July, 2006

Prevalence and Costs
Asthma is a large, growing, and expensive health problem in all industrialized countries (American Lung Assn.). As of 2003, 20.7 million American adults and 9.1 million children were affected by asthma, a condition that generates 12.9 million office visits annually (CDC). In 2002, asthma was responsible for 4261 deaths and 1.7 emergency room visits in this country (CDC).

According to the Labor Occupational Safety & Health Administration, 15% of disabling asthma cases are work related. Occupational asthma is the most common type of occupational lung disease in the industrialized nations (Rabatin, 2001).

Workers with asthma are twice as likely to retire early; they have higher rates of absenteeism, and they rate their ability to work and their general health as poorer than non-asthmatic workers (Sauni, Oksa et al, 2001). Baking, electronics, chemical and metal manufacturing, paints and plastics, farming, and house cleaning are the highest risk occupations (Rabatin; Sauni, 2001).

What is Asthma?
Asthma is thought to result from genetic sensitivity, environmental exposure to irritants and stress responses that lead to a cycle of “hyper-responsiveness” and inflammation in the bronchi. This inflammation, along with excess mucus production, can close airways and make breathing out difficult. Once established, this cycle is difficult to stop.

Medical Treatment of Asthma
Standard medical treatment includes daily use of an inhaled steroid medication, as-needed use of a bronchodilator (or “rescue medication”), and avoidance of environmental asthma “triggers.” (Oral medications are sometimes needed as well.) The biggest problem in asthma care is noncompliance, particularly with the steroid inhalers. Seventy percent of patients in some studies (Rand & Wise, 1994) either failed to take prescribed daily inhalers, or never filled the prescriptions (Piecoro, Potoski et al, 2001)

Non-Pharmacologic Treatment Including Imagery
According to researchers Bloomberg and Chen (2005) at St. Louis Children's Hospital, "The mind-body paradigm that links psychologic stress to disease is necessary when considering the global evaluation of childhood asthma." The mind-body connection is important in adult asthma, as well.

Behavioral and mind/body approaches are also used to control inflammation and spasm. Guided imagery was able to increase oxygenation in COPD patients (Louie, 2004). In two British studies, hypnosis reduced hyper-responsiveness, and increased forced expiratory volume through one year of follow up in adult patients who were easily hypnotized (Ewer & Stewart, 1986).

In a group of 250 patients who had not been tested for susceptibility, 59% of those receiving hypnotic suggestion were rated as “much better,” compared with 40% of a group who received relaxation training without hypnotic suggestions (Maher-Loughna, Macdonald et al, 1962).

Guided imagery uses deep relaxation and positive suggestion in ways nearly identical to hypnosis. The terms “self-hypnosis” or “auto-hypnosis” are used almost interchangeably with “guided imagery” in the literature (Olness, 1981).

A meta-analysis by Hackman, Stern, and Gershwin showed that, though larger, more randomized studies were needed, hypnosis has shown definite, long-term effectiveness in asthma, and that effectiveness is enhanced by the use of self-hypnosis. In one study, 303 pediatric asthmatics were offered hypnosis; some patient’s symptoms resolved after one session, and there was measurable improvement in 80% of those participating. No patients’ symptoms worsened (Anbar, 2002).

In another study of self-hypnosis with children, the researcher followed participants for a mean of nine months post-hypnosis. Positive results were recorded in 13 patients. Two of the children had no more symptoms and were able to discontinue their medication (Anbar, 2001). Hypnosis, combined with an education program, improved pediatric cooperation and compliance with taking peak flow measurements (Lehrer, Feldman et al, 2002).

In another study, adult asthmatics who listened to imagery tapes were less depressed an anxious, and were able to use less medication (Report, 1997). Asthma education programs that instruct patients about asthma, medications, and avoiding triggers, as this program does, help to reduce asthma morbidity.

According to a 2005 Mayo Clinic review of the hypnosis literature (Stewart, 2005), no fewer than five studies showed positive results for asthma patients using hypnosis; results included a large multicenter trial, with hypnosis patients reporting a "significant decrease" in failed treatments and an even larger number deemed "much improved" (Hypnosis for asthma, 1968).

In another study, 54% of hypnosis patients had "excellent" results, and 21% became asymptomatic and were able to discontinue medication (Collison, 1975).

In the Freeman and Welton 2005 study, the results were contrary to the researchers' hypothesis when it was shown that biologically targeted imagery was more efficacious than critical thinking asthma management.

Biofeedback was also effective in reducing some asthmatics’ dependence on steroid medication (Lehrer, Vaschillo, et al, 2004).

Team or combination approaches in asthma management can be beneficial, as with Stanford University School of Medicine's multicomponent program (Shames, Sharek et al, 2004).

Remarkable improvement occurred in the Anbar-Hummell (2005) multicomponent approach which incorporates hypnosis; 82% of their patients showed either improvement or resolution of their primary symptoms.

A low-cost imagery intervention may reduce asthmatic patients’ anxiety and use of medical services, and improve their pulmonary function.

Anbar R D. Hypnosis in pediatrics: applications at a pediatric pulmonary center. BMC Pediatr. 2002 Dec 3;2(1):11

Anbar RD. Self-hypnosis for management of chronic dyspnea in pediatric patients. Pediatrics. 2001 Feb;107(2):E21.

Anbar RD, Hummell KE. Teamwork approach to clinical hypnosis at a pediatric pulmonary center. Am J Clin Hypn. 2005 Jul;48(1):45-9.

Bloomberg GR, Chen E. The relationship of psychologic stress with childhood asthma. Immunol Allergy Clin North Am. 2005 Feb;25(1):83-105.

Centers for Disease Control, National Center for Health Statistics. Asthma. Accessed June, 2006.

Collison DR. Which asthmatic patients should be treated by hypnotherapy? Med J Aust. 1975;1:776-781.

Ewer TC, Stewart DE. Improvement in bronchial hyper-responsiveness in patients with moderate asthma after treatment with a hypnotic technique: a randomized controlled trial. British Medical Journal.1986 Nov 1; 293 (6555) 1129-32.

Family Guide to Asthma and Allergies. (1997). American Lung Association Asthma Advisory Group with Norman Edelman, MD. Little, Brown: New York.

Freeman LW, Welton D., Effects of imagery, critical thinking, and asthma education on symptoms and mood state in adult asthma patients: a pilot study. J Altern Complement Med. 2005 Feb;11(1):57-68.

Hackman RM, Stern JS, Gershwin ME. Hypnosis and asthma: a critical review. Journal of Asthma. 2000; Feb 37(1): 1–15.

[no authors listed] Hypnosis for asthma—a controlled trial: a report to the Research Committee of the British Tuberculosis Association. Br Med J. 1968;4:71-76.

Kohen DP. Applying hypnosis in a preschool family asthma education program: uses of storytelling, imagery and relaxation. American Journal of Clinical Hypnosis. 1997; 39 (3): 169-81.

Lehrer P, Feldman J, Giardino N, Song H, Schmaling K. Psychological aspects of asthma. Journal of Consulting and Psychology. 2002 70(3):691-711.

Lehrer PM, Vaschillo E, Vaschillo B, Lu SE, Scardella A, Siddique M, Habib RH. Biofeedback treatment for asthma. Chest. 2004 Aug; 126 (2): pages 352-61.

Lewith GT, Watkins AD. Unconventional therapies in asthma: an overview. Allergy.1996 Nov, 51(11):761-9.

Louie SW. The effects of guided imagery relaxation in people with COPD. Occup Ther Int. 2004 11(3):145-59.

Maher-Loughna GP, Macdonald N, Mason AA, Fry L. Controlled trial of hypnosis in the symptomatic treatment of asthma. British Medical Journal. 1962 (2): 371-76.

Morrison JB. Chronic asthma and improvement with relaxation induced by hypnotherapy. J R Soc Med. 1988;81:701-704.

National Center for Health Statistics. Accessed November, 2005. Accessed June, 2006.

Olness K. Imagery (self-hypnosis) as adjunct therapy in childhood cancer. Am. Journal of Pediatric Hematology/Oncology. 1981 3 (3) 313-320.

Piecoro LT, Potoski M, Talbert JC, Doherty DE. Asthma prevalence, cost, and adherence with expert guidelines on the utilization of healthcare services and costs in a state Medicaid population. Health Services Research. 2001, June; 36(2): 357-71.

Rabatin JT. A guide to the treatment of occupational asthma. Clin Proc (Mayo Clinic). 2001 June 76(6):633-40.

Rand CS, Wise RA. Measuring adherence to asthma medication regimens. Am J Resp Crit Care Med. 1994 149: S69-76.

[no authors listed] Report. Alternative Health practitioner: The Journal of Complementary and Natural Care Fall/Winter, 1997 3 (3).

Sauni R, Oksa P, Vattulainen K, Uitti J, Palmroos P, Roto P. The effects of asthma on the quality of life and employment of construction workers. Occupational Medicine (London), 2001 May 51 (3): 163-7.

Shames RS, Sharek P, Mayer M, Robinson TN, Hoyte EG, Gonzalez-Hensley F, Bergman DA, Umetsu DT. Effectiveness of a multicomponent self-management program in at-risk, school-aged children with asthma. Ann Allergy Asthma Immunol. 2004 Jun;92(6):611-8.

Stewart JH. Hypnosis in contemporary medicine. Mayo Clin Proc. 2005 Apr;80(4):511-24.

United States Department of Labor Department of Labor Occupational Safety & Health Administration. Accessed June, 2006.

Wyler-Harper J, Bircher AJ, Langewitz W, Kiss A. Hypnosis and the allergic response. Schweizerische Medizinische Wochenschrift. Supplementum. 1994, 62:67-76.