Alternative modalities for asthma that reduce stress and modify mood states: evidence for underlying psychobiologic mechanisms.
OBJECTIVE
To review the evidence supporting a role for psychological interventions in the treatment of asthma, with particular emphasis on underlying psychobiological mechanisms.


METHODS
Independent literature searches on MEDLINE, PREMEDLINE, Cochrane Library, and PSYCHINFO from their respective inception to 2003 were performed. Separate searches were performed for psychological stress and asthma, psychoneuroimmunology and asthma, stress management, relaxation, asthma, complementary and alternative medicine and asthma, and immune function and psychological intervention. The search was not limited based on language of publication.


METHODS
Supportive evidence from overlapping research was included based on the expert opinion of the author and through discussions with consultants in the field.


RESULTS
This review first discusses human and animal studies focused on psychological stress and the effects of stress on the neuroendocrine and immune system, emphasizing the implication of these effects on asthma. Second, studies that evaluated the influence of stress reduction modalities on neuroendocrine and immune function were examined. Existing evidence from human clinical studies that explored the role of psychological interventions for asthma is reexamined in this context.


CONCLUSIONS
A growing appreciation of the interactions among behavioral, neural, endocrine, and immune processes suggests possible mechanisms through which psychological interventions for asthma may be operating. This review provides a framework in which we can begin to see links among these systems that might provide new insights to guide future explorations.
Wright
Rosalind J
RJ
Department of Medicine, Brigham and Women's Hospital, and the Pulmonary/Critical Care Division, Boston's Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115, USA. rosalind.wright@channing.harvard.edu
D000818:Animals; D001249:Asthma / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D001342:Autonomic Nervous System Diseases / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D000529:Complementary Therapies; D016208:Databases, Factual; D006801:Humans; D007107:Immune System / Q000276:immunology / Q000503:physiopathology; D011598:Psychoneuroimmunology; D013315:Stress, Psychological / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*