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.

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