Heart Rate Variability Biofeedback: It's Role in Asthma Therapeutics

NCT02766374 | Completed Results DMC

• 1 other identifier: R01HL089495-01A2
• Study Type: interventional
• Target: 68
• Locations: 1 country
• Sites: 2

Brief Summary

The goal of this research study to see whether biofeedback therapy helps treat asthma, and if so, how it works. Biofeedback is a treatment method that can teach how to bodily control. Biofeedback is widely used to help people relax. In this study however, the investigators want to learn if a specific type of biofeedback actually improves asthma in a way that might allow the reduction or elimination of other controller treatments like inhaled-corticosteroids.

Conditions

Asthma

Keywords

Asthma; Biofeedback; Heart rate variability biofeedback; Inhaled corticosteroids

Outcome Measures

Primary Outcomes (1)

• Magnitude Change of Airway Reactivity Measured by Methacholine PC20FEV1

  Change in PEC20FEV1 measured after biofeedback from the PC20FEV1 measured at baseline

  4-weeks

Study Arms (2)

Heart Rate Variability Biofeedback

EXPERIMENTAL

During the first training session, we will measure heart rate variability (HRV) amplitude while the patient breathes for two minutes at a frequency ranging between 4.5-6.5 breaths/min, providing a "pacing stimulus" for this purpose. In subsequent sessions, the individual will be given personal heart rate variability biofeedback (HRV-BF), and instructed to increase the amplitude of heart rate oscillations, using a cardiotachometer tracing and frequency peaks as biofeedback stimuli, while avoiding hyperventilation symptoms, by breathing more shallowly, although slowly, at whatever frequency produces maximum-amplitude HRV.

Behavioral: Heart rate variability biofeedback

Placebo Biofeedback

PLACEBO COMPARATOR

A credible Placebo Biofeedback (PBO-BF) consists of: 1) receiving EEG/music biofeedback (actually, a mildly relaxing intervention, using EEG biofeedback to alternately increase and decrease frontal/occipital EEG alpha rhythms while listening to relaxing music), and 2) listening to recorded sounds of nature along with relaxing music with instructions to maintain a condition of "relaxed alertness." For home training, subjects will be given "placebo" StressEraser programmed to give feedback to maintain their breathing at baseline rate.

Behavioral: Placebo

Interventions

Heart rate variability biofeedback BEHAVIORAL

Biofeedback teaches voluntary control of physiological functions by providing instantaneous feedback of variations in that bodily activity. Feedback usually is given in the form of visual and/or auditory signals derived from physiological recording devices. Among its salutary effects is a sense of medical self-efficacy, i.e., less dependency on medical professionals for maintaining personal health. The HRV-BF protocol we have developed and propose to examine herein works by a different pathway. It involves teaching the individual to increase the amplitude of heart rate accelerations during inhalation and de-celerations during exhalation, thus increasing the amplitude of respiratory sinus arrhythmia (RSA).

Heart Rate Variability Biofeedback

Placebo BEHAVIORAL

The method consists of: 1) receiving EEG/music biofeedback (actually, a mildly relaxing intervention, using EEG biofeedback to alternately increase and decrease frontal/occipital EEG alpha rhythms while listening to relaxing music), and 2) listening to recorded sounds of nature along with relaxing music with instructions to maintain a condition of "relaxed alertness." For home training, subjects will be given "placebo" StressEraser programmed to give feedback to maintain their breathing at baseline rate.

Placebo Biofeedback

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Mild to moderate persistent asthma for at least the past one year
• Patients must not have taken oral or inhaled anti-inflammatory agents, including ICS and leukotriene inhibitors, for at least one month prior to study entry; and anti-IgE medications at least the past six months. Documented use of inhaled short-acting or long-acting β2-agonists during the month prior to study entry is, however, required. Xanthines, long-acting anticholinergics, and long-acting β2-agonists must be withdrawn within 72 hours upon entering the screening phase; short acting anticholinergics must be withdrawn within 48 hours before entering the screening phase. Patients will be required to abstain from these medications for the duration of study participation.
• FEV1 values must be ≥60% of predicted normal values following a 6 hour albuterol withhold, and reversibility of FEV1 of at least 12% (equal to or greater than 200 cc) following up to four puffs of albuterol must occur; or asthma physician at study site must state based on medical history, exam, and spirometry data that patient has presumptive mild-moderate persistent asthma.
• Lack of current asthma control as evidenced by ACT ≤ 19, or rescue use of B2-agonist ≥ 2/week within past 2 weeks, or waking due to asthma ≥ 1/week within past 2 weeks.
• Patients must be non-smokers for at least the past year and have less than a 15 pack-year smoking history. This will minimize the risk of co-occurring COPD
• Behavioral/linguistic competence: Ability to complete questionnaires and assessments in English
• Patients must give informed consent prior to any study procedures.

You may not qualify if:

• Diagnosis of severe persistent asthma
• or more inpatient hospitalizations in the past year for asthma exacerbations;
• History of only seasonal asthma
• Patients with serious concomitant disease
• Patients who have had a respiratory tract infection within 4 weeks of screening
• Patients with a history of chronic bronchitis, COPD, or emphysema
• Patients with a history of alcohol or drug abuse, or emotional or cognitive problems requiring psychotropic medication or likely to interfere procedural and treatment adherence
• Any other clinically relevant deviation from normal in general medical history, physical examination, or laboratory parameters that would limit participation or interfere with study procedures and/or data collection;
• Presence of exclusive extra-thoracic airway dysfunction
• Women who are pregnant
• Presence of a heart rhythm or other abnormality of heart rhythm on screening EKG that could preclude ac-curate HRV assessment
• Chronically taking any medication likely to affect the autonomic or respiratory systems
• Asthma therapy and concomitant medication
• Previous participation in an investigational drug trial within 30 days prior to screening.
• Concurrent participation in any other clinical trial or observational study at any time in the study.

Sponsors & Collaborators

• Fred Wamboldt, MD: lead
• Rutgers University: collaborator
• National Jewish Health: collaborator
• National Institutes of Health (NIH): collaborator
• National Heart, Lung, and Blood Institute (NHLBI): collaborator

Study Sites (2)

National Jewish Health

Denver, Colorado, 80206, United States

Location

Rutgers Robert Wood Johnson Medical School

Piscataway, New Jersey, 08854, United States

Location

Related Publications (1)

• Lehrer PM, Irvin CG, Lu SE, Scardella A, Roehmheld-Hamm B, Aviles-Velez M, Graves J, Vaschillo EG, Vaschillo B, Hoyte F, Nelson H, Wamboldt FS. Heart Rate Variability Biofeedback Does Not Substitute for Asthma Steroid Controller Medication. Appl Psychophysiol Biofeedback. 2018 Mar;43(1):57-73. doi: 10.1007/s10484-017-9382-0.

  PMID: 29124506 RESULT

MeSH Terms

Conditions

Asthma

Condition Hierarchy (Ancestors)

Bronchial Diseases; Respiratory Tract Diseases; Lung Diseases, Obstructive; Lung Diseases; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Immune System Diseases

Results Point of Contact

• Title: Paul M. Lehrer, PhD
• Organization: Rutgers - Robert Wood Johnson Medical School

[email protected]

(732) 235-4413

Study Officials

• Frederick S Wamboldt, MD

  National Jewish Health

  PRINCIPAL INVESTIGATOR

• Paul Lehrer, PhD

  Rutgers Robert Wood Johnson Medical School

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, CARE PROVIDER
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Executive Director Research Administration

Study Record Dates

• First Submitted: February 14, 2014
• First Posted: May 9, 2016
• Study Start: December 1, 2009
• Primary Completion: October 1, 2015
• Study Completion: January 1, 2018
• Last Updated: January 15, 2019
• Results First Posted: January 3, 2019

Record last verified: 2019-01

Locations

US (2)