***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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    Input: STUDY OBJECTIVES We evaluated the effectiveness of heart rate variability ( HRV ) biofeedback as a complementary treatment for asthma . PATIENTS Ninety-four adult outpatient paid volunteers with asthma . SETTING The psychophysiology laboratory at The University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School , and the private outpatient offices of participating asthma physicians . INTERVENTIONS The interventions were as follows : ( 1 ) a full protocol ( ie , HRV biofeedback and abdominal breathing through pursed lips and prolonged exhalation ) ; ( 2 ) HRV biofeedback alone ; ( 3 ) placebo EEG biofeedback ; and ( 4 ) a waiting list control . DESIGN Subjects were first prestabilized using controller medication and then were r and omly assigned to experimental groups . Medication was titrated biweekly by blinded asthma specialists according to a protocol based on National Heart , Lung , and Blood Institute guidelines , according to symptoms , spirometry , and home peak flows . MEASUREMENTS Subjects recorded daily asthma symptoms and twice-daily peak expiratory flows . Spirometry was performed before and after each weekly treatment session under the HRV and placebo biofeedback conditions , and at triweekly assessment sessions under the waiting list condition . Oscillation resistance was measured approximately triweekly . RESULTS Compared with the two control groups , subjects in both of the two HRV biofeedback groups were prescribed less medication , with minimal differences between the two active treatments . Improvements averaged one full level of asthma severity . Measures from forced oscillation pneumography similarly showed improvement in pulmonary function . A placebo effect influenced an improvement in asthma symptoms , but not in pulmonary function . Groups did not differ in the occurrence of severe asthma flares . CONCLUSIONS The results suggest that HRV biofeedback may prove to be a useful adjunct to asthma treatment and may help to reduce dependence on steroid medications . Further evaluation of this method is warranted Background : An integrated breathing and relaxation technique known as the Papworth method has been implemented by physiotherapists since the 1960s for patients with asthma and dysfunctional breathing , but no controlled trials have been reported . This study evaluated the effectiveness of the Papworth method in a r and omised controlled trial . Methods : Eighty-five patients ( 36 men ) were individually r and omised to the control group ( n = 46 ) or to the intervention group receiving five sessions of treatment by the Papworth method ( n = 39 ) . Both groups received usual medical care . Assessment s were undertaken at baseline , post-treatment ( 6 months after baseline ) and at 12 months . The primary outcome measure was the St George ’s Respiratory Symptoms Question naire ( SGRQ ) . Secondary outcome measures included the Hospital Anxiety and Depression Scale ( HADS ) , the Nijmegen dysfunctional breathing question naire and objective measures of respiratory function . Results : Post-treatment and 12 month data were available for 78 and 72 patients , respectively . At the post-treatment assessment the mean ( SD ) score on the SGRQ Symptom subscale was 21.8 ( 18.1 ) in the intervention group and 32.8 ( 20.1 ) in the control group ( p = 0.001 for the difference ) . At the 12 month follow-up the corresponding figures were 24.9 ( 17.9 ) and 33.5 ( 15.9 ) ( p = 0.007 for the difference ) . SGRQ Total scores and HADS and Nijmegen scores were similarly significantly lower in the intervention group than in the control group . The groups did not differ significantly following the treatment on objective measures of respiratory function except for relaxed breathing rate . Conclusions : The Papworth method appears to ameliorate respiratory symptoms , dysfunctional breathing and adverse mood compared with usual care . Further controlled trials are warranted to confirm this finding , assess the effect in other patient groups and determine whether there is some effect on objective measures of respiratory function 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 : Asthma is a frequently disabling and almost invariably distressing disease that has a high overall prevalence . Although relaxation techniques and hypnotherapeutic interventions have proven their effectiveness in numerous trials , relaxation therapies are still not recommended in treatment guidelines due to a lack of method ological quality in many of the trials . Therefore , this study aims to investigate the efficacy of the brief relaxation technique of functional relaxation ( FR ) and guided imagery ( GI ) in adult asthmatics in a r and omized controlled trial . Methods : 64 patients with extrinsic bronchial asthma were treated over a 4-week period and assessed at baseline , after treatment and after 4 months , for follow-up . 16 patients completed FR , 14 GI , 15 both FR and GI ( FR/GI ) and 13 received a placebo relaxation technique as the control intervention ( CI ) . The forced expiratory volume in the first second ( FEV1 ) as well as the specific airway resistance ( sRaw ) were employed as primary outcome measures . Results : Participation in FR , GI and FR/GI led to increases in FEV1 ( % predicted ) of 7.6 ± 13.2 , 3.3 ± 9.8 , and 8.3 ± 21.0 , respectively , as compared to –1.8 ± 11.1 in the CI group at the end of the therapy . After follow-up , the increases in FEV1 were 6.9 ± 10.3 in the FR group , 4.4 ± 7.3 in the GI and 4.5 ± 8.1 in the FR/GI , compared to –2.8 ± 9.2 in the CI . Improvements in sRaw ( % predicted ) were in keeping with the changes in FEV1 in all groups . Conclusions : Our study confirms a positive effect of FR on respiratory parameters and suggests a clinical ly relevant long-term benefit from FR as a nonpharmacological and complementary therapy treatment option Background : Asthma is a serious medical problem in pregnancy and is often associated with stress , anger and poor quality of life . The aim of this study was to determine the efficacy of progressive muscle relaxation ( PMR ) on change in blood pressure , lung parameters , heart rate , anger and health-related quality of life in pregnant women with bronchial asthma . Methods : We treated a sample of 64 pregnant women with bronchial asthma from the local population in an 8-week r and omized , prospect i ve , controlled trial . Thirty-two were selected for PMR , and 32 received a placebo intervention . The systolic blood pressure , forced expiratory volume in the first second , peak expiratory flow and heart rate were tested , and the State-Trait Anger Expression Inventory and  Health Survey ( SF-36 ) were employed . Results : According to the intend-to-treat principle , a significant reduction in systolic blood pressure and a significant increase in both forced expiratory volume in the first second and peak expiratory flow were observed after PMR . The heart rate showed a significant increase in the coefficient of variation , root mean square of successive differences and high frequency ranges , in addition to a significant reduction in low and middle frequency ranges . A significant reduction on three of five State-Trait Anger Expression Inventory scales , and a significant increase on seven of eight SF-36 scales were observed . Conclusions : PMR appears to be an effective method to improve blood pressure , lung parameters and heart rate , and to decrease anger levels , thus enhancing health-related quality of life in pregnant women with bronchial asthma 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 Objectives This pilot study aim ed to evaluate the feasibility and potential benefits of a novel biofeedback breathing training for achieving sustained increases in pCO2 levels . Methods Twelve asthma patients were r and omly assigned to an immediate 4-week treatment group or waiting list control . Patients were instructed to modify their respiration in order to change levels of end-tidal pCO2 using a h and -held capnometer . Treatment outcome was assessed in frequency and distress of symptoms , asthma control , lung function , and variability of peak expiratory flow ( PEF ) . Results We found stable increases in pCO2 and reductions in respiration rate during treatment and 2-month follow-up . Mean pCO2 levels rose from a hypocapnic to a normocapnic range at follow-up . Frequency and distress of symptoms was reduced and reported asthma control increased . In addition , mean PEF variability decreased significantly in the treatment group . Conclusions Our pilot intervention provided evidence for the feasibility of pCO2-biofeedback training in asthma patients 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 A prospect i ve , r and omised , single blind , and controlled trial of a hypnotic technique was undertaken in 39 adults with mild to moderate asthma grade d for low and high susceptibility to hypnosis . After a six week course of hypnotherapy  12 patients with a high susceptibility score showed a 74.9 % improvement ( p less than 0.01 ) in the degree of bronchial hyper-responsiveness to a st and ardised methacholine challenge test . Daily home recordings of symptoms improved by 41 % ( p less than 0.01 ) , peak expiratory flow rates improved by 5.5 % ( p less than 0.01 ) , and use of bronchodilators decreased by 26.2 % ( p less than 0.05 ) . The improvement in bronchial hyper-reactivity occurred without a change in subjective appreciation of the degree of bronchoconstriction . A control group 17 patients and 10 patients undergoing treatment with low susceptibility to hypnosis had no change in either bronchial hyper-responsiveness or any of the symptoms recorded at home . This study shows the efficacy of a hypnotic technique in adult asthmatics who are moderately to highly susceptible to hypnosis Background This study evaluated the efficacy of a mindfulness training programme ( mindfulness-based stress reduction ( MBSR ) ) in improving  asthma-related quality of life and lung function in patients with asthma . Methods A r and omised controlled trial compared an 8-week MBSR group-based programme ( n=42 ) with an educational control programme ( n=41 ) in adults with mild , moderate or severe persistent asthma recruited at a university hospital outpatient primary care and pulmonary care clinic . Primary outcomes were quality of life ( Asthma Quality of Life Question naire ) and lung function ( change from baseline in 2-week average morning peak expiratory flow ( PEF ) ) . Secondary outcomes were asthma control assessed by 2007 National Institutes of Health/National Heart Lung and Blood Institute guidelines , and stress ( Perceived Stress Scale ( PSS ) ) . Follow-up assessment s were conducted at 10 weeks , 6 and 12 months . Results At 12 months MBSR result ed in clinical ly significant improvements from baseline in quality of life ( differential change in Asthma Quality of Life Question naire score for MBSR vs control : 0.66 ( 95 % CI 0.30 to 1.03 ; p<0.001 ) ) but not in 
    Output:
    
Deficiencies in the current evidence base , notably trial heterogeneity , means that application to clinical practice is limited and clear guidelines regarding the use of nonpharmacological therapies in asthma is limited .
Relaxation and CBT , however , appear to have a consistent positive effect on asthma-related quality of life and some psychological outcomes , and lung function ( relaxation only ) .