化，这是哮喘临床相关性的标志。此外，通过检查免疫学标记，临床症状和心理社会变量的任何变化之间的关联，样本量足以进行可能的心理介体/主持人的探索性分析。从四个评估点的每个参与者中收集血液：研究条目（基线），10周（干预后），6个月和12个月的随访。补充资金将用于获取和运送血液样本，流式细胞仪的免疫学测定以及输入，管理和分析所获得的数据的机构和受试者相关费用。 公共卫生相关性：尽管大约40％的哮喘患者报告使用某种形式的补充和替代药物（CAM）来帮助缓解症状，研究表明，放松改善了他们的呼吸功能，但没有证据表明其免疫系统随附发生变化。这种变化的存在将表明这些CAM程序在身体和思想中的水平。这项研究将研究是否存在与患者肺功能的任何改善有关的免疫系统变化及其对哮喘症状的自我报告，这是由于参与众所周知的减轻压力计划而导致的。这些信息对人们知道很重要，以便他们可以就此类程序是否适合其情况做出明智的决定。