THE UPTAKE AND EFFECT OF MINDFULNESS BASED COGNITIVE THERAPY ON PATIENTS WITH POORLY CONTROLLED ASTHMA ATTENDING A UK ASTHMA CENTRE

Introduction There is a strong association between poorly controlled asthma (PCA) and psychological conditions of stress, depression and anxiety; this can worsen asthma control and quality of life (QoL).1 Despite this, not all asthma centres have access to clinical psychology and patients can be resistant to referral. Mindfulness based cognitive therapy (MBCT) is a group-based programme aimed to reduce stress and has reported benefit in several chronic diseases. We assessed the attendance rate of patients with PCA at a 10-week mindfulness programme and MBCT efficacy for improving asthma control. Methods Patients with physician diagnosed asthma attending a difficult asthma clinic were offered referral for MBCT if they had an asthma control questionnaire (ACQ-6) score ≥ 1.5 despite optimised asthma medication. Spirometry, FeNO, blood eosinophils, ACQ-6, asthma quality of life questionnaire (AQLQ), Hospital anxiety and depression scale (HADS-A/HADS-D) and perceived stress scale (PSS) were recorded before and after the MBCT course and at 3- and 6-months following completion. Results 60 patients were considered for MBCT; 24(40%) did not meet criteria for referral, 14(24%) declined referral, 22 patients (36%) were referred. Of those referred 9(41%) started MBCT, 6(27%) did not attend, 3(14%) patients declined, 1(5%) had newly diagnosed malignancy, 1 was from out-with Glasgow, 2 (10%) were interrupted by the coronavirus pandemic. Only 5 patients completed MBCT; 2 stopped attending for social reasons, 2 due to intercurrent medical issues. In those who completed; a median reduction in PSS (21 to 13), HADS-A (11 to 6) and HADS-D (12 to 6) was seen by end of course and persisted at 6 months (Table1). A median improvement in ACQ-6 was seen by 3 months; 2.8 from 3.3 (MCID 0.5) which was sustained at 6 months (2.8), and in AQLQ; 4.8 from 3.3 (MCID 0.5) which was not sustained. Conclusion In the small numbers who completed MBCT, we observed an improvement in asthma symptom control at follow-up and a reduction in stress, anxiety and depression scores. MBCT attendance rate was poor and understanding barriers for attendance is needed for any further study. Reference Thomas, et al. Asthma and psychological dysfunction. Prim Care Respir 2011;20(3):250–256