Photo Credit: Tumsasedgars

A psychoeducational intervention for extrapulmonary manifestations of severe asthma was found feasible and rated as beneficial by patients.

“When assessing the impact of management and treatment interventions aimed at improving HRQOL for those with severe asthma, it is important to look beyond the lung,” researchers wrote in PEC Innovation. “The frequency and severity of extra-pulmonary symptoms in severe asthma are similar to those in patients diagnosed with syndromes of medically unexplained symptoms, such as fibromyalgia and chronic fatigue syndrome.”

Joseph Lanario, PhD, and colleagues also noted that pulmonary rehabilitation, an evidenced-based education and exercise program for patients with COPD, has been found beneficial in addition to medication. Building on this and evidence from other respiratory diseases, the researchers hypothesized that an intervention designed to increase patients’ knowledge of disease management, physical activity, relaxation, and other lifestyle changes that improve well-being and mood may also improve self-management and HRQOL for patients with severe asthma.

The study team conducted a feasibility study on the use of Body Reprogramming, a non-pharmacological, multi-component intervention originally developed for people with fibromyalgia, in patients with severe asthma to gauge its ability to improve the regulation of inflammatory mediators that contribute to extra-pulmonary symptoms.

The researchers assessed the benefits of the intervention using pre- and post-intervention asthma questionnaires and post-intervention interviews.

Feedback from Participants

The intervention enrolled 28 participants (mean age, 50; 93% women), and 12 of these patients participated in a post-course interview.

The post-course interviews identified four primary themes: time to reflect, interaction with others, pre-existing knowledge, and areas for improvement.

Time to Reflect

Participants noted that the small-group structure of the course, with content delivered from a trusted source, allowed them to reflect on their experience with severe asthma.

Other subthemes included:

• Uncertainty about course design
• Concerns about exercise requirements during sessions
• Interest in learning more about asthma and comorbidities coupled with the inability to do so because of concerns about misinformation and anxiety
• Viewing the course instructor as a trusted source

Interactions With Others

“Group interaction was viewed as a major benefit to partaking in [Body Reprogramming] for most participants,” Dr. Lanario and colleagues wrote. “The lack of group discussion during the sessions was noticed by some that did comment. This was a source of disappointment and a viewed as a missed opportunity to involve patients who may have engaged more.” 

Additional feedback provided under this theme included:

• Mismatched experiences with severe asthma, leading to feedback from others being seen as “irrelevant” by some participants;
• Discomfort with the group format;
• Ability to ask questions and engage with the group; and
• Ability to listen and observe others. 

Pre-Existing Knowledge

“Participants’ pre-existing knowledge of their disease, symptom management, diet, and exercise framed how they experienced the course,” the researchers wrote.

Additional feedback under this theme included:

• Affirmation of techniques already used for managing health;
• Importance of gentle movements and avoiding overexertion;
• Comments that the course was better suited for newly diagnosed patients with no current methods for managing symptoms;
• Course was too general;
• Challenging preconceptions about health; and
• New understanding of the relationship between eating habits and well-being.

 Areas for Improvement

“Group interaction was important to many participants,” Dr. Lanario and colleagues wrote. “However, due to non-attendance of some participants, course sizes reduced over time. This was a source of disappointment.” 

In addition to better attendance, other areas of improvement included:

• Time for introductions during the first session;
• More time for group discussions/questions and socializing; and

A session that addressed asthma medications

Directions for Future Studies

Based on the feedback, Dr. Lanario and colleagues outlined several areas to be addressed in future studies, focused primarily on research methods and the intervention parameters.

Strategies for addressing these included:

• Stricter inclusion/exclusion criteria;
• Use of 28 extrapulmonary symptoms as inclusion criteria;
• Recruiting from multiple centers;
• Increasing convenience and decreasing the burden of asthma questionnaires ;
• Explanations of what the Body Reprogramming intervention does not involve; and
• Optional group discussions at the end of sessions.

“An educational course focused on managing extra-pulmonary symptoms is feasible and of perceived benefit to patients with severe asthma,” the researchers wrote. “[Body Reprogramming] could be incorporated into a rehab [program] for patients with severe asthma with significant extrapulmonary symptoms.”