Practicing Mindfulness May Help Alleviate Asthma Symptoms, Improve QOL

In a study of adult patients with asthma receiving care at general practitioner practices in the United Kingdom, improvements were seen by the 3-month mark in both symptoms of the chronic condition and the patients’ quality of life (QOL) following use of the mindfulness app Headspace.

This and other findings appear in a new study published recently in Journal of Behavioral Medicine.

“Asthma is a multifaceted chronic disease,” the study authors wrote. “Increasingly, the role of psychological comorbidity including anxiety, depression, and panic has become apparent. Anxiety and depression-related psychological dysfunction are up to 6 times more common in people with an asthma diagnosis.”

They highlighted the importance of multifaceted treatment strategies that include a psychological component to promote overall patient well-being, because patients can sometimes use avoidant coping strategies or maladaptive behaviors that decrease their overall QOL. However, because mindfulness-based interventions (MBIs) can have a significant time burden and cost, digital options may be a suitable alternative.

Of the 158-patient study cohort—recruited from July 2017 through April 2018 and randomized 2:1 to Headspace app access (intervention cohort; n = 93) or no access (control cohort; n = 51)—73% completed follow-up questionnaires on asthma symptom control (Asthma Control Questionnaire [ACQ]; lower score = better control), asthma-related QOL (Mini-Asthma Quality of Life Questionnaire [AQLQ]; higher score = more anxiety), and anxiety and depression (Hospital Anxiety and Depression Scale [HADS]; higher score = greater impairment) at baseline, 6 weeks, and 3 months.

Questionnaires were also administered to gauge mindfulness (Philadelphia Mindfulness Scale [PHLMS]; higher score = more mindfulness) and asthma medication adherence (Medical Adherence Report Scale; higher score = better adherence).

Headspace was accessed for 2277 individual sessions by 70% of the intervention group, with individual overall access ranging from 0 to 192 times, or a median (interquartile range) of 9 (0-38.5) sessions, for averages of 7.2 minutes per session and 51 days between the first and last sessions.

At baseline, the intervention group had lower levels of anxiety via the AQLQ vs the control group (mean [SD] score, 5.32 [1.1] vs 5.64 [1.0]), slightly worse asthma control via the ACQ (1.18 [0.9] vs 1.06 [0.8]), higher HADS levels of anxiety (8.24 [4.3] vs 6.76 [4.1]) and depression (4.72 [3.9] vs 3.65 [3.1]), and greater mindfulness awareness (31.3 [7.7] vs 29.6 [8.1]) and acceptance (35.1 [6.8] vs 33.9 [5.7]) via PHLMS.

Medication adherence was close to equal in the intervention and control groups, at 37.9 (8.5) and 38.1 (8.4), respectively.

For the AQLQ, between-group differences were not deemed statistically significant at 6 weeks and 3 months, overall and for subscale measures of symptoms, emotions, environment, and activities. However, a within-group analysis did indicate significantly improved scores for the intervention group from baseline to both time points. For the ACQ, at 6 weeks and 3 months, significant improvements again were not seen between the groups, but a within-group analysis did show superior asthma control at 6 weeks for the intervention group.

In addition, significantly lower depression scores on HADS were seen at both 6 weeks and 3 months among the intervention group compared with the control group, but there were no differences in mindfulness awareness/acceptance or medication adherence via PHLMS. Results differed following a within-group analysis. In the intervention group, depression and mindful awareness scores improved at 6 weeks and 3 months, but anxiety, mindfulness acceptance, and medication adherence scores did not. The control group’s depression and anxiety scores, meanwhile, had worsened by the 6-week mark and their mindfulness awareness scores were significantly lower by 3 months; marked changes were not seen in the other measures.

“This pragmatic, randomized feasibility trial shows that the digital mindfulness intervention ‘Headspace’ is relevant and acceptable to at least a proportion of people with asthma, with the potential to benefit patients,” the authors concluded.

Still, they recommend that their findings should be confirmed with a randomized, controlled trial due to limitations that include possible impaired QOL at baseline for the intervention group and lack of long-term evidence on the intervention’s benefits.

Reference

Ainsworth B, Stanescu S, Stuart B, et al. A feasibility trial of a digital mindfulness-based intervention to improve asthma-related quality of life for primary care patients with asthma. J Behav Med. Published online August 27, 2021. doi:10.1007/s10865-021-00249-3