Heart Rate Variability Biofeedback: It's Role in Asthma Therapeutics

Inclusion Criteria: * Mild to moderate persistent asthma for at least the past one year * Patients must not have taken oral or inhaled anti-inflammatory agents, including ICS and leukotriene inhibitors, for at least one month prior to study entry; and anti-IgE medications at least the past six months. Documented use of inhaled short-acting or long-acting β2-agonists during the month prior to study entry is, however, required. Xanthines, long-acting anticholinergics, and long-acting β2-agonists must be withdrawn within 72 hours upon entering the screening phase; short acting anticholinergics must be withdrawn within 48 hours before entering the screening phase. Patients will be required to abstain from these medications for the duration of study participation. * FEV1 values must be ≥60% of predicted normal values following a 6 hour albuterol withhold, and reversibility of FEV1 of at least 12% (equal to or greater than 200 cc) following up to four puffs of albuterol must occur; or asthma physician at study site must state based on medical history, exam, and spirometry data that patient has presumptive mild-moderate persistent asthma. * Lack of current asthma control as evidenced by ACT ≤ 19, or rescue use of B2-agonist ≥ 2/week within past 2 weeks, or waking due to asthma ≥ 1/week within past 2 weeks. * Patients must be non-smokers for at least the past year and have less than a 15 pack-year smoking history. This will minimize the risk of co-occurring COPD * Behavioral/linguistic competence: Ability to complete questionnaires and assessments in English * Patients must give informed consent prior to any study procedures. Exclusion Criteria: * Diagnosis of severe persistent asthma * 2 or more inpatient hospitalizations in the past year for asthma exacerbations; * History of only seasonal asthma * Patients with serious concomitant disease * Patients who have had a respiratory tract infection within 4 weeks of screening * Patients with a history of chronic bronchitis, COPD, or emphysema * Patients with a history of alcohol or drug abuse, or emotional or cognitive problems requiring psychotropic medication or likely to interfere procedural and treatment adherence * Any other clinically relevant deviation from normal in general medical history, physical examination, or laboratory parameters that would limit participation or interfere with study procedures and/or data collection; * Presence of exclusive extra-thoracic airway dysfunction * Women who are pregnant * Presence of a heart rhythm or other abnormality of heart rhythm on screening EKG that could preclude ac-curate HRV assessment * Chronically taking any medication likely to affect the autonomic or respiratory systems * Asthma therapy and concomitant medication * Previous participation in an investigational drug trial within 30 days prior to screening. * Concurrent participation in any other clinical trial or observational study at any time in the study. * Planning to move away from the area within the next 4 months