Presentación realizada en la Barcelona Cough Conference, Enero 2019. El Mindfulness como terapia complementaria para aliviar a los enfermos con tos en sus distintos grados de cronicidad.

1. 18-19 de enero de 2019
BARCELONA
Auditori AXA
Mindfulness en la tos
Dr. Jordi Roig Cutillas
SESIÓN V
Viernes, 18 de enero de 2019

2. • ¿Cómo vive el paciente su enfermedad - tos?
• Mindfulness en entidades y aspectos relacionados con la tos
• Avances en neuroimagen
• Base científica de la relación respiración “body & mind”
• Mindfulness & “social graph”
• Sugerencias en la aplicación de mindfulness en Neumología
Mindfulness en enfermedades con tos

3. Epicteto S. I
“No importa lo que te
pasa, importa como te
tomas lo que te pasa.”
Dhammapada verso 1
“Nuestra vida está
conformada por nuestra
mente; nos convertimos en
lo que pensamos.”
“Las cosas no tienen más peso
que el que les damos.”

4. ?

5. Functional
2012

6. The effect of mindfulness meditation on cough reflex sensitivity
Young EC. Thorax 2017
Changes in cough reflex sensitivity
to citric acid in healthy volunteers
for the control, mindfulness
intervention and voluntary cough
suppression groups. Horizontal lines
represent median values and error
bars represent the interquartile
range.

7. Mindfulness-based cognitive therapy in COPD:
a cluster randomised controlled trial
Farver-Vestergraard I. ERJ 2018
• COPD patients eligible for PR were cluster randomised to receive
either an 8-week, group-based MBCT programme as an add-on
to an 8-week PR programme (n=39), or PR alone (n=45)
• The primary outcomes of psychological distress and physical health
status impairment were measured with the Hospital Anxiety and
Depression Scale (HADS) and the COPD Assessment Test (CAT)
• Before randomisation (T1), mid- (T2) and post-intervention (T3),
and at 3 (T4) and 6 (T5) months’ follow-up
• MBCT: statistically significant and durable effect on psychological
distress

8. Shi L. J Asthma 2017
Mindfulness and asthma symptoms: A study among college students
Multilevel logistic regressions to estimate the association between trait mindfulness (measured by Mindful
Awareness Attention Scale, MAAS) and self-report of ever having an asthma diagnosis, ever having had
persistent dry cough, and ever having had wheezing symptoms. n=1392 students

9. Sensations and regional brain responses evoked by
tussive stimulation of the airways
Farrell MJ. Respiratory Physiology & Neurobiology 2014

10. Cough-related neural processing in the brain:
A roadmap for cough dysfunction?
Overview of the brain regions implicated in
(A)the processing sensory inputs arising from the airways,
(B)reflex, urge-related and voluntary coughing, and
(C)the inhibition or modulation of cough and the urge-to-cough.
. Ando A. Neuroscience and Biobehavioral Reviews 2014

12. Abbreviations: AMCC, anterior midcingulated cortex; CB, cerebellum; IFG, inferior frontal gyrus; Ins, insula; MD,
mediodorsal nucleus of the thalamus; OFC, orbitofrontal cortex; PM, premotor area; STG, superior temporal gyrus;
VPM, ventral posteriomedial nucleus of the thalamus.
Mazzone SB. Pulmonary Pharmacology & Therapeutics 2009
Mapping supramedullary pathways involved in cough
using functional brain imaging: Comparison with pain
Comparison between BOLD
signal changes associated with
capsaicin inhalation (green) and
painful thermal somatosensory
stimulation (blue).
Regions of overlapping
activations appear red.

13. Shikhbahaer S. Science 2017
Breathing
to inspire
and arouse
A small population
of brainstem
neurons
connects
breathing
behavior to brain
arousal
Breathing
control
center
neurons
that
promote
arousal
in mice
NEUROSCIENCE
Yackle K. Science 2017

14. The rhythmic activity of a cluster of neurons in the brainstem initiates breathing. This cluster is
composed of distinct, though intermingled, subgroups of neurons. A small, molecularly defined
neuronal subpopulation in this breathing rhythm generator that directly projects to a brain
center that plays a key role in generalized alertness, attention, and stress. Removal of these
cells did not affect normal breathing but left the animals unusually calm. The breathing center
thus has a direct and dramatic influence on higher-order brain function.
The calming effect of breathing
Ascending neural circuit from
preBötC. Cdh9/Dbx1 preBötC
neurons provide monosynaptic
excitatory input to noradrenergic
LC neurons, which project
throughout brain to promote
arousal and active behaviors.
Yackle K. Science 2017

15. Depression & Anxiety in respiratory disease
Montserrat-Capdevila J. Mental disorders
in chronic obstructive pulmonary diseases.
Perspect Psychiatr Care 2018
Miravitlles M. Depressive status explains a
significant amount of the variance
in COPD assessment test (CAT) scores. Int J
Chron Obstruct Pulmon Dis. 2018
Yohannes AM. Depression and anxiety in
patients with COPD. Eur Respir Rev. 2014

16. Self blame & catastrophizing interpretation
• Plaufcan MR. Behavioral and
characterological self-blame in chronic
obstructive pulmonary disease. J Psychosom
Res 2012.
• Solomon BK. A breathlessness
catastrophizing scale for chronic obstructive
pulmonary disease. J Psychosom Res 2015.
• Livermore N. Catastrophic interpretations and
anxiety sensitivity as predictors of panic-
spectrum psychopathology in chronic
obstructive pulmonary disease. J Psychosom
Res 2012.

17. Gender, cough & mindfulness
Tomljenovic D. Females have stronger neurogenic
response than males after non-specific nasal
challenge in patients with seasonal allergic
rhinitis. Med Hyp 2018

18. “Cuando cerramos
los ojos y miramos
a nuestro interior,
participamos
de la inmensidad.”
J. Plensa

20. Telomeres

21. Can meditation slow rate of cellular aging?
Cognitive stress, mindfulness, and telomeres
Epel E. Ann NY Acad Sci 2009 ; 1172: 34–53..

22. Intensive meditation training, immune cell telomerase activity,
and psychological mediators
Telomerase Activity higher in the Retreat Group

23. Black DS. Ann N Y Acad Sci 2016 ;1373(1): 13–24.
Mindfulness meditation and the immune system: a
systematic review of randomized controlled trials

24. Davidson RJ. Psychosomatic Medicine 2003.
Means SE antibody rise from the 3- to 5-week to the 8- to 9-week blood draw in the Meditation and Control
groups. The ordinate displays the difference in the log-transformed antibody rise between the 3- to 5- and
the 8- to 9-week blood draws derived from the hemagglutination inhibition assay.
Alterations in Brain and Immune Function Produced
by Mindfulness Meditation
n = 16
n = 25
p < 0.05

25. Mindfulness During Pregnancy Linked To
Healthier Birth Weight In Newborns
Douros K. Prenatal maternal stress and
the risk of asthma in children: Front
Pediatr 2017
Savran O. Early life insults as
determinants of chronic obstructive
pulmonary disease in adult life. Int J
COPD 2018

26. www.health.harvard.edu • 101 TIPS FOR TIP-TOP HEALTH
What makes a good life? Lessons from the longest study
on happiness | Robert Waldinger

27. Individualized medicine
Topol EJ. Individualized Medicine from Prewomb to Tomb. Cell 2014 .
Social graph

29. Strengthen your social bonds

31. Dancing

32. When analyzing individual intervention types,
cognitive behavioral therapy appeared to be
effective (g = 0.39, CI = 0.15–0.62; p = 0.001) for
improving psychological outcomes. In contrast for
physical outcomes, only mind-body interventions
(e.g. mindfulness based therapy, yoga, and
relaxation) revealed a statistically significant effect
(g = 0.40; CI = 0.01–0.79; p = 0.042).
Farver-Vestergraard I. Psychother Psychosom 2015

34. Al cabo de los años he observado que la belleza,
como la felicidad, es frecuente. No pasa un día en que
no estemos en el paraíso.
Jorge Luis Borges

35. La historia no contada del movimiento
Mindfulness de Norteamérica
New York Society for Ethical Culture 2017

36. Mindfulness aplicada a la tos
• Optimizar diseño estudio
• Selección adecuada pacientes: prejuicios, estereotipos
• Definir opción Mindfulness MBSR
• Valorar dificultad en fase inicial de respiración
• Innovar outputs: incluir dolor
• Énfasis en obviar “lo estoy haciendo bien o mal”
• Mindfulness es un aprendizaje en el que se progresa
• Instructores titulados