The role of psychological factors in the management of severe asthma in adult patients
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Pneumonology Department, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
Thomai Prapa   

Pneumonology University Clinic, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Greece
Pneumon 2017;30(4):236–242
Asthma is a long-lasting and life threatening condition. Patients with asthma often have unpleasant subjective complaints regarding their respiratory symptoms. Many studies highlight the association between psychosocial factors and asthma. Asthmatic patients have higher prevalence of anxiety and depressive disorders. Focusing on physiological and psychological elements is important for treatment. Management strategies combining pharmacologic with non-pharmacologic treatment are more effective in controlling asthma. Psychotherapeutic interventions aim to reduce patients’ complaints, improve quality of life and disease self-management. Various psychotherapeutic approaches/techniques have been studied; Cognitive Behavioral and Analytic Therapy, Psychodynamic psychotherapies, Counseling, psycho-educational interventions, self-management education, relaxation, music therapies, hypnosis, biofeedback. Meta-analytic studies show that psychotherapy works. Following this, many studies tried to specify if psychotherapy is effective specifically for patients with moderate to severe asthma. Results show that psychological interventions have a positive supplementary impact on patients’ traditional medical treatment. Variables examined are health-care services utilization, asthma symptoms, lung function, medication use, absence from work, quality of life, coping skills, self efficacy, locus of control, anxiety, depression. Future research should focus on high-quality, well-conducted and reported randomized trials. Research on psychological interventions in asthmatic patients provide the health care professionals with accurate information about the appropriate psychotherapeutic technique and the frequency of intervention needed for each patient. Asthma morbidity and mortality are still increasing and severe asthma accounts for half of the health service costs related to asthma. Therefore, it is urgent for patients, health-care services and professionals to manage and reduce asthmatic patients’ symptoms and, by extension, hospital visits and admissions.
Global Initiative for Asthma, Global strategy for asthma management and prevention 2017. Available from: Accessed August 31, 2017.
Lesova I, Susa Z. Possibilities of psychotherapy in the comprehensive treatment of bronchial asthma. Cas Lek Cesk 1991; 130:463-5.
Duff AJ. Psychological interventions in cystic fibrosis and asthma. Paediatr Respir Rev 2001; 2:350-7.
Yorke J, Fleming LS, Shuldham C. Psychological interventions for adults with asthma: A systematic review. Respiratory Medicine 2007; 101:1-14.
Sarver N, Murphy K. Management of asthma: new approaches to establishing control. J Am Acad Nurse Pract 2009; 21:54-65.
Diamantidou K. The role of psychological factors in bronchial asthma. Info Respiratory & Internal Medicine, 2002 Apr-Jun; 22., (in Greek). Accessed August 31, 2017.
Kew KM, Nashed M, Dulay V, et al. Cognitive behavioural therapy (CBT) for adults and adolescents with asthma. Cochrane Database Syst Rev 2016; 9:CD011818.
Lehrer PM, Isenberg JS, Hochron SM. Asthma and emotion: A review. J Asthma 1993; 30:5-21.
Corecnzy HJ, Brantley PJ, Buss RR, et al. Daily stress and anxiety and their relation to daily fluctuations of symptoms in asthma and chronic obstructive pulmonary disease (COPD) patients. J Psychopathol Behav Assess 1988; 10:259-67.
Heaney LG, Conway E, Kelly C, et al. Prevalence of psychiatric morbidity in a difficult asthma population: Relationship to asthma outcome. Respiratory Medicine 2005; 99:1152-9.
Van Lieshout RJ, MacQueen G. Psychological factors in asthma. Allergy Asthma Clin Immunol 2008; 4:12-28.
Put C, Van den Bergh O, Lemaigre V, et al. Evaluation of an individualised asthma programme directed at behavioral change. Eur Respir J 2003; 21:109-15.
Ross CJ, Davis TM, MacDonald GF. Cognitive-behavioral treatment combined with asthma education for adults with asthma and coexisting panic disorder. Clin Nurs Res 2005; 14:131-57.
Smith HE, Jones CJ. Psychological interventions in Asthma. Curr Treat Options Allergy 2015; 2:155-68.
Smith JR, Mildenhall S, Noble MJ, et al. The Coping with Asthma Study: a randomised controlled trial of a home based, nurse led psychoeducational intervention for adults at risk of adverse asthma outcomes. Thorax 2005; 60:1003-11.
Smith JR, Mugford M, Holland R, et al. Psycho-educational interventions for adults with severe or difficult asthma: a systematic review. J Asthma 2007; 44:219-41.
Gibson PG, Powell H, Wilson A, et al. Self-management education and regular practitioner review for adults with asthma. Cochrane Database of Systematic Reviews 2002; DOI: 10.1002/14651858. CD001117.
Erskine J, Schonell M. Relaxation therapy in bronchial asthma. J Psychosom Res 1979; 23:131-9.
Lehrer PM, Hochron SM, Mayne T, et al. Relaxation and music therapies for asthma among patients prestabilized on asthma medication. J Behav Med 1994; 17:1-24.
Ewer TC, Stewart DE. Improvement in bronchial hyper-responsiveness in patients with moderate asthma after treatment with a hypnotic technique: a randomised controlled trial. BMJ 1986; 293:1129-32.
Lehrer PM, Vaschillo E, Vaschillo B, et al. Biofeedback treatment for asthma. Chest 2004; 126:352-61.
Walsh S, Hagan T, Gamsu D. Rescuer and rescued: Applying a cognitive analytic perspective to explore the ‘mis-management’ of asthma. Br J Med Psychol 2000; 73:151-68.
Creer TL. Behavioral and cognitive processes in the self-management of asthma. J Asthma 2008; 45:81-94.
Sommaruga M, Spanevello A, Migliori GB, et al. The effects of a cognitive behavioural intervention in asthmatic patients. Mondali Arch Chest Dis 1995; 50:398-402.
Parry GD, Cooper CL, Moore JM, et al. Cognitive behavioural intervention for adults with anxiety complications of asthma: prospective randomized trial. Respir Med 2012; 106:802-10.
Gibson PG, Coughlan J, Abramson M. Self-management education for adults with asthma improves health outcomes. West J Med 1999; 170:299.
Nickel C, Lahmann C, Muehlbacher M, et al. Pregnant women with bronchial asthma benefit from progressive muscle relaxation: a randomized, prospective, controlled trial. Psychother Psychosom 2006; 75:237-43.
Smith JR, Mugford M, Holland R, et al. A systematic review to examine the impact of psycho-educational interventions on health outcomes and costs in adults and children with difficult asthma. NIHR Health Technology Assessment programme: Executive summaries. Published: 2005.
Hockemeyer J, Smyth J. Evaluating the feasibility and efficacy of a self administered manual-based stress management intervention for individuals with asthma: results from a controlled study. Behav Med 2002; 27:161-72.
Epstein GN, Halper JP, Barret EA, et al. A pilot study of mind-body changes in adults with asthma who practice mental imagery. Altern Ther Health Med 2004; 10:66-71.
Wagaman MJ. Psysiological and psychological effects of various hypnotic suggestions with asthma patients. Diss Abstr Int B Sci Eng 2000; 61:185.
Aalto AM, Harkapaa K, Aro AR, et al. Ways of coping with asthma in everyday life: validation of the Asthma Specific Coping Scale. J Psychosom Res 2002; 53:1061-9.
European Respiratory Society, International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma 2014. Available from: Accessed August 31, 2017.
British Thoracic Society, SIGN 153, British guideline on the management of asthma 2016. Available from: Accessed August 31, 2017.
Khateeb Z. Effectiveness of psychotherapy in asthma; metaanalysis. Acta Psychiatr Belg 1995; 95:25-43.
Schmaling KB, Afari N, Blume AW. Assessment of psychological factors associated with adherence to medication regimens among adult patients with asthma. J Asthma 2000; 37(4): 335-43.
Calvert R, Kellett S. Cognitive analytic therapy: a review of the outcome evidence base for treatment. Psychol Psychother 2014; 87:253-77.