Harry Kotses

A self-management program for adult asthma. Part I: Development and evaluation☆☆☆★★★

BACKGROUND We developed and evaluated a self-management program for adult asthma. In developing the program, we considered questions of format and behavior control. The format we selected included components known to be effective in educational settings. We regulated asthma management behavior through the introduction of environmental cues. METHODS Seventy-six subjects, whose asthma was generally under medical control, were assigned randomly to either a treatment group or a waiting-list control group. Those in the treatment group were exposed to a 7-week program that incorporated proven features of providing effective training and establishing behavioral control. Subsequently, subjects in the control group received the treatment. Short-term evaluation of the treatment was made after the subjects in the experimental group were trained but before the control subjects were trained. Long-term evaluation was conducted after both groups of subjects were trained. RESULTS Over the short term, self-management training led to fewer asthma symptoms and physician visits and improvement in asthma management skills and cognitive abilities. Over the long term, self-management training was related to lower asthma attack frequency, reduced medication use, improvement in cognitive measures, and increased use of self-management skills. CONCLUSIONS The program improved asthma management in patients whose conditions were already under good medical control. The effects of the program were apparent a year after the conclusion of self-management training.

Guidelines for mechanical lung function measurements in psychophysiology

Studies in psychophysiology and behavioral medicine have uncovered associations among psychological processes, behavior, and lung function. However, methodological issues specific to the measurement of mechanical lung function have rarely been discussed. This report presents an overview of the physiology, techniques, and experimental methods of mechanical lung function measurements relevant to this research context. Techniques to measure lung volumes, airflow, airway resistance, respiratory resistance, and airflow perception are introduced and discussed. Confounding factors such as ventilation, medication, environmental factors, physical activity, and instructional and experimenter effects are outlined, and issues specific to children and clinical groups are discussed. Recommendations are presented to increase the degree of standardization in the research application and publication of mechanical lung function measurements in psychophysiology.

A Life Activities Questionnaire for Childhood Asthma

The paper describes the development and testing of a paper-and-pencil instrument, the Life Activities Questionnaire for Childhood Asthma, that can be applied to assess activity restriction in children with asthma. It describes how items for the instrument were selected to ensure the validity of the developed instrument. The method by which the reliability of the questionnaire was established is also discussed. The result is a valid and reliable instrument that should have wide applicability in measuring activity restriction because of childhood asthma. The developed instrument has potential use in clinical settings, research, and policy making.

Operant reduction of frontalis EMG activity in the treatment of asthma in children

Abstract The effect of operantly produced frontalis muscle relaxation on peak expiratory flow rates in asthmatic children was studied in an investigation incorporating a Contingent Feedback group and two control groups, one a Noncontingent Feedback group yoked to the experimental group and the second, a No Treatment group. Thirty-six asthmatic children, ranging in age from 8 to 16 yr, were assigned equally to the three groups in a manner designed to balance the groups along a variety of subject variables. The evaluation of frontalis muscle activity revealed the presence of a strong conditioned effect with the Contingent group exhibiting reliably lower values than the Noncontingent group over the course of the experiment. Group peak expiratory flow rates, measured prior to the initiation of muscle relaxation training and subsequent to training, improved substantially in the Contingent group but not in the Noncontingent or No Treatment groups. Also, more children in the Contingent group showed improvement in peak expiratory flow rate than in either of the control groups. It was concluded that operantly produced frontalis muscle relaxation may be of potential significance in the development of asthma therapies based on conditioning.

Evaluation of individualized asthma self-management programs.

We compared the effectiveness of personalized asthma self-management recommendations with that of a group self-management program. We assigned each of 34 asthma patients randomly to one of three conditions: individualized asthma self-management, group asthma self-management, and control. We derived individualized self-management recommendations from patient recordings of asthma occurrence, asthma precipitants, and peak expiratory flow rate made during a 3-month period. The group program we used was the Wheezers Anonymous program. As compared to a control group of patients who received no self-management training, the patients in both the individualized and group condition evidenced improvement of pulmonary function, as measured daily with a home peak flow meter. The improvement was equivalent for patients in the two conditions. Patients in the individualized condition also exhibited a drop in frequency of asthma attacks, but patients in the group condition did not. We concluded that individualized asthma self-management is effective in reducing symptoms of asthma.

Long-term effects of biofeedback-induced facial relaxation on measures of asthma severity in children

We studied the effects of electromyographic biofeedback on measures of asthma severity in children. Fifteen children received biofeedback training to reduce facial tension, and 14 children, who served as controls, received biofeedback training to maintain facial tension at a stable level. Assignment to experimental condition was random. As a result of training, electromyographic levels decreased in children trained in facial relaxation and remained fairly constant in children trained in facial tension stability. Biofeedback training was augmented for children in both groups by having them practice their facial exercises at home. Each childs condition was followed for a five-month period subsequent to biofeedback training. Throughout the experiment, the following measures of asthma severity were monitored: lung function, self-rated asthma severity, medication usage, and frequency of asthma attacks. In addition, standardized measures of attitudes toward asthma, self-concept, and chronic anxiety were recorded at regular intervals. As compared to the facial stability subjects, the facial relaxation subjects exhibited higher pulmonary scores, more positive attitudes toward asthma, and lower chronic anxiety during the followup period. Subjects in the two groups, however, did not differ on self-rated asthma severity, medication usage, frequency of asthma attacks, or self-concept. Based on the improvements we observed in pulmonary, attitude, and anxiety measures, we concluded that biofeedback training for facial relaxation contributes to the self-control of asthma and would be a valuable addition to asthma self-management programs.

A Life Activities Questionnaire for Adult Asthma

The development, testing, and applicability of an instrument, the Life Activities Questionnaire for Adult Asthma is described that can be used to assess activity restriction in adults with asthma. It explains how items for the instrument were selected to insure the validity of the developed instrument. The reliability of the questionnaire is also discussed. The result is a valid and reliable paper-and-pencil instrument that should have wide applicability as a component of quality of life measurement. This instrument has potential for functional use in clinical settings, research environments, and policy-making procedures.

Improving the ability of peak expiratory flow rates to predict asthma

A major problem in the behavioral management of childhood asthma concerns recognition of the early signs of impending episode. An objective measure commonly used to aid recognition of early warning signs is the peak expiratory flow rate (PEFR). This study examined the ability of PEFRs to predict asthma within a 12-hour period; the prediction method used was based on prior and conditional posterior probabilities. Twenty-five children with asthma recorded their PEFR twice daily, and also recorded the date and time of their asthma episodes. Conditional posterior probabilities and the ratio of hits to misses were computed for each subject at successively lower flow rates. The average improvement in predictability from the prior probability to the highest posterior probability was 491%. The ratio of hits to misses and the number of episodes predicted, however, decreased as the posterior probability increased. Selection of the PEFR at lower posterior probabilities resulted in fewer prediction errors and led to prediction of a higher number of episodes than selection of the PEFR at the highest posterior probability.

Operant muscular relaxation and peak expiratory flow rate in asthmatic children

Abstract The effects of two types of operant muscular relaxation, frontalis relaxation and brachio- radialis relaxation, on peak expiratory flow rate were studied in a group of 40 asthmatic children. Using a yoked control design, conditioned frontalis relaxation was shown to occur in one group of asthmatic children. These individuals exhibited increases in PEFR, whereas children in the frontalis conditioning control group showed no improvement in this variable. Conditioned brachioradialis relaxation could not be demonstrated with the training procedures currently employed. Also, in this case, neither the brachioradialis conditioning nor its yoked control group experienced PEFR changes as a result of training. The results of the present study provided support for the previous finding that frontalis muscle relaxation effects PEFR increases in asthmatic children.

Facial muscle tension influences lung airway resistance; limb muscle tension does not ☆

In healthy adult subjects, operantly conditioned increases in facial (frontalis) muscle tension produce increased lung airway resistance, whereas conditioned facial muscle relaxation results in decreased airway resistance. Conditioned increases and decreases in limb (brachioradialis) tension do not affect airway resistance. The latter finding rules out general muscular events and mitigates against metabolic agents as explanations of the airway resistance changes associated with facial tension change and suggests that the facial muscles influence airway resistance through the operation of a neural reflex.