Adam Hurewitz

Daily Psychosocial Factors Predict Levels and Diurnal Cycles of Asthma Symptomatology and Peak Flow

This study examines the relationship among psychosocial factors, asthma symptoms, and peak expiratory flow rate (PEFR) in the natural environment. Twenty adult asthmatics wore preprogrammed wristwatches that prompted them to assess PEFR, asthma symptoms, and psychosocial factors five times a day for 10 days. Psychosocial variables (activities, locations, social contacts, mood, and stressors) were strongly related to PEFR and asthma symptoms, suggesting that they may play a more important role in disease expression than has been previously thought. Diurnal cycles of asthma symptoms and PEFR were observed. However, statistically controlling for psychosocial factors eliminated diurnal cycles for PEFR or asthma symptoms, indicating that psychosocial factors are a major contributor to the observed diurnal cycle in PEFR and symptoms. These relationships underscore the need to include psychosocial factors in future asthma research.

Structured writing about stressful events: exploring potential psychological mediators of positive health effects.

In a previous study, the authors found that structured writing about stressful events improved symptomatology in 112 patients with rheumatoid arthritis and asthma relative to patients who did not write (J. Smyth, A. Stone, A. Hurewitz, & A. Kaell, 1999). However, little is currently known about the pathways from the intervention to alterations in outcomes. In addition to measuring symptom outcomes after the intervention in the previous study, the authors monitored perceived stress, quality of sleep, affect, substance use, and medication use on a momentary basis for the 7 days prior to writing, during the 3 intervention days, and for the 14 days following the intervention (N = 105). These variables were tested in a secondary data analysis to determine whether they mediated the effects observed in the J. Smyth, A. Stone, et al. study. No evidence was found supporting mediation, and the mechanism underlying structured writing about stressful events remains unknown.

INCREASED PLASMA LEVELS OF MATRIX METALLOPROTEINASE-9 AND TISSUE INHIBITOR OF METALLOPROTEINASE-1 IN LUNG AND BREAST CANCER ARE ALTERED DURING CHEST RADIOTHERAPY

PURPOSE Does the release of plasma matrix metalloproteinase-9 (MMP-9) by radiation-activated airway epithelial cells and infiltrating inflammatory cells play a role in the radiation damage or repair process in the lungs? We evaluated lung damage by ionizing radiation using plasma levels of MMP-9, tissue inhibitor of metalloproteinase-1 (TIMP-1), and MMP-3 as biologic markers of tissue damage, and also their relationship to changes in pulmonary epithelial permeability, clinical signs and symptoms, and lung structural changes. METHODS AND MATERIALS Seven serial studies were conducted in each of 8 patients undergoing chest radiotherapy (RT) for lung or breast cancer, beginning before the first treatment (baseline) and then biweekly to approximately 100 days during and after RT. Chest radiographs were monitored for each patient. Sandwich enzyme-linked immunoassays (ELISA) were used to measure plasma MMP-3, MMP-9, and TIMP-1 levels. Lung permeability was evaluated by measuring the rate of epithelial clearance of approximately 150 microCi ( approximately 5.6 MBq) inhaled (99m)Tc diethylenetriamine pentaacetate aerosol (DTPA). RESULTS Lung and breast cancer resulted in very high plasma levels of MMP-9 (126-893 ng/mL) and TIMP-1 (496-8985 ng/mL) in all subjects studied before initiation of RT. This compares with plasma MMP-9 and TIMP-1 values in healthy volunteers of 29 +/- 11 ng/mL and 436 +/- 86 ng/mL, respectively. RT was followed by a sharp decrease in plasma MMP-9 within the first 2 weeks, but without a corresponding change in TIMP-1. In contrast, plasma MMP-3 levels, which are generally increased with inflammation, were elevated in only 1 of 5 subjects. CONCLUSION Lung and breast cancer are associated with high plasma levels of MMP-9 and TIMP-1. These high baseline plasma levels of MMP-9 were reduced in the first 2 weeks of RT in 7 of 8 subjects, and TIMP-1 plasma levels remained high in all subjects. The decrease in plasma MMP-9 after initiation of chest RT appears to reflect a suppressive effect on cancer-induced cellular responses rather than a primary role for MMP-9 in radiation-induced lung damage. Likewise, the lack of a rise in plasma MMP-3 levels does not support a role for MMP-3 in tissue injury or repair in the lung. It remains to be determined whether plasma MMP-9 measurements will serve as a useful parameter in predicting cancer relapse.

The effect of tape-recorded relaxation training on well-being, symptoms, and peak expiratory flow rate in adult asthmatics: A pilot study

Abstract Evidence indicates that psychological stress plays a role in precipitating and exacerbating asthma symptoms and suggests that relaxation techniques aimed at reducing stress and autonomic arousal leads to symptom reduction. This study explored the effect of a tape-recorded relaxation intervention on well-being (mood and stresson). asthma symptoms, and a measure of pulmonary function (PEFR). Twenty adult asthmatics were studied for 21 days in their natural environment using a multiple baseline design. Self-administered relaxation training (including both breathing exercises and muscle relaxation) led to decreased negative mood and stressor report. Reporting of asthma symptoms decreased over time, and PEFR was increased by relaxation training. Asthma medication use was unchanged. Results suggest that tape–recorded relaxation training positively impacts well-being, asthma symptoms. and PEFR in a naturalistic setting. Further study of the potential use of inexpensive tape-recorded interventions in chr...

Relaxation Training and Cortisol Secretion in Adult Asthmatics

Relaxation techniques can lead to symptom reduction and improved pulmonary functioning in asthmatics, although the mechanism is not clear. One possibility is by influencing cortisol secretion, as cortisol is implicated in inflammatory processes and relaxation has been shown to alter cortisol secretion in healthy individuals. This study explored the effect of relaxation training on cortisol levels and cortisol reactivity to stress in asthmatics. Twenty adult asthmatics participated for 21 days in their natural environment, and received relaxation training halfway through the study. Cortisol was assessed from saliva five times per day for three weeks. Relaxation training was successful, but did not lead to the hypothesized reduction in overall cortisol levels. Participants using corticosteroid medication showed increases in cortisol after relaxation, whereas those not using corticosteroids showed decreases in cortisol (p< .05). Relaxation altered the cortisol reactivity to stress (p= .007); before relaxation training cortisol levels increased after a stressor, whereas following relaxation training cortisol levels decreased after a stressor. This study suggests that relaxation training can influence cortisol secretion in asthmatics, but that these effects differ from those observed in healthy individuals and may be influenced by corticosteroid medication use.

Written disclosure therapy for patients with chronic lung disease undergoing pulmonary rehabilitation.

PURPOSE: Chronic lung diseases are typically associated with impaired quality of life, stress, and anxiety. Written disclosure therapy (WDT) reduces stress in patients with a variety of chronic illnesses. We sought to determine whether WDT benefits patients with chronic lung disease. METHODS: A prospective, randomized, controlled trial was performed to evaluate the effect of using WDT in patients (N = 66) participating in a pulmonary rehabilitation program. Patients were randomly assigned to write about a particularly traumatic life event (WDT group) or to write about an emotionally neutral subject (control group). Exercise capacity, dyspnea and quality of life, and values of spirometry were recorded at baseline, at the end of the program, and at 6 months. RESULTS: The 6-minute walk distance (6MWD) significantly improved in both groups at 2 months, from 278 to 327 m in WDT and from 269 to 314 m in control groups (P < .01 in both groups). There was no difference in improvement in 6MWD between groups (P = .88). At 6 months, the gains made in 6MWD were no longer present. Dyspnea severity, as well as most of the other domains of the Chronic Respiratory Disease Questionnaire and the St. Georges Respiratory Questionnaire, showed improvement within each group, but not between WDT and control groups. CONCLUSION: WDT did not add any additional benefit in patients with chronic obstructive pulmonary disease or idiopathic pulmonary fibrosis when included as a component of pulmonary rehabilitation. These results are in contrast to previously seen benefits in patients with asthma.