Sep. 1, 1997 ATHENS, Ohio -- Many people with asthma aren't able to detect a problem with their breathing until the asthma attack becomes severe. But a new training method developed by researchers at Ohio University could one day help asthma patients detect an attack as early as 30 minutes before its onset.
Self-management of asthma includes the ability to detect resistance to air flow that is caused by constricted air passages. But research suggests that many people with asthma are unable to detect this breathing difficulty in time to stop the attack.
Researchers at Ohio University have developed a training method that helps asthma patients improve their perception of air flow resistance. In a study of 45 asthma patients who took part in the training, researchers found that participants had fewer asthma attacks because they detected the problems earlier and took medication before the onset of an attack.
"Breathing is so natural to us, we do it without thinking, and that's true for asthma patients as well," said Harry Kotses, professor of psychology at Ohio University and co-author of the study. "If people with asthma can learn to be sensitive to changes in resistance to air flow, they might be able to detect the early stages of an asthma attack and stop it before serious breathing difficulty occurs."
Asthma, the most common chronic childhood illness, affects nearly 15 million Americans, 5 million of whom are under the age of 19. According to the Centers for Disease Control and Prevention, asthma accounted for an estimated 198,000 hospitalizations and 342 deaths in 1993.
During an asthma attack, air flow into and out of the lungs is restricted by inflammation and swelling of the bronchial tubes and by bronchial narrowing caused by smooth muscle contraction.
An attack can be triggered by exercise, infection, respiratory irritants, stress or an allergy to things such as pollen, dust mites or animal dander. The illness usually is controlled by steroids that reduce inflammation of tissues in the airway, by bronchial dilators that relax constricted muscles, or both.
Because an asthma attack is costly to the patient in terms of health risk and hospital cost, physicians emphasize prevention through self-management. An attack can happen any time, Kotses said, and it's important that asthma patients learn to judge the illness' warning signs and take preventative measures early.
For the study, researchers interviewed 20 men and 25 women ages 18 to 24, all Ohio University undergraduate students. Each had been diagnosed with asthma by a physician and used prescribed medication for the illness.
Before undergoing training, study participants were interviewed about the frequency and severity of their asthma attacks. Sixteen had at least four asthma attacks a month, 20 had two or three attacks a month and nine had fewer attacks.
During the study, asthma patients were asked to breath through nylon mesh screens. Each screen had a different weave -- some allowed for greater resistance to air flow and some for less resistance. Participants judged the level of difficulty they experienced while breathing through each of the screens.
At the beginning of the study, some participants said that widely woven screens caused more air flow resistance than those more tightly woven, which added support to theories that asthma patients are unable to determine air flow resistance accurately. But by the end of the study, most participants were able to identify correctly those screens that presented the most problems.
"It is possible that change in air flow obstruction associated with asthma occurs so gradually that it goes unnoticed until it is severe," Kotses said. "But the wide range we observed in ability to predict asthma suggests this is not the case. Some of our subjects reported ability to forecast occurrence of asthma by 30 minutes or more. A primary benefit of perception training may be that it increases the length of the warning period a patient has prior to the onset of an attack."
Although self-management of asthma has been part of asthma control for many years, the idea of adding perception training is new, Kotses said. Many of the study participants reported that breathing through the different mesh screens was very similar to an actual asthma attack, which suggests this method may be useful in a perception training program.
"The fact that our subjects were able to detect the onset of an attack earlier than before is very promising, but now we want to study the method using a larger group of asthma patients and examining them over a longer period of time," Kotses said.
The study, published in a recent issue of the journal Psychosomatic Medicine, was co-authored by Thomas Creer, a former professor of psychology who retired in 1996, and Cynthia Stout, a former psychology graduate student, both from Ohio University.
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Contact: Harry Kotses, 614-593-1080; firstname.lastname@example.org. Written by Kelli Whitlock, 614-593-0383; email@example.com.
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