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Heart Rate Variability Biofeedback Does Not Substitute for Asthma Steroid Controller Medication

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Abstract

Despite previous findings of therapeutic effects for heart rate variability biofeedback (HRVB) on asthma, it is not known whether HRVB can substitute either for controller or rescue medication, or whether it affects airway inflammation. Sixty-eight paid volunteer steroid naïve study participants with mild or moderate asthma were given 3 months of HRVB or a comparison condition consisting of EEG alpha biofeedback with relaxing music and relaxed paced breathing (EEG+), in a two-center trial. All participants received a month of intensive asthma education prior to randomization. Both treatment conditions produced similar significant improvements on the methacholine challenge test (MCT), asthma symptoms, and asthma quality of life (AQOL). MCT effects were of similar size to those of enhanced placebo procedures reported elsewhere, and were 65% of those of a course of a high-potency inhaled steroid budesonide given to a sub-group of participants following biofeedback training. Exhaled nitric oxide decreased significantly only in the HRVB group, 81% of the budesonide effect, but with no significant differences between groups. Participants reported becoming more relaxed during practice of both techniques. Administration of albuterol after biofeedback sessions produced a large improvement in pulmonary function test results, indicating that neither treatment normalized pulmonary function as a potent controller medication would have done. Impulse oscillometry showed increased upper airway (vocal cord) resistance during biofeedback periods in both groups. These data suggest that HRVB should not be considered an alternative to asthma controller medications (e.g., inhaled steroids), although both biofeedback conditions produced some beneficial effects, warranting further research, and suggesting potential complementary effects. Various hypotheses are presented to explain why HRVB effects on asthma appeared smaller in this study than in earlier studies. Clinical Trial Registration NCT02766374.

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Abbreviations

ACT:

Asthma Control Test

AQOL:

Juniper’s Asthma Quality of Life Questionnaire with Standardized Activities

AX:

A forced oscillation measure of lung reactance

EEG+:

The comparison condition, comprising EEG biofeedback, relaxing music, and relaxed paced breathing at ~ 15 breaths/min

EPAC:

Episodes of poor asthma control

eNO:

Exhaled nitric oxide

FEV1 :

Quantity of air exhaled in the first second of a forced expiratory maneuver from maximum vital capacity

FVC:

Total air exhaled in a forced expiratory maneuver from maximum vital capacity

GEE:

Generalized estimating equation

HRV:

Heart rate variability

HRVB:

Heart rate variability biofeedback

ICS:

Inhaled corticosteroids

IOS:

Impulse oscillometry system

LS mean:

Least square mean

MCT:

Methacholine challenge test

NJH:

National Jewish Health

PC20FEV1 :

The dose of methacholine at which a 20% decrease in FEV1 occurs

PEF:

Peak expiratory flow during a forced airway maneuver

RSA:

Respiratory sinus arrhythmia

RWJMS:

Robert Wood Johnson Medical School

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Acknowledgements

This research was funded by National Institutes of Health – National Heart Lung and Blood Institute Grant #R01 HL089495, and at the National Jewish site was supported by NIH/NCATS Colorado CTSI Grant Number UL1 TR001082. Contents are the sole responsibility of the authors and do not necessarily represent official NIH views. The study was approved by the institutional review boards of Rutgers Robert Wood Johnson Medical School # 0220080228 and National Jewish Health # 17604.

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Authors and Affiliations

  1. Department of Psychiatry, Rutgers – Robert Wood Johnson Medical School, 671 Hoes Lane, Piscataway, NJ, 08854, USA

    Paul M. Lehrer, Anthony Scardella, Beatrix Roehmheld-Hamm & Milisyaris Aviles-Velez

  2. University of Colorado School of Medicine, Aurora, CO, USA

    Flavia Hoyte, Harold Nelson & Frederick S. Wamboldt

  3. University of Vermont, Larner College of Medicine, Burlington, VT, USA

    Charles G. Irvin

  4. Rutgers School of Public Health, Piscataway, NJ, USA

    Shou-En Lu

  5. Rutgers, The State University of New Jersey, Piscataway, NJ, USA

    Evgeny G. Vaschillo & Bronya Vaschillo

  6. National Jewish Health, Denver, CO, USA

    Jessica Graves, Flavia Hoyte, Harold Nelson & Frederick S. Wamboldt

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  1. Paul M. Lehrer
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Lehrer, P.M., Irvin, C.G., Lu, SE. et al. Heart Rate Variability Biofeedback Does Not Substitute for Asthma Steroid Controller Medication. Appl Psychophysiol Biofeedback 43, 57–73 (2018). https://doi.org/10.1007/s10484-017-9382-0

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