The effects of expressive writing on lung function, quality of life, medication use, and symptoms in adults with asthma: a randomized controlled trial.
OBJECTIVE
Asthma is a chronic condition affecting 300 million people worldwide. Management involves adherence to pharmacological treatments such as corticosteroids and β-agonists, but residual symptoms persist. As asthma symptoms are exacerbated by stress, one possible adjunct to pharmacological treatment is expressive writing (EW). EW involves the disclosure of traumatic experiences which is thought to facilitate cognitive and emotional processing, helping to reduce physiological stress associated with inhibiting emotions. A previous trial reported short-term improvements in lung function. This study aimed to assess whether EW can improve lung function, quality of life, symptoms, and medication use in patients with asthma.


METHODS
Adults (18-45 years) diagnosed as having asthma requiring regular inhaled corticosteroids were recruited from 28 general practices in South East England (n = 146). In this double-blind randomized controlled trial, participants were allocated either EW or nonemotional writing instructions and asked to write for 20 minutes for 3 consecutive days. Lung function (forced expired volume in 1 second [FEV1]% predicted), quality of life (Mark's Asthma Quality of Life Questionnaire), asthma symptoms (Wasserfallen Symptom Score Questionnaire), and medication use (inhaled corticosteroids and β-agonist) were recorded at baseline, 1, 3, 6, and 12 months.


RESULTS
Hierarchical linear modeling indicated no significant main effects between time and condition on any outcomes. Post hoc analyses revealed that EW improved lung function by 14% for 12 months for participants with less than 80% FEV1% predicted at baseline (β = 0.93, p = .002) whereas no improvement was observed in the control condition (β = 0.10, p = .667).


CONCLUSIONS
EW seems to be beneficial for patients with moderate asthma (<80% FEV1% predicted). Future studies of EW require stratification of patients by asthma severity.


BACKGROUND
ISRCTN82986307.
From the Division of Public Health & Primary Care (Smith, Jones), Brighton & Sussex Medical School, Brighton, United Kingdom; Real-World Evidence Solutions (Hankins), IMS Health, London, United Kingdom; School of Psychology (Field), University of Sussex, Brighton, United Kingdom; National Institute for Stroke and Applied Neurosciences (Theadom), Auckland University of Technology, Auckland, New Zealand; Mill View Hospital (Bowskill), Sussex Partnership Trust, East Sussex, United Kingdom; Department of Practice & Policy (Horne), School of Pharmacy, University of London, Centre for Behavioural Medicine, London, United Kingdom; and Department of Respiratory Medicine (Frew), Royal Sussex County Hospital, Brighton & Sussex University Hospitals Trust, Brighton, United Kingdom.
Helen E
HE
Smith
Christina J
CJ
Jones
Matthew
M
Hankins
Andy
A
Field
Alice
A
Theadom
Richard
R
Bowskill
Rob
R
Horne
Anthony J
AJ
Frew
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000328:Adult; D001249:Asthma / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D004311:Double-Blind Method; D019260:Expressed Emotion / Q000502:physiology; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life; D016896:Treatment Outcome; D014956:Writing; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists