RESEARCH FINDINGS USING GUIDED IMAGERY FOR

CHILDHOOD ASTHMA

July, 2006

Definition of the problem

Pediatric asthma is chronic inflammation of the airways. Children with asthma have inflammation of their bronchial tree, leading to partial airway blockage by swelling and mucus. Their airways also narrow. This combination can make breathing extremely difficult. The causes of asthma are not fully understood, but include genetic tendencies, exposure to environmental irritants, and stress (American Lung Association2002).

Dimensions and costs of the problem

Statistics for the year 1998 indicate that chronic pediatric asthma affects 4.8 million children in the United States (American Academy of Allergy, Asthma & Immunology, 2002). The incidence of pediatric asthma increased 74% between 1980 and 1994, probably due to increased indoor and outdoor air pollution (National Institutes of Health, 1998).

Asthma is a leading cause of missed school (10 million), kills 5,000 children annually, and the care of asthmatic children cost the economy $1 billion due to missed work days for parents (NIH). According to GlaxoSmithKline’s web site ibreathe.com, the estimated annual cost of treating asthma in children under 18 years of age in 1999 was $3.2 billion. Asthma is the most prevalent chronic condition in American children (Klements, 2001).

Medical Treatment of Pediatric Asthma

A wide range of asthma medications has greatly improved treatment of young asthmatics. Steroid inhalers can now reduce inflammation. Bronchodilators can open constricted airways. A number of oral medications can moderate immune response and reduce airway sensitivity.

Improved home monitoring of asthma can greatly reduce the incidence of respiratory emergencies. Use of peak flow meters to check children’s respiratory status can give ample warning of an impending attack (Klements, 2001).

Problems in treating pediatric asthma

Several difficulties remain in medical management of pediatric asthma. As many as 70% of patients do not take their steroid inhalers as prescribed. Most patients and families still do not have a peak flow meter or do not use it (Rand and Wise, 1994). The expense of asthma medications and medical care is a major problem for some families. Many families do not regard asthma as a serious problem, and stressful family dynamics can worsen a child’s condition or ability to cope with it.

Non-medical therapies including imagery

There is a large body of research on the effective use of self-hypnosis, guided imagery, hypnosis and relaxation in asthma in adults (Ewer and Stewart, 1996; Hackman, Stern, and Gershwin, 2000; Maher-Loughna, Macdonald, et al, 1962) and children (Anbar, 2001; Anbar, 2002; Castes, Hagel, et al, 1999; Kohen, Olness, et al, 1984). For example, pulmonologist Ran Anbar (2001) found that 13 of 16 pediatric patients who learned self-hypnosis (guided imagery) had no shortness of breath within one month, and this improvement continued for nine months of follow-up.

Two of seven patients on inhaled steroids were able to discontinue them, and their lung function remained normal. In another Anbar (2002) study, 303 pediatric asthmatics were offered hypnosis (with 254 participating and continuing to follow up). Some of these children’s symptoms resolved after one session, and there was measurable improvement in 80% of the others. No one’s symptoms got worse.

In another study, after 25 preschoolers and their parents used a relaxation and imagery program, the children’s symptoms were less severe and they needed fewer office visits. The number of asthmatic episodes did not change significantly, but their ability to cope did. Preschoolers developed new cooperation in asthma-care skills, including cooperative and consistent performance of peak flow measurements (Kohen and Wynne, 1997).

In addition, relaxation and imagery has been found to reduce stress and improve patient and family coping with asthmatic children (Kohen and Wynne, 1997; Chernoff, Ireys et al, 2002).

Pulmonary rehabilitation breathing exercises (Bingol Karakoc, Yilmaz, et al, 2000), massage (Field, Henteleff, et al, 1998), and increased self-monitoring with peak flow meters Klements, 2001) have also been shown effective in pediatric asthma.

Conclusion

Guided imagery can improve coping skills, willingness to follow treatment regimens and lifestyle changes, and reduce the severity, though perhaps not the frequency, of asthmatic episodes.

References

American Academy of Allergy, Asthma & Immunology. Pediatric Asthma. Originally published in Discover. April, 2002. Quoted on:
http://www.aaaai.org/patients/allergic_conditions/pediatric_asthma/ped_allergies_asthma_discover.stm
Accessed July, 2006.

American Lung Association Asthma Advisory Group with Norman Edelman, M.D. Family Guide to Asthma and Allergies. 1997 Little, Brown and Company, pp 1–13.

Anbar RD. Self-hypnosis for management of chronic dyspnea in pediatric patients. Pediatrics. 2001 Feb;107(2):E21.

Anbar RD. Hypnosis in pediatrics: applications at a pediatric pulmonary center. BMC Pediatr. 2002 Dec;3;2(1):11.

Bingol Karakoc G, Yilmaz M, Sur S, Ufuk Altintas D, Sarpel T, Guneter Kendirli S. The effects of daily pulmonary rehabilitation program at home on childhood asthma. Allergol Immunopathol (Madr). 2000 Jan-Feb;28(1):12-4.

Castes M, Hagel I, Palenque M, Canelones P, Corao A, Lynch NR. Immunological changes associated with clinical improvement of asthmatic children subjected to psychosocial intervention. Brain Behav Immun. 1999 Mar;13(1):1-13.

Chernoff RG, Ireys HT, DeVet KA, Kim YJ. A randomized, controlled trial of a community-based support program for families of children with chronic illness: pediatric outcomes. Arch Pediatr Adolesc Med. 2002 Jun;156(6):533-9.

Ewer TC, Stewart DE. Improvement in bronchial hyper-responsiveness in patients with moderate asthma after treatment with a hypnotic technique: a randomized controlled trial. British Medical Journal. 1986 Nov 1; 293(6555) 1129-32.

Field T, Henteleff T, Hernandez-Reif M, Martinez E, Mavunda K, Kuhn C, Schanberg S. Children with asthma have improved pulmonary functions after massage therapy. J Pediatr. 1998 May;1.

GlaxoSmithKline. My Child’s Asthma – Pediatric Asthma Statistics. 2002. http://www.healthsmart.org/ibreathe/2_0_asthma/2_6_3_pediatric_asthma_stats.htm Accessed July, 2006.

Hackman RM, Stern JS, Gershwin ME. Hypnosis and asthma: a critical review. Journal of Asthm. 2000 Feb 37(1): 1–15.

Klements EM. Monitoring peak flow rates as a health-promoting behavior in managing and improving asthma. Clin Excell Nurse Pract. 2001 May;5(3):147-51.

Kohen DP, Wynne E. Applying hypnosis in a preschool family asthma education program: uses of storytelling, imagery, and relaxation. Am J Clin Hypn. 1997 Jan;39(3):169-81.

Kohen DP, Olness KN, Colwell SO, Heimel A. The use of relaxation-mental imagery (self-hypnosis) in the management of 505 pediatric behavioral encounters. J Dev Behav Pediatr. 1994 Feb;5(1):21-5.

Maher-Loughna GP, Macdonald N, Mason AA, Fry L. Controlled trial of hypnosis in the symptomatic treatment of asthma. British Medical Journal. 1994 (2): 371-76.

National Institutes of Health. Press Release. Global Plan Launched To Cut Childhood Asthma Deaths by 50%. Dec. 11, 1998. http://www.nhlbi.nih.gov/new/press/asthma1.htm Accessed July, 2006.

Rand CS, Wise RA. Measuring adherence to asthma medication regimens. Am J Resp Crit Care Med. 1994 149: S69-76.