***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 
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    ***EXAMPLES*** 
    Input: An educational training program for children with asthma , aged between 8 and 13 years , was evaluated in an 18-month r and omized , controlled experiment , including three follow-up evaluations . The objective of the program is to improve coping with asthma in daily life . The program , ten 1-hour sessions , is a combination of self-management training and cognitive behaviour therapy in a group , using games and learning material s specifically design ed for this age group . From 195 asthmatic children , 112 with inadequate self-management abilities were selected ; these children were r and omly divided into an experimental group and two control groups . The results indicated highly significant differences in favor of the experimental group on the psychological and medical variables . There were no drop-outs during the program . The conclusion is that this multi-faceted program is an effective method of teaching children how to cope with their asthma and helping them to achieve a less anxious and more realistic attitude towards their illness AIM This article describes a study that aim ed to investigate the effect of nurse-delivered behaviour therapy on anxiety levels and quality of life in children with asthma and coexistent anxiety . METHOD A prospect i ve cohort pilot study in which ten children , aged between seven and ten years , with asthma and diagnosed with health-related anxiety took part . Data were collected over a two-year period , cognitive behaviour therapy sessions were provided , and asthma , anxiety and quality of life scores were measured . FINDINGS The Child and Adolescent Mental Health Services-devised , respiratory nurse-delivered , cognitive behaviour therapy programme was associated with an increase in quality of life for children with asthma and a decrease in anxiety levels and hyperventilation scores . CONCLUSION All nursing staff need to be aware of the detrimental effects of anxiety on asthma control , so that early symptoms of anxiety can be identified and addressed quickly The hierarchy of evidence in assessing the effectiveness of interventions or treatments is explained , and the gold st and ard for evaluating the effectiveness of interventions , the r and omised controlled trial , is discussed . Issues that need to be considered during the critical appraisal of r and omised controlled trials , such as assessing the validity of trial methodology and the magnitude and precision of the treatment effect , and deciding on the applicability of research results , are discussed . Important terminologies such as r and omisation , allocation concealment , blinding , intention to treat , p values , and confidence intervals are explained This study examined whether cognitive behavioural therapy ( CBT ) could prevent the development or worsening of panic-spectrum psychopathology and anxiety symptoms in chronic obstructive pulmonary disease ( COPD ) . 41 patients with COPD , who had undergone pulmonary rehabilitation , were r and omised to either a four-session CBT intervention condition ( n = 21 ) or a routine care condition ( n = 20 ) . Assessment s were at baseline , post-intervention , and at 6- , 12- and 18-month follow-ups . Primary outcomes were the rates of panic attacks , panic disorder and anxiety symptoms . Secondary outcomes were depressive symptoms , catastrophic cognitions about breathing difficulties , disease-specific quality of life and hospital admission rates . There were no significant differences between the groups on outcome measures at baseline . By the 18-month follow-up assessment , 12 ( 60 % ) routine care group participants had experienced at least one panic attack in the previous 6 months , with two ( 17 % ) of these being diagnosed with panic disorder , while no CBT group participants experienced any panic attacks during the follow-up phase . There were also significant reductions in anxiety symptoms and catastrophic cognitions in the CBT group at all three follow-ups and a lower number of hospital admissions between the 6- and 12-month follow-ups . The study provides evidence that a brief , specifically targeted CBT intervention can treat panic attacks in COPD patients and prevent the development and worsening of panic-spectrum psychopathology and anxiety symptoms 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 Confusion between panic and asthma symptoms can result in serious self-management errors . A cognitive behavior psychophysiological therapy ( CBPT ) intervention was culturally adapted for Latinos consisting of CBT for panic disorder ( PD ) , asthma education , differentiation between panic and asthma symptoms , and heart rate variability biofeedback . An RCT compared CBPT to music and relaxation therapy ( MRT ) , which included listening to relaxing music and paced breathing at resting respiration rates . Fifty-three Latino ( primarily Puerto Rican ) adults with asthma and PD were r and omly assigned to CBPT or MRT for 8 weekly sessions . Both groups showed improvements in PD severity , asthma control , and several other anxiety and asthma outcome measures from baseline to post-treatment and 3-month follow-up . CBPT showed an advantage over MRT for improvement in adherence to inhaled corticosteroids . Improvements in PD severity were mediated by anxiety sensitivity in CBPT and by depression in MRT , although earlier levels of these mediators did not predict subsequent improvements . Attrition was high ( 40 % ) in both groups , albeit comparable to CBT studies targeting anxiety in Latinos . Additional strategies are needed to improve retention in this high-risk population . Both CBPT and MRT may be efficacious interventions for comorbid asthma-PD , and CBPT may offer additional benefits for improving medication adherence An individualised asthma programme directed at behavioural change was evaluated in asthmatic subjects who reported complaints and impairment , despite adequate medical treatment . Mild-to-moderate asthma patients ( n=23 ) were r and omly assigned to a programme or waiting list condition . Outcome measures were : McMaster Asthma Quality of Life Question naire , Asthma Symptom Checklist , Negative Emotionality Scale , Knowledge , Attitude and Self-Efficacy Asthma Question naire , Adherence Scale , and peak flow measurements . Both groups were evaluated at three consecutive moments , each separated by 3 months ; the programme was delivered between the first two evaluations . At onset the patient received a workbook containing information , exercises and homework assignments . Psycho-education , behavioural and cognitive techniques were introduced during six 1‐h individual sessions . Compared with controls the programme group reported less symptoms ( obstruction , fatigue ) , better quality of life ( activity , symptoms , emotions ) , decreased negative affectivity , and increased adherence , immediately after finishing the programme and at 3 months follow-up . All three cognitive variables ( knowledge , attitude towards asthma , self-efficacy ) and day and night peak flow ratings improved in the programme group but not in the waiting list group . Participation in an individualised programme result ed in improvement of asthma morbidity , and asthma-related behaviour and cognitions , in subjects reporting symptoms and impairment despite adequate medical therapy BACKGROUND High levels of asthma-related fear and panic exacerbate asthma symptoms and complicate the management of asthma . Asthma-specific fear may be reduced by a cognitive behavioural intervention . We aim ed to test if there is a reduction in asthma-specific fear after cognitive behavioural intervention compared with routine treatment . METHODS Adults with asthma registered with family doctors in Sheffield UK were screened for anxiety and 94 highly anxious patients were r and omly allocated to receive either a cognitive behavioural intervention to improve self-management of their anxiety ( n = 50 ) or routine clinical care ( n = 44 ) . Asthma-specific fear at the end of treatment and at six month follow up were the primary endpoints . Service usage in the six months prior to and six months following the intervention was monitored to allow estimation of costs . Data were analysed by intention to treat . FINDINGS At the end of treatment , there was a significantly greater reduction in asthma-specific fear for people in the CBT group compared with controls . At six months after treatment the reduction in asthma-specific fear in the CBT group was increased and the difference between treatment and control group was statistically significant . Service use costs were not reduced in the CBT group . INTERPRETATION A brief cognitive behavioural intervention was found to have efficacy in reducing asthma-specific panic fear immediately after treatment and at 6 months follow up . There was no cost advantage to cognitive behavioural treatment ABSTRACT Objectives : Evidence for the efficacy of Cognitive Behavioural Therapy ( CBT ) in asthma is developing but it is not known if this translates to benefits in severe asthma or if a group approach is acceptable to this patient group . This study aim ed to assess the feasibility and acceptability of Group-CBT in severe asthma . Method : This was a two-centre , r and omised controlled parallel group feasibility study . Eligible participants ( patients with severe asthma and a clinical ly significant diagnosis of anxiety and /or depression – Hospital Anxiety and Depression Scale ( HAD ) score greater than 8 for the anxiety or depression sub-scale ) received Group-CBT in weekly sessions for eight consecutive weeks and usual care or usual care only . Follow-up was for 16 weeks and end points were : Asthma Quality of Life Question naire , Asthma Control Question naire , HAD , Dyspnoea-12 , EuroQual-5D and EuroQuol-VAS . Results : 51 patients were r and omised : 36 % ( 51 out of 140 ) consent rate and attrition at week 16 was 12 . Screening logs indicated that study take-up was influenced by patients living long distances from the treatment centre and inability to commit to the weekly dem and s of the programme . Drop-out was higher in Group-CBT compared due to inability to commit to the weekly programme because of poor health . Participants who contributed to focus group discussion s reported that Group-CBT contributed to a better underst and ing of their illness and related approaches to anxiety management and acceptance of their asthma condition . Although weekly face-to-face sessions were challenging , this was the preferred method of delivery for these participants . Conclusions : This feasibility study shows that Group-CBT warrants further investigation as a potentially promising treatment option for patients with severe asthma . It has been possible but not easy to recruit and retain the sample . Options for a less dem and ing intervention schedule , such as less frequent face-to-face visits and the use of web-based interventions , require careful consideration 
    Output:
    
Studies were more likely to indicate beneficial effects where anxiety-focused ( rather than illness-focused ) intervention protocol s were utilised , asthma-related education was provided and where the trials focused on individuals with likely clinical levels of anxiety at baseline .
Whilst further high- quality research is needed , available evidence is supportive of  anxiety-focused CBT interventions tailored to target the particular mechanisms thought to maintain this comorbidity in asthma