Psychological Interventions for Asthma 111disease (COPD), the results are relevant because inhaled
medications are a cornerstone of COPD treatment, as they
are for asthma. It appears, then, that the presence of an inti-
mate partner and satisfaction with close relationships may
be associated with more appropriate medication utilization
(more adherent use of medications; less necessity for oral
steroids suggesting better disease control through inhaled
medications), perhaps resulting in less morbidity due to
asthma.
As mentioned, patients with a tendency toward general-
ized fearful, catastrophizing reactions have more medical
utilization. How might fearful reactions and social rela-
tionships interact in patients with asthma? Two models are
relevant: “rst, the concept of the safety signal, which was de-
veloped based on persons with panic disorder. Safety signals
are items (e.g., medications) or people associated with feel-
ings of security and relief (Rachman, 1984). Among patients
with asthma, the presence of the signi“cant other may be
hypothesized to decrease fearful cognitions, and be associ-
ated with lesser reports of asthma symptoms. An alternate
hypothesis comes from kindling-sensitization models that
posit that over time, increasingly lower levels of stimuli are
needed to prompt the occurrence of the target symptoms
(Post, Rubinow, & Ballenger, 1986). Extending this model to
asthma, to the extent that the signi“cant other is a source of
stress, the signi“cant other may be associated with increasing
discomfort and greater reports of asthma symptoms over
time. Theory-driven examinations of the role of the signi“-
cant other and the moderating effects of relationship satisfac-
tion await future research efforts.
PSYCHOLOGICAL INTERVENTIONS
FOR ASTHMA
Asthma Education
Self-care for asthma involves a number of rather complex be-
haviors. The patient must be able to identify asthma symp-
toms, measure his/her peak ”ow at home; calculate whether
pulmonary function is low enough to require action; take
various kinds of medications, each with different purposes,
effects, and side effects; avoid certain asthma triggers; and
visit a doctor regularly.
The NHLBI-sponsored Expert Panel Report (1997) has
recommended that each asthma patient should have a written
action plan. The asthma action plan instructs the patient to
take medication and to contact health care providers ac-
cording to the patient•s asthma severity. Severity is portrayed
as a traf“c light. Three zones are based on signs, symptoms,
and peak ”ow values. When in the green zone (no symptoms,
relatively normal pulmonary function), the patient continues
taking his or her regular dose of •controllerŽ medication (anti-
in”ammatory medication, usually inhaled steroids and/or
leukotreine inhibitors, sometimes along with a long-acting
beta-2 agonist) at the current dose. When in the yellow zone,
the patient takes •relieverŽ or emergency medication (bron-
chodilator, usually albuterol) and may increase the dose of
controller medication. If yellow zone symptomatology does
not resolve within a speci“c time frame, the patient is in-
structed to contact his or her asthma physician. The red zone
describes a severe asthma exacerbation. The patient is in-
structed to take more medication (sometimes including oral
steroid medication), contact the physician, and, in some
cases, proceed to an emergency room.
The following components are included in asthma edu-
cation: instructing the patient about basic facts of asthma
and the various asthma medications, teaching techniques for
using inhalers and avoiding allergens, devising a daily self-
management plan, and completing an asthma diary for
self-monitoring.
Asthma education programs have been shown to be cost
effective for both children (Greineder, Loane, & Parks, 1999)
and adults (Taitel, Kotses, Bernstein, Bernstein, & Creer,
1995). Studies of these programs have demonstrated improve-
ments on measures such as frequency of asthma attacks and
symptoms, medication consumption, and self-management
skills (Kotses et al., 1995; Wilson et al., 1996). More research,
though, is needed to determine which speci“c components
of the interventions (e.g., environmental control, peak ”ow
monitoring) are effective.PsychotherapySommaruga and colleagues (1995) combined an asthma edu-
cation program with three sessions of cognitive-behavioral
therapy (CBT) focusing on areas that may interfere with
proper medical management. However, few signi“cant
between-group differences on measures of anxiety, depres-
sion, and asthma morbidity (e.g., missed school/work days)
emerged between the control group receiving medical treat-
ment alone and the CBT group. In an uncontrolled study, Park,
Sawyer, and Glaun (1996) applied principles of CBT for panic
disorder to children with asthma reporting greater subjective
complaints and consuming medication in excess of the level
warranted by their pulmonary impairment. In the 12 months
following treatment, the rate of hospitalization for asthma
decreased, but other measures of clinical outcome were not