***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Asthma patients pose special problems as far as the medical supervision , danger of symptoms and the course of the disease are concerned . Some 90 asthma patients were registered for the treatment in the Heidelberg Medical Clinic . 31 patients who were interested in taking part were r and omized into 3 groups : two treatment group consisted of the exchange of information , discussion sessions on the illness as well as ' autogenic training ' or ' functional relaxation ' . The third group was the control group . Before and after treatment the patients were su bmi tted to a thorough examination both of lungs and other internal organs as well as from the psychodiagnostical point of view . The average age of the patients was 43.5 years and the average duration of illness 16.8 years . Nevertheless , the treatment group 's sympathomimetics use was significantly reduced by 1 year of treatment ( p less than 0.05 ) ; the use of steroids decreased as well . The number of visits of the general practitioner also decreased . These results support the conclusion that psychosomatic group therapy can make an important contribution to the treatment of asthma patients .  Body therapy practised in ' autogenic training ' and ' functional relaxation ' seems to be another important healing factor for the treatment in addition to the discussion sessions and the exchange of information Background : Morbidity and mortality associated with severe asthma might be reduced by interventions that address psychosocial factors contributing to adverse outcomes . A study was undertaken to assess the effectiveness of a 6 month home based psychoeducational intervention delivered by a respiratory nurse specialist for adults at risk of adverse asthma outcomes . Methods : A pragmatic r and omised controlled trial was performed in 92 adults registered with hospital or primary care asthma clinics . All had previous hospital admissions and /or were on British Thoracic Society step 4–5 treatment and had failed to attend clinic appointments or were considered to have poor adherence to other aspects of their agreed management . Patients were visited in their homes for assessment and , where appropriate , intervention . The main outcomes measured were symptom control , asthma specific quality of life , and generic health status . Results : At the 6 month primary time point there were no significant differences between usual care and intervention groups in mean symptom control , physical functioning , or mental health scores ( differences ( with 95 % CI ) −0.35 ( −1.83 to 1.13 ) , 3.10 ( −11.42 to 17.63 ) , 0.42 ( −10.22 to 11.07 ) , respectively ) . Small effects on asthma specific quality of life up to 12 months ( e.g. adjusted difference at 12 months 0.13 ( 95 % CI 0.02 to 0.25 ) ) and short term effects on generic health status , which mirrored improvements in aspects of self-care observed at the end of the intensive phase of the intervention , were apparent only from fully adjusted analyses . Conclusions : A home based intervention provided by a nurse receiving psychological supervision may have effects on quality of life but is overall of limited long term benefit to adults at risk of adverse asthma outcomes Stress , unpleasant emotions and autonomic imbalance may play a main role in precipitating asthmatic attacks . In this study two homogeneous groups of asthmatic patients ( N = 24 ) are treated over an eight-month period . The experimental group was treated with autogenic therapy and the control group with supportive group psychotherapy .  Respiratory function parameters measured were Forced Vital Capacity ( FVC ) , Forced Expiratory Volume in the first sec ( FEV1 ) , Forced Expiratory Flow between 25 % and 75 % of the FVC ( FEF25 - 75 % ) , and Mesoexpiratory Flow ( MEF50 % ) . The group under Autogenic Therapy obtained a relevant clinical improvement ( > 15 % of pretreatment values ) in respiratory function . No significant changes were observed in the control group . These results suggest that autogenic therapy could be an effective adjunctive treatment in bronchial asthma One hundred six asthmatic subjects were medically prestabilized , then assigned to eight sessions of progressive relaxation , music , or a waiting-list .  Seventy-two subjects completed treatment , of which 37 were evaluated in the laboratory with measures of forced expiratory flow . Relaxation-group subjects reported feeling the most deeply relaxed and produced the greatest improvement in forced expiratory flow during the last presession assessment period . All groups evidence d decreases in asthma symptoms . All groups showed decreases in pulmonary function immediately after relaxation sessions . None of the changes in pulmonary function reached levels that are accepted in drug trials to be of clinical significance , and the therapeutic changes occurred only in the situation where training was rendered . Listening to music produced greater decreases in peaks of tension than progressive relaxation , and it produced greater compliance with relaxation practice , but it did not produce any specific therapeutic effects on asthma CONTEXT Despite the growing number of studies of imagery and the use of complementary and alternative modalities as treatments for asthma , research on mental imagery in adults with asthma is practically , nonexistent . The purpose of this feasibility study was to lay groundwork for a larger follow-up clinical trial . OBJECTIVE To determine whether pulmonary function , asthma symptoms , quality of life , depression , anxiety , and power differ over time in adults with asthma who do and do not practice mental imagery ( MI ) .  ( Power is the ability to make aware choices with the intention of freely involving oneself in creating desired change . ) DESIGN R and omized controlled study using univariate repeated measures analysis of variance ( ANOVA ) and replacement through block design . SETTING Lenox Hill Hospital , an affiliate of New York University Medical School , New York , NY . SUBJECTS Sixty-eight adults with symptomatic asthma , after 4 weeks of baseline data collection and analysis , met requirements for this r and omized controlled study . Thirty-three completed pulmonary function as well as self-report tests at 4 time points over 17 weeks . The 16 experimental participants also completed the 4-session imagery protocol . INTERVENTION Individual imagery instruction ( week 1 ) and follow-up ( weeks 4 , 9 , 15 ) . Participants were given 7 imagery exercises to select from and practice 3 times a day for a total of 15 minutes . MAIN OUTCOME MEASURES 1 ) Spirometry ( FEV1 ) ; 2 ) medication use ; 3 ) Asthma Quality of Life Question naire ; 4 ) Beck Depression Inventory ; 5 ) Spielberger Anxiety Scales ( A-State and A-Trait ) ; 6 ) Barrett Power as Knowing Participation in Change Tool , Version II ; 7 ) Epstein Balloon Test of Ability to Image . RESULTS There was little evidence of statistical change in this feasibility study ; yet , valuable lessons were learned . Paired t-tests indicated there was a significant difference in the total power scores in the imagery group , and in the expected direction ( two-tailed , t-statistic = -2.3 , P = 0.035 ) and the choices sub-scale ( two-tailed , tstatistic = -2.93 , P = 0.01 ) of the power instrument from weeks one to 16 of the study . Eight of 17 ( 47 % ) participants in the MI group reduced or discontinued their medications . Three of 16 ( 19 % ) participants in the control group reduced their medications ; none discontinued . Chi-square indicated differences between groups ( X2 = 4.66 , P = 0.05 ) . Persons who reduced or discontinued their medications showed neither an increase in pulmonary function prior to medication discontinuation , nor a fall in these parameters following discontinuation . CONCLUSIONS Findings related to major outcome measures must be viewed with caution due to the small sample size result ing from attrition related to labor intensiveness and , therefore , low statistical power . However , the study did provide significant data to plan a larger scale study of the use of mental imagery with adult asthmatics . The study also demonstrated that imagery is inexpensive , safe and , with training , can be used as an adjunct therapy by patients themselves . Its efficacy needs additional exploration . Further research for adults with asthma who practice imagery is important , as current treatments are not entirely efficacious . Lessons learned in this study may facilitate improvement in research design Objective : This study examined the within-person relations between transitory changes in mood  ,  asthma symptoms  , and peak expiratory flow rate ( PEFR ) . Methods : Thrice-daily for 21 consecutive days , 48 adults with moderate to severe asthma entered information in palm-top computers about their mood and asthma symptoms . A multidimensional model of mood , ie , the mood circumplex , informed the assessment of mood arousal and mood pleasantness . At each observation , participants also recorded their  PEFR  with peak flow meters that stored blinded data . Albuterol doses were also monitored electronically . Before and after the 21-day study , spirometric measures of airways obstruction were taken under controlled conditions . Results : R and om effects regression models revealed a significant , but weak , within-person relation between symptoms and PEFR . Changes in mood vectors with an arousal component were significantly related to PEFR changes , whereas changes in mood vectors with a pleasantness component tracked changes in asthma symptom reports , even after adjustment for contemporaneous PEFR and after controlling for time of day and albuterol dosing . Comparison of spirometric assessment s with unsupervised PEFR suggested that part of the relation between mood arousal and PEFR may be attributable to the “ effort-dependence ” of peak flow self-monitoring . Conclusions : Different dimensions of mood were associated with transitory changes in asthma symptoms and PEFR . This may be one reason why individuals with asthma misperceive the severity of their symptoms in relation to underlying airways obstruction Abstract Several behavioral medicine interventions ( eg , relaxation training and written emotional expression ) have been proposed as effective supplemental treatments for individuals with chronic illnesses such as asthma . Whether these treatments are feasible or effective in a manual-based , self-administered format is unclear , and few studies have examined the effectiveness of such treatments presented in a complementary format . We examined the feasibility and effectiveness of a 4 week stress management treatment compared with a matched placebo intervention in young adults with asthma . Both groups considered the workbooks credible treatment interventions and completed them conscientiously . The treatment group showed significant improvement in measures of lung function compared with the placebo group , but analysis revealed no differences in measures of perceived stress . These findings provide initial support for the feasibility of self-administered manual-based interventions and some evidence that they can produce health benefits in individuals with asthma and , perhaps other chronic conditions There is evidence that educational programmes may improve patient 's compliance with asthma treatment and control symptoms . Whilst medical parameters have been thoroughly studied , few data are available concerning psychological intervention . The aim of our open pilot study was to verify whether any difference in perceived illness and response style to asthma existed in the patients enrolled in an  Asthma Rehabilitation Group  ( ARG ) and in a Control Group ( CG ) . Forty consecutive asthmatics were r and omly enrolled , all of whom were diagnosed , treated and followed-up according to the International Guidelines . Both groups underwent a  psychological assessment  at baseline and after one year . A battery of question naires was used to obtain data relating to baseline characteristics ( anxiety , depression , psychophysiological disorders ) , emotional reactions to asthma attacks ( panic-fear , etc , ) and cognitive variables ( external control , psychological stigma , internal beliefs , external chance , etc . ) involved in the perceived illness . In addition , the Asthma Rehabilitation Group patients underwent an educational programme and a cognitive-behavioural intervention . In both groups , a reduction of anxiety and depression scores was observed , as well as a significant improvement of the medical parameters evaluated . Only the Asthma Rehabilitation Group reported lower scores on the Psychophysiological Question naire and on the External Control Subscale after 1 year . The Control Group reported higher score on the External Chance Scale . The data of our study seem to confirm the effectiveness of psychological intervention on the cognitive skills involved in the perception and management of asthma . Larger scale studies on this topic are suggested This study tested the efficacy of a nurse-administered 8-week group treatment program for adults with asthma suffering from coexisting panic disorder . The program consisted of cognitive behavioral treatment ( CBT ) for panic disorder combined with asthma education ( AE ) .  Forty-eight women with a confirmed diagnosis of asthma and panic disorder were r and omly allocated to a treatment condition ( n=25 ) and a wait-list control condition ( n=23 ) . Twenty-five participants —15 in the treatment group and 10 in the wait-list control group— completed treatment . Repeated measures ANOVA procedures were used to compare the groups on panic and asthma outcomes at posttreatment and 6-month follow-up . The results demonstrate that the CBT-AE program is capable of producing substantial and durable antipanic and antianxiety treatment effects and led to substantial but nonsustained improvement in morning peak-flow expiratory rate and asthma-related quality of life . Implication s of these findings for this clinical population are addressed Abstract Twelve patients with chronic bronchial asthma were matched in pairs and r and omly assigned to two treatment groups , one group received mental and muscular relaxation , the second group received muscular relaxation alone . Treatment consisted of 4 weekly treatment sessions . Pre , post and follow-up phases each consisted of 3 weekly sessions . Respiratory function was measured by the forced expiratory volume in 1 second ( FEV 1 ) . Two self-report inventories were used to measure change in the symptoms and signs of the patient 's asthma . Following factor analysis , 3 factors were used — Psychological , Physical and Bronchoconstriction . Results showed that for each of these 3 factors and for FEV 1 , there was no overall mean significant difference between results in either treatment group . In addition , patients showed no significant trend of improvement in respiratory 
    Output:
    
Some promising results did emerge from meta-analyses performed .
However , due to heterogeneity and the low quality of included studies , this review was unable to draw firm conclusions for the role of psychological interventions in asthma .