Asthma Relief: All in the Head?

Placebo works nearly as well as inhaler on asthma patients

/ Author:  / Reviewed by: Joseph V. Madia, MD

Could it be mind over matter? Getting relief from many asthma symptoms may be as simple as believing you are taking a treatment that will help.

The power that the mind has over sickness has been shown to be significant. When it comes to asthma, it looks as if that power of suggestion is almost as good as actual medication.

Researchers at Harvard Medical School conducted a study of 46 patients with chronic asthma to look at the differences between various treatments. Placebo treatments were just as effective as the actual asthma drugs, in terms of relieving symptoms and helping patients feel better. There was not a placebo effect in terms of actual lung function, however.

The Placebo Effect

Placebos are "dummy pills" that have no actual active drug ingredients at all. Many patients who take a placebo claim similar results to patients who are given an authentic treatment or medicine.

Scientists struggle to explain the effect. Anne Harrington, a science historian at Harvard College, says that placebos "rally endogenous healing processes within patients." Cultural beliefs also play a role in the way people respond to placebos. The effect is also heightened by conditioning. For example, once a patient has taken opiod drugs, which block the pain-stimulation pathways in the nervous system, a placebo alone can later mimic the same pain blocking effect — but only if the patient believes the placebo is the real thing.

The Harvard Study

The research was led by Michael Wechsler, M.D., associate director of the Asthma Research Center at Brigham and Women's Hospital and assistant professor of medicine at Harvard Medical School. The 46 test patients were divided into four groups for treatment with either an albuterol inhaler, a placebo inhaler, sham acupuncture or no intervention. The participants did not know which treatment they were receiving, though most believed they were getting an active treatment.

After a total of 12 visits, during which time volunteers recieved each treatment, patient's forced expiratory breathing volume was measured. Researchers also recorded the self-reported improvements that each patient gave rating their asthma symptoms on a scale of zero to 10. The results were startling:

  • Albuterol inhaler group - 50 percent improvement
  • Placebo inhaler group - 45 percent improvement
  • Sham acupuncture group - 46 percent improvement
  • No intervention group - 21 percent improvement

It's significant that there was only a five percent difference between the patients who actually used an albuterol inhaler and those who had a placebo inhaler. "Albuterol provided no incremental benefit with respect to the self-reported outcomes," wrote the study authors. When it came to patient-reported outcomes, placebos were equally as effective as albuterol in helping to relieve discomfort and self-described asthma symptoms.

Again, lung functions were not affected by the placebo effect, only the symptoms. There was a 20 percent improvement in expiratory lung volume among those given albuterol, while the placebo inhaler patients only measured a 7 percent increase in lung function.

What it Means

The study clearly states that patient self-reports can be unreliable; but the results show the significance of the placebo effect on asthma symptoms. "Placebo effects can be clinically meaningful and can rival the effects of active medication in patients with asthma," wrote Dr. Wechsler in the report published in the New England Journal of Medicine.

“Despite beneficial effects on objective physiological outcome, pharmacologic therapy may not provide incremental benefit on subjective symptoms provided by placebos,” Wechsler says. He believes that the findings suggest physicians consider having a “placebo for the placebo” to monitor a patient’s natural history.

Senior author Ted Kaptchuk, director of the program in placebo studies at Beth Israel Deaconess Medical Center, adds, “While I was initially surprised that there was no placebo effect in this experiment [after looking at the objective air flow measures] once I saw patients’ subjective descriptions of how they felt following both the active treatment and the placebo treatments, it was apparent that the placebos were as effective as the active drug in helping people feel better. This study suggests that in addition to active therapies for fixing diseases, the idea of receiving care is a critical component of what patients value in health care. In a climate of patient dissatisfaction, this may be an important lesson.”

Reviewed by: 
Review Date: 
July 15, 2011