Psychoneuroimmunoendocrinology review and commentary

Townsend Letter for Doctors and Patients,  Jan, 2003  by Robert A. Anderson

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Psychoneuroimmunoendocrinology is the term describing the unity of mental, neurological, hormonal and immune functions with its many potential applications. PNIE addresses the influence of the cognitive images of the mind (whatever its elusive definition) on the central nervous system and consequent interactions with the endocrine and immune systems. It encompasses several arenas, including but not limited to biofeedback and voluntary controls, the impacts of thought and belief on physiology, past and present effects of stress on mental, emotional and physical function, placebo effects, cumulative effects of social relationships on health and disease, and contiguous and remote impacts of "energy medicine" on one's own function and that of others. This column highlights the impact of cogent studies from these arenas on the understanding of holistic medicine in this new millennium.

Asthma and programmed Buteyko breathing

Buteyko breathing teaches subjects how to reduce the depth and rate of respiration. Thirty-nine patients (age 1270) meeting criteria for asthma were recruited from the community and, after stratification for severity based on daily use of salbutamol or comparable bronchodilators, were randomly assigned to receive general asthma education and relaxation techniques including abdominal breathing, or to a series of Buteyko breathing training sessions. Medication continued to be used as needed. Patients recorded symptoms and medication use in a diary. At baseline, and at 3 months, flow volume loops were completed with and without bronchodilator, and patients completed a quality of life questionnaire. At each evaluation, indices of resting ventilation were determined. End-tidal CO2, FEV1, and peak expiratory flow did not change in either group. Use of betaagonist agents fell 904 v. 57 [micro]g/day in Buteyko and educational groups, respectively (p=.002), inhaled steroid use fell 49% and 0%, respectively (p=.06), an d minute volume decreased more in the Buteyko group (p=.004); quality of life scores were also significantly better in the Buteyko group.

Bowler SD et al. Buteyko breathing techniques in asthma: a blinded randomised controlled trial. Med J Aust 1998 Dec 7-21; 169(11-12):575-8.

COMMENT: In spite of no change in FEV1, CO2 and expiratory flow rate, minute volume improved and quality of life indices improved. This technique is a matter of programming better quality respiratory patterns with controlled practice. The feedback of better results strengthens the intentions and motivation in a positive feedback loop which achieves far more than mere education. The added component is experiential, always a very effective tool in teaching. When one experiences something, it is far better grounded than something which is only experienced cognitively.

Asthma and yoga

Forty-six asthmatic patients age 11-18 engaged in the practice of yoga for 90 minutes in the a.m. and 60 minutes in the p.m. for 40 days. The yoga exercises included krigas (cleansing practices), asanas (body postures) and pranayama (breathing practices). The following changes occurred: [FEV.sub.1] increased from 67.9% of predicted to 75.8% (p<.01); MVV (maximum ventilatory volume) improved from 70.9 to 85.8 L/min (p<.01); and MMFR (maximum mid-expiratory flow rate) increased from 94.5 to 121.1 L/min (NS). Physical fitness index (step test) increased from 324 to 343 (p<.01). After 2 years of followup (n=26) subjective responses termed "good" totaled 15, "fair" 9 and "poor" 2. Fourteen were totally asymptomatic and drug use decreased.

Jain SC et al. Effect of yoga training on exercise tolerance in adolescents with childhood asthma. J Asthma 1991; 28(6):437-42.

COMMENT: The practice of yoga in most of its forms involves physical, mental, and sometimes, emotional focus. Some of the results of yoga are similar to those experienced with biofeedback. Like biofeedback, yoga may address a specific disease process, but has generic benefits in nearly everyone who takes up the practice. One-third of the subjects in this study became asymptomatic within two years. And for those who succeed with incorporation of yoga practice, the benefit is permanent: i.e. the very function of the involved organ system is changed, as opposed to medication use in which the changed functions (lung in this case) require continued use of the medications.

Asthma and relaxation-biofeedback

Nine asthmatic patients were treated with 16 sessions of relaxation (progressive relaxation, desensitization) and EMG biofeedback and compared with nine who received a complex placebo. General condition was significantly better in the biofeedback group (p<.03). Frontalis muscle relaxation compared to controls was significantly better (p<.05). Respiration following a challenge with methacholine, which stimulates bronchospasm, was improved and subjective evaluation of life management was dramatically improved compared to placebo (p<.001).

Lehrer PM et al. Relaxation decreases large-airway but not small-airway asthma. J Psychosom Res 1986; 30(1):13-25