Biofeedback Treatment for Asthma

Paul M. Lehrer, PhD; Evgeny Vaschillo, PhD; Bronya Vaschillo, MD; Shou-En Lu, PhD; Anthony Scardella, MD, FCCP; Mahmood Siddique, DO, FCCP; Robert H. Habib, PhD


CHEST. 2004;126(2) 

In This Article

Abstract and Introduction

Study Objectives: We evaluated the effectiveness of heart rate variability (HRV) biofeedback as a complementary treatment for asthma.
Patients: Ninety-four adult outpatient paid volunteers with asthma.
Setting: The psychophysiology laboratory at The University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, and the private outpatient offices of participating asthma physicians.
Interventions: The interventions were as follows: (1) a full protocol (ie, HRV biofeedback and abdominal breathing through pursed lips and prolonged exhalation); (2) HRV biofeedback alone; (3) placebo EEG biofeedback; and (4) a waiting list control.
Design: Subjects were first prestabilized using controller medication and then were randomly assigned to experimental groups. Medication was titrated biweekly by blinded asthma specialists according to a protocol based on National Heart, Lung, and Blood Institute guidelines, according to symptoms, spirometry, and home peak flows.
Measurements: Subjects recorded daily asthma symptoms and twice-daily peak expiratory flows. Spirometry was performed before and after each weekly treatment session under the HRV and placebo biofeedback conditions, and at triweekly assessment sessions under the waiting list condition. Oscillation resistance was measured approximately triweekly.
Results: Compared with the two control groups, subjects in both of the two HRV biofeedback groups were prescribed less medication, with minimal differences between the two active treatments. Improvements averaged one full level of asthma severity. Measures from forced oscillation pneumography similarly showed improvement in pulmonary function. A placebo effect influenced an improvement in asthma symptoms, but not in pulmonary function. Groups did not differ in the occurrence of severe asthma flares.
Conclusions: The results suggest that HRV biofeedback may prove to be a useful adjunct to asthma treatment and may help to reduce dependence on steroid medications. Further evaluation of this method is warranted.

An effective nonpharmacologic alternative or adjunctive treatment of asthma could provide a potentially useful contribution to asthma care.[1] Adherence to asthma regimens tends to be low,[2] and the resort to complementary treatments is common despite the lack of evidence for effectiveness.[3,4] The long-term use of oral steroids is expensive and can have undesirable side effects.[5] Although the weight of empirical evidence strongly indicates that the positive effects of inhaled corticosteroids in asthma far outweigh any negative consequences, there is some evidence for adverse effects for these medications as well,[6,7] and, regardless of the weight of evidence, many asthma patients remain wary of the potential side effects, which, in turn, leads to non-adherence.[8,9,10]

Preliminary research has found that biofeedback training to increase heart rate variability (HRV) produces a decrease in respiratory resistance[11] and improves spirometry performance in asthma patients,[12] although the mechanism of action has not been proven. HRV tends to be reduced in patients with asthma[13] and various diseases affecting the cardiovascular and/or CNS.[14] HRV biofeedback has been found to increase peak flow and resting baroreflex gain and high-frequency HRV among healthy adults,[15] but a relationship between autonomic and pulmonary changes has not been established. The purpose of the study was to determine whether this biofeedback method can serve as an effective non-pharmacologic alternative or complementary treatment method for asthma.


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