This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Placebo responses have often been considered to be false, non-specific, or confounding responses to inert medications, and the intentional prescription of placebos by healthcare personnel has been considered disreputable. Evidence that placebo treatments can not only evoke symptomatic responses but also can evoke neuronal and immunologic responses has raised the possibility that components of the placebo response can be harnessed to augment the effect of pharmacologically active treatment. Asthma is a chronic disorder in which acute physiological responses to placebo inhalation has been documented, but there is no research focusing on longer-term placebo effects. Patients assigned placebo treatment in clinical trials usually show improvement, but the mechanism of this phenomenon is not understood. If we can better understand this placebo response, we may be able to use these mechanisms to improve asthma therapy. We propose to conduct a randomized clinical trial using a 2X2 factorial design plus a usual-care control group to address important unanswered questions about the placebo effect in asthma. We will alter the expectancy of participants that the drug will be of benefit by varying the manner in which the drug is presented to patients, using standardized treatment presentations that seek to alter the knowledge, beliefs and symbolic meaning of the drug. Approximately 600 subjects at 19 different clinical centers will take part in this study.
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