Asthma

J R Soc Med. 1988 Dec;81(12):701-4.
Comment in: " J R Soc Med. 1989 Jul;82(7):446. Chronic asthma and improvement with relaxation induced by hypnotherapy.
Morrison JB.
Southport General Infirmary, Merseyside.

Sixteen chronic asthmatic patients inadequately controlled by drugs had, after one year of hypnotherapy, a fall in admissions from 44 in the year before starting therapy to 13 in the year after. Duration of stay was reduced for 13 patients by 249 days; prednisolone was withdrawn in 6, reduced in 8 and increased in none. Side effects of drugs were reduced. Although 62% reported improvement on a visual analogue scale, observations of air flow gave variable results.

BMC Pediatr. 2002 Dec 3;2:11. Epub 2002 Dec 3.
Hypnosis in pediatrics: applications at a pediatric pulmonary center.
Anbar RD. Department of Pediatrics, Upstate Medical University, 750 E, Adams Street, Syracuse, NY 13210, USA. Anbarr@mail.upstate.edu

BACKGROUND: This report describes the utility of hypnosis for patients who presented to a Pediatric Pulmonary Center over a 30 month period. METHODS: Hypnotherapy was offered to 303 patients from May 1, 1998 - October 31, 2000. Patients offered hypnotherapy included those thought to have pulmonary symptoms due to psychological issues, discomfort due to medications, or fear of procedures. Improvement in symptoms following hypnosis was observed by the pulmonologist for most patients with habit cough and conversion reaction. Improvement of other conditions for which hypnosis was used was gauged based on patients' subjective evaluations. RESULTS: Hypnotherapy was associated with improvement in 80% of patients with persistent asthma, chest pain/pressure, habit cough, hyperventilation, shortness of breath, sighing, and vocal cord dysfunction. When improvement was reported, in some cases symptoms resolved immediately after hypnotherapy was first employed. For the others improvement was achieved after hypnosis was used for a few weeks. No patients' symptoms worsened and no new symptoms emerged following hypnotherapy. CONCLUSIONS: Patients described in this report were unlikely to have achieved rapid improvement in their symptoms without the use of hypnotherapy. Therefore, hypnotherapy can be an important complementary therapy for patients in a pediatric practice.

J Asthma. 2000 Feb;37(1):1-15.
Hypnosis and asthma: a critical review.
Hackman RM, Stern JS, Gershwin ME.
University of California, Davis 95616, USA.

Asthma is among the most common chronic diseases of the western world and has significant effects on patients' health and quality of life. Asthma is typically treated with pharmaceutical products, but there is interest in finding nonpharmaceutical therapies for this condition. Hypnosis has been used clinically to treat a variety of disorders that are refractive to pharmaceutical-based therapies, including asthma, but relatively little attention has been given recently to the use of clinical hypnosis as a standard treatment for asthma. Significant data suggest that hypnosis may be an effective treatment for asthma, but it is premature to conclude that hypnosis is unequivocally effective. Studies conducted to date have consistently demonstrated an effect of hypnosis with asthma. More and larger randomized, controlled studies are needed. Existing data suggest that hypnosis efficacy is enhanced in subjects who are susceptible to the treatment modality, with experienced investigators, when administered over several sessions, and when reinforced by patient autohypnosis. Children in particular appear to respond well to hypnosis as a tool for improving asthma symptoms.

Am J Clin Hypn. 2005 Oct-2006 Jan;48(2-3):199-211.
Comment in: Am J Clin Hypn. 2006 Apr;48(4):245-6; author reply 246.
Helping children with asthma by repairing maternal-infant bonding problems.
Madrid A. madrid@sonic.net

Studies about the psychology of childhood asthma have revealed that parenting difficulties are related to the development of asthma in some children. Disruptions in maternal-infant bonding are highly correlated with pediatric asthma and are presented as a cause for these parenting problems. Bonding problems are known to be caused most often by physical separation at birth or by some recent trauma in the mother's life. By using hypnosis to remove the pain of the separation or trauma in the mother, and by creating a new birth history in her imagination, some children's asthmatic symptoms have been shown to remit or greatly improve. The hypnotic method for this treatment is described.

BMC Pediatr. 2003 Jul 22;3:7. Epub 2003 Jul 22.
Self-hypnosis for anxiety associated with severe asthma: a case report.
Anbar RD. Anbarr@mail.upstate.edu
Department of Pediatrics, State University of New York Upstate Medical University, Syracuse, NY 13210, United States.

BACKGROUND: Management of asthma can be complicated by both medical and psychiatric conditions, such as gastroesophageal reflux, chronic sinusitis, and anxiety. When symptoms of asthma are interpreted without regard to such conditions treatment may yield a suboptimal outcome. For example, anxiety-associated dyspnea, tachypnea, and chest tightness can be mistakenly interpreted as resulting from an exacerbation of asthma. Medical treatment directed only for asthma may thus lead to overuse of asthma medications and increased hospitalizations. CASE PRESENTATION: The described case illustrates how a systemic steroid-dependent patient with asthma benefited from receiving care from a pediatric pulmonologist who also was well versed in the diagnosis and treatment of anxiety. By using self-hypnosis, the patient was able to reduce her dependence on bronchodilators. Following modification of her medical therapy under supervision of the pulmonologist, and regular use of hypnosis, the patient ultimately was weaned off her systemic steroid therapy. CONCLUSIONS: This report emphasizes that anxiety must be considered as a comorbid condition in the treatment of asthma. Self-hypnosis can be a useful skill in the treatment of a patient with anxiety and asthma.

Ann Allergy. 1975 Jun;34(6):356-62.
Hypnotherapy in the treatment of bronchial asthma.
Aronoff GM, Aronoff S, Peck LW.

The efficacy of hypnotherapy in aborting acute asthmatic attacks was studied in 17 children ranging in age from six to 17. All had as their primary diagnosis bronchial asthma. Prior to hypnotic induction pulmonary function was assessed, then monitored in the immediate post hypnotic period and at two intervals thereafter. The average improvement for all subjects was greater than 50% above the baseline measurement as documented by spirometry, monitored dyspnea, wheezing and subjective ratings by the subjects. It is suggested that hypnotherapy may be an important tool in ameliorating asthma, improving ventilatory capacity and promoting relaxation without recourse to pharmacologic agents. One explanation offered is that hypnosis affects an automic response, thereby diminishing bronchospasm.

J Consult Clin Psychol. 2002 Jun;70(3):691-711.
Psychological aspects of asthma.
Lehrer P, Feldman J, Giardino N, Song HS, Schmaling K. lehrer@umdnj.edu
Department of Psychiatry, Robert Wood Johnson Medical School, Piscataway, New Jersey 08854, USA.

Asthma can be affected by stress, anxiety, sadness, and suggestion, as well as by environmental irritants or allergens, exercise, and infection. It also is associated with an elevated prevalence of anxiety and depressive disorders. Asthma and these psychological states and traits may mutually potentiate each other through direct psychophysiological mediation, nonadherence to medical regimen, exposure to asthma triggers, and inaccuracy of asthma symptom perception. Defensiveness is associated with inaccurate perception of airway resistance and stress-related bronchoconstriction. Asthma education programs that teach about the nature of the disease, medications, and trigger avoidance tend to reduce asthma morbidity. Other promising psychological interventions as adjuncts to medical treatment include training in symptom perception, stress management, hypnosis, yoga, and several biofeedback procedures.

Br Med J (Clin Res Ed). 1986 Nov 1;293(6555):1129-32.
Improvement in bronchial hyper-responsiveness in patients with moderate asthma after treatment with a hypnotic technique: a randomised controlled trial.
Ewer TC, Stewart DE.

A prospective, randomised, single blind, and controlled trial of a hypnotic technique was undertaken in 39 adults with mild to moderate asthma graded for low and high susceptibility to hypnosis. After a six week course of hypnotherapy 12 patients with a high susceptibility score showed a 74.9% improvement (p less than 0.01) in the degree of bronchial hyper-responsiveness to a standardised methacholine challenge test. Daily home recordings of symptoms improved by 41% (p less than 0.01), peak expiratory flow rates improved by 5.5% (p less than 0.01), and use of bronchodilators decreased by 26.2% (p less than 0.05). The improvement in bronchial hyper-reactivity occurred without a change in subjective appreciation of the degree of bronchoconstriction. A control group 17 patients and 10 patients undergoing treatment with low susceptibility to hypnosis had no change in either bronchial hyper-responsiveness or any of the symptoms recorded at home. This study shows the efficacy of a hypnotic technique in adult asthmatics who are moderately to highly susceptible to hypnosis.

Am Rev Respir Dis. 1982 Apr;125(4):392-5.
Hypnosis for exercise-induced asthma.
Ben-Zvi Z, Spohn WA, Young SH, Kattan M.

Hypnosis has been used for many years in the treatment of asthma, but studies of its usefulness have been controversial. We assessed the efficacy of hypnosis in attenuating exercise-induced asthma (EIA) in 10 stable asthmatics. The subjects ran on a treadmill while mouth breathing for 6 min on 5 different days. Pulmonary mechanics were measured before and after each challenge. Two control exercise challenges resulted in a reproducible decrease in forced expiratory volume in one second (FEV1). On 2 other days, saline or cromolyn by nebulization was given in a double-blind manner with the suggestion that these agents would prevent EIA. Hypnosis prior to exercise resulted in a 15.9% decrease in FEV1 compared with a 31.8% decrease on the control days (p less than 0.001). Pretreatment with cromolyn resulted in a 7.6% decrease in FEV1. We conclude that hypnosis can alter the magnitude of a pathophysiologic process, namely, the bronchospasm after exercise in patients with asthma.

Med J Aust. 1975 Jun 21;1(25):776-81.
Which asthmatic patients should be treated by hypnotherapy?
Collison DR.

Certain patients with bronchial asthma can benefit, often greatly, from hypnotherapy. This report is based on a retrospective analysis of 121 asthmatic patients who were treated by hypnotherapy. Hypnotic techniques and treatment procedure are described. Of the total number, 21% had an excellent response to treatment, becoming completely free from asthma and requiring no drug therapy. A further 33% had a good response, with worthwhile decrease in frequency and severity of the attacks of asthma, or a decrease in drug requirements. About half of the 46% who had a poor response had a marked subjective improvement in general well-being. Statistical evaluation of the six variables (age, sex, result, trance depth, psychological factors and severity of the asthma) confirmed the clinical impression that the ability to go into a deep trance (closely associated with the youthfulness of the subject) gives the best possibility of improvement, especially if there are significant aetiological psychological factors present and the asthma is not severe. Subjective improvement in well-being and outlook is a potential outcome at all age levels, independent of severity of the illness or entranceability of the patient.

Schweiz Med Wochenschr Suppl. 1994;62:67-76.
Hypnosis and the allergic response.
Wyler-Harper J, Bircher AJ, Langewitz W, Kiss A.
Dermatologische Universitatsklinik, Kantonsspital Basel.

In recent years our knowledge of the immune system and the pathogenesis of immune disorders has increased. There has been much research on the complex connections between the psyche, the central nervous system and the immune system and the effect of mood on disease processes. This paper reviews the evidence on the effects of hypnosis on the allergic skin test reaction, on allergies, particularly respiratory allergies and hayfever, and on bronchial hyperreactivity and asthma. Hypnosis, which is generally regarded as an altered state of consciousness associated with concentration, relaxation and imagination, and amongst other characteristics an enhanced responsiveness to suggestion, has long been thought to be effective in the amelioration of various bodily disorders. It has seemed that the state of hypnosis is capable of a bridging or mediating function in the supposed dualism between mind and body. There has been great variation in the experimental and clinical procedures such as type of hypnotic intervention employed, the training of subjects and the timing of the intervention. Also, variability in the type of allergen used and its mode of application is evident. But despite these limitations, many of the studies have shown a link between the use of hypnosis and a changed response to an allergic stimulus or to a lessened bronchial hyperreactivity. There is as yet no clear explanation for the effectiveness of hypnosis, but there is some evidence for an influence on the neurovascular component of the allergic response.

Pediatrics. 2001 Feb;107(2):E21.
Self-hypnosis for management of chronic dyspnea in pediatric patients.
Anbar RD. anbarr@mail.upstate.edu
Department of Pediatrics, State University of New York Upstate Medical University, Syracuse, New York 13210, USA.

INTRODUCTION: Hypnotherapy can be useful in the management of anxiety, discomfort, and psychosomatic symptoms, all of which may contribute to a complaint of dyspnea. Therefore, instruction in self-hypnosis was offered to 17 children and adolescents with chronic dyspnea, which had not resolved despite medical therapy, and who were documented to have normal lung function at rest. This report documents the result of this intervention.

METHODS: A retrospective chart review identified all patients followed by a single pediatric pulmonologist (R.D.A.), with a chief complaint of chronic dyspnea from April 1998 through December 1999. These patients had been evaluated and treated for medical diseases according to their history, physical examination, and laboratory investigations. The pulmonologist offered to teach self-hypnosis to all of these patients, who comprise the cohort in this report. Chronic dyspnea was defined as recurrent difficulty breathing or shortness of breath at rest or with exertion, which had existed for at least 1 month in patients who had not suffered within a month from an acute pulmonary illness. The pulmonologist was trained in hypnosis through his attendance at three 20-hour workshops. Hypnosis was taught to individual patients in 1 or two 15- to 45-minute sessions. Patients were taught hypnotic self-induction techniques and imagery to achieve relaxation. Additionally, imagery relating to dyspnea was developed by coaching patients to change their imagined lung appearance from a dyspneic to a healthy state. Patients were encouraged to practice self-hypnosis regularly and to use lung imagery to eliminate dyspnea if it occurred.

RESULTS: Seventeen patients (13 males and 4 females) with chronic dyspnea were documented to have normal pulmonary function at rest. Their mean age was 13.4 years (range: 8-18 years). Twelve of the 17 previously were diagnosed with other conditions, such as allergies, asthma, and gastroesophageal reflux. Fifteen of the 17 manifested at least 1 other symptom associated with their dyspnea, including an anxious appearance (4 patients); chest tightness or pain (5); cough (4); wheeze (3); difficulty with inspiration (2); hyperventilation (1); inspiratory noise, such as stridor, gasping, rasping, or squeak (8); dizziness (1); feeling something is stuck in the throat (2); parasthesias (4); and tachycardia (3). Of the 17 patients, 2 complained of dyspnea at rest only, 13 complained of dyspnea with activity only, and 2 complained of dyspnea both at rest and with activity. Nine patients reported that they frequently needed to discontinue their physical activity because of dyspnea. The mean duration of their dyspnea before learning self-hypnosis was 2 years (range: 1 month to 5 years). The dyspnea was of <6 months duration for 4 of the patients. For 9 of the 17 patients a potential psychosocial association with their dyspnea was identified: 3 developed symptoms at school only; 2 with exercise during competitive races only; 3 after a major disagreement between their parents; and 1 developed symptoms each time his family moved to a new neighborhood. Before presentation, 7 of the 17 patients received chronic inhaled antiinflammatory therapy, and 3 were using inhaled albuterol, as needed. All 17 patients had normal physical examinations, with the exception of healed scars on the chest and abdomen of 1 patient, a repaired cleft palate in 1 patient, and rhinitis in another. Four of the 17 underwent pulmonary function testing before and after exercise, 6 had chest radiographs, and 3 had electrocardiograms. All of these tests were normal. A patient with a history of psychogenic cough declined to learn self-hypnosis. Thirteen of the remaining 16 patients were taught to use self-hypnosis in 1 session. A second session was provided to 3 patients within 2 months. Thirteen of the 16 patients reported their dyspnea and any associated symptoms had resolved within 1 month of their final hypnosis instruction session. Eleven believed that resolution of their dyspnea was attributable to hypnosis, because their symptoms cleared immediately after they received hypnosis instruction (5 patients) or with its regular use (6). Two did not attribute resolution of dyspnea to hypnosis because they did not use it at home. The remaining 3 reported that their dyspnea had improved. Patients were followed for a mean 9 months (range: 2-15 months) after their final hypnosis session. Ten of the 16 regularly used self-hypnosis at home for at least 1 month after the final hypnosis session. There was no recurrence of dyspnea, associated symptoms, or onset of new symptoms in patients in whom the dyspnea resolved. Under supervision of the pediatric pulmonologist, 2 of 7 patients discontinued their chronic antiinflammatory therapy when they became asymptomatic after hypnosis. Subsequently, their pulmonary function remained normal. (ABSTRACT TRUNCATED)