Integrative medicine, spirituality improves outcomes in urban adolescents with asthma, study suggests

These findings, being presented at the National Conference in Pediatric Psychology in San Antonio April14-16, could help physicians and other providers gain insight into additional ways to help pediatric populations self-manage chronic illnesses.

The study, led by Sian Cotton, PhD, assistant professor in the department of family and community medicine, looked at urban adolescents dealing with asthma and uncovered the ways that they were both coping with their illness as well as ways coping methods affected their mental and physical health outcomes.

One set of analyses examined ways these adolescents used complementary and alternative medicine strategies for symptom management; the other set of analyses looked at spiritual struggles in adolescents with asthma to see whether they contributed to health-related quality of life.

"Few studies have examined the role of spiritual struggles in children, and none have examined the relationship between spiritual struggles, secular coping and their outcomes; we wanted to see if spiritual struggles contribute uniquely to a patient's quality of life, beyond demographic variables," says Cotton.

"Similarly, prior studies have shown that 50 to 80 percent of adolescents with asthma have used complementary and alternative medicine and feel that these actions are successful in treating symptoms. We wanted to understand more about which sorts of patients might benefit from being approached on this subject by a physician."

The analyses involved 151 adolescents with asthma between the ages of 11 and 19 at a children's hospital in the Midwest who were given questionnaires assessing spiritual coping, secular coping, complementary alternative medicine use and other psychosocial, clinical and demographic variables.

In the spiritual struggles analyses, outcome variables included anxiety and depressive symptoms as well as quality of life. Researchers then determined the association between spiritual struggles and health outcomes after accounting for age, gender, ethnicity and asthma severity.

Those who were male African-Americans, experiencing more spiritual struggles and using more negative secular coping methods, had poorer quality of life.

In addition, researchers found that non-African-Americans, adolescents who struggled spiritually and adolescents with more severe disease had increased anxiety symptoms. Also, non-African-Americans and females had increased depressive symptoms.

"As hypothesized, religious or spiritual coping and secular coping predicted similar amounts of variance in these outcomes, similar to previous findings in adult populations, suggesting that spiritual coping is an important element to consider when caring for adolescents with asthma," Cotton says.

"These issues may be particularly relevant among urban African-American adolescents for whom religion and spirituality is especially important. Future studies should examine the effectiveness of interventions or screening efforts to address spiritual struggles in these populations."

In the second analysis, the same group of adolescents completed a survey looking at 10 forms of complementary and alternative medicine methods used for symptom management, including prayer, guided imagery, relaxation, meditation, yoga, massage, herbs, vitamins and rubs as well as dietary changes.

Eight-five percent of participants were African-American and 52 percent had persistent asthma.

"We asked how often they used these methods, if they would consider using any of these methods for symptom management, if they told their doctor or provider about the use of these methods and if they thought it helped their symptoms," Cotton says.

Response frequencies for all four questions were examined for each method. Researchers then examined characteristics associated with alternative medicine use, consideration of use, disclosure and perceived efficacy for the two most commonly used modalities.

"Seventy-one percent of participants reported using complementary or alternative medicine, most commonly relaxation, at 64 percent, and prayer, at 61 percent, for symptom management in the last month," Cotton says. "Adolescents would most often consider using relaxation (85 percent) and prayer (80 percent) in the future for symptom management."

Participants were most likely to tell their provider about their use of yoga and dietary changes and least likely to discuss their use of prayer and guided imagery. Relaxation and prayer were perceived to be most efficacious, while imagery and massage were perceived to be least helpful.

In addition, adolescents with more frequent asthma symptoms used prayer more often than those with less frequent symptoms. African-Americans were more likely to report using prayer and consider using prayer in the future for symptom management compared with non-African-Americans.

Also, older adolescents perceived relaxation to be more efficacious for symptom management.

"These findings show that this group of chronically ill adolescents is using complementary methods and finding them helpful," says Cotton. "Providers should consider discussing the use of complementary or alternative medicine with their patients with asthma to help improve outcomes.

"These analyses point to findings that will help physicians care not only for patients with asthma but also for those with other chronic illnesses to ensure the best outcomes physically, mentally, emotionally and spiritually, producing a better quality of life."

This study was funded by the National Institute of Child Health and Human Development.