表达性写作对成年哮喘患者肺功能、生活质量、药物使用及症状的影响：一项随机对照试验。

The effects of expressive writing on lung function, quality of life, medication use, and symptoms in adults with asthma: a randomized controlled trial.

作者信息

Smith Helen E, Jones Christina J, Hankins Matthew, Field Andy, Theadom Alice, Bowskill Richard, Horne Rob, Frew Anthony J

机构信息

From the Division of Public Health & Primary Care (Smith, Jones), Brighton & Sussex Medical School, Brighton, United Kingdom; Real-World Evidence Solutions (Hankins), IMS Health, London, United Kingdom; School of Psychology (Field), University of Sussex, Brighton, United Kingdom; National Institute for Stroke and Applied Neurosciences (Theadom), Auckland University of Technology, Auckland, New Zealand; Mill View Hospital (Bowskill), Sussex Partnership Trust, East Sussex, United Kingdom; Department of Practice & Policy (Horne), School of Pharmacy, University of London, Centre for Behavioural Medicine, London, United Kingdom; and Department of Respiratory Medicine (Frew), Royal Sussex County Hospital, Brighton & Sussex University Hospitals Trust, Brighton, United Kingdom.

出版信息

Psychosom Med. 2015 May;77(4):429-37. doi: 10.1097/PSY.0000000000000166.

DOI:10.1097/PSY.0000000000000166

PMID:25939030

Abstract

OBJECTIVES

Asthma is a chronic condition affecting 300 million people worldwide. Management involves adherence to pharmacological treatments such as corticosteroids and β-agonists, but residual symptoms persist. As asthma symptoms are exacerbated by stress, one possible adjunct to pharmacological treatment is expressive writing (EW). EW involves the disclosure of traumatic experiences which is thought to facilitate cognitive and emotional processing, helping to reduce physiological stress associated with inhibiting emotions. A previous trial reported short-term improvements in lung function. This study aimed to assess whether EW can improve lung function, quality of life, symptoms, and medication use in patients with asthma.

METHODS

Adults (18-45 years) diagnosed as having asthma requiring regular inhaled corticosteroids were recruited from 28 general practices in South East England (n = 146). In this double-blind randomized controlled trial, participants were allocated either EW or nonemotional writing instructions and asked to write for 20 minutes for 3 consecutive days. Lung function (forced expired volume in 1 second [FEV1]% predicted), quality of life (Mark's Asthma Quality of Life Questionnaire), asthma symptoms (Wasserfallen Symptom Score Questionnaire), and medication use (inhaled corticosteroids and β-agonist) were recorded at baseline, 1, 3, 6, and 12 months.

RESULTS

Hierarchical linear modeling indicated no significant main effects between time and condition on any outcomes. Post hoc analyses revealed that EW improved lung function by 14% for 12 months for participants with less than 80% FEV1% predicted at baseline (β = 0.93, p = .002) whereas no improvement was observed in the control condition (β = 0.10, p = .667).

CONCLUSIONS

EW seems to be beneficial for patients with moderate asthma (<80% FEV1% predicted). Future studies of EW require stratification of patients by asthma severity.

TRIAL REGISTRATION

ISRCTN82986307.

摘要

目的

哮喘是一种影响全球3亿人的慢性疾病。其管理包括坚持使用皮质类固醇和β-激动剂等药物治疗，但仍有残余症状。由于压力会加剧哮喘症状，一种可能的药物治疗辅助方法是表达性写作（EW）。EW包括披露创伤经历，这被认为有助于认知和情绪处理，有助于减轻与抑制情绪相关的生理压力。先前的一项试验报告了肺功能的短期改善。本研究旨在评估EW是否能改善哮喘患者的肺功能、生活质量、症状和药物使用情况。

方法

从英格兰东南部的28家全科诊所招募了被诊断为需要定期吸入皮质类固醇的哮喘成人患者（18 - 45岁，n = 146）。在这项双盲随机对照试验中，参与者被分配接受EW或非情感写作指导，并要求连续3天每天写作20分钟。在基线、1、3、6和12个月时记录肺功能（一秒用力呼气量[FEV1]占预计值的百分比）、生活质量（马克哮喘生活质量问卷）、哮喘症状（瓦塞尔法伦症状评分问卷）和药物使用情况（吸入皮质类固醇和β-激动剂）。