The Mental Issues Surrounding Asthma

Since the twelfth century, when Jewish philosopher and physician Maimonides (1135-1204) first observed the link between asthma and emotions, a tremendous body of literature has accumulated examining how negative emotions increase asthma risk. One study followed 5,231 adults for thirteen years and found that anxiety and depression were "independent predictors of asthma." Negative emotions not only predispose people to asthma, they can make asthma worse. Multiple studies have documented that anxiety, depression, and inadequate social networks exacerbate asthma. Acute and chronic stress is particularly devastating; research demonstrates that some asthmatics feel worse when stressed. In fact, emotions can radically alter lung function, and it is estimated that 20 to 45 percent of asthmatics experience bronchoconstriction when stressed.

 

Children are especially susceptible. Asthma is the fourth-leading cause of childhood disability, responsible for an estimated ten million lost school days. One study from the National Jewish Medical and Research Center in Colorado found that the "severity of asthma is related to increased emotional difficulties" in children. Asthmatic children also tend to have more anxiety and medically related fears than non-asthmatic children. University of Rochester School of Medicine scientists monitored lung function in twenty-four asthmatic children while they watched the movie E.T. The Extra-Terrestrial. The researchers found that emotions were "associated with increased airway reactivity and decreased pulmonary function," which persisted even after the movie ended.

 

A study from North Dakota State University examined the relationship between lung function and social interactions in twenty asthmatics. While "mood and stressors" had the greatest impact on peak expiratory flow, social contacts had the most influence on symptoms; the authors concluding that "psychosocial variables were clearly related to [peak expiratory flow rate] and asthma symptoms." Another study examined the effects of final examinations on a group of twenty mildly asthmatic college students and found that the number of eosinophils (which cause inflammation) increased significantly with stress. The authors concluded that the stress associated with final exams acts as a cofactor to increase airway inflammation and may enhance the severity of asthma.

 

Not only can stress make the life of an asthmatic miserable, but there is also evidence that asthmatics are generally more depressed and anxious than the rest of the population. Poorly controlled asthmatics often experience depression and disruptions in their personal lives. One study of 230 asthmatics found that 45 percent were clinically depressed and that this depression directly influenced their symptoms. Another study found that "anxiety and depression levels were noticeably higher in asthmatic patients than in patients with chronic liver disease and healthy subjects." Does asthma cause depression or does depression cause asthma? It is reasonable to say that there is probably an element of truth to both of these assertions. Having asthma can certainly cause some people to become depressed and anxious, whereas depression and anxiety clearly appear to be risk factors for developing asthma. Regardless of what causes what, depression and anxiety take a devastating toll on asthmatics.

An even more dramatic reflection of this observation can be found in studies that examine asthma-related deaths. In a study on children who died from asthma, the authors concluded that these children had "exhibited emotional states of hopelessness and despair in the days immediately preceding their deaths."

 

Researchers have also found a strong association between asthma and panic disorder, as well as "passive" or "repressive" coping styles. It is believed that panic leads to hyperventilation, which creates nervous system imbalances that predispose a person to asthma. These imbalances involve the autonomic nervous system, which is responsible for controlling bodily functions such as breathing and digestion. It is hypothesized that anxiety, panic, and passive-repressive coping result in a heightened autonomic sensitivity that leads to negative health consequences like bronchoconstriction. One study found that panic and repressive coping increase the risk of asthma morbidity. This report suggests that panic sufferers benefit most from "relaxation-oriented methods," whereas asthmatics who cope through repression and/or panic benefit from therapies that increase their awareness of respiratory symptoms.

 

Social support and emotions can even influence how asthmatics respond to viral infections; one study found that "negative life events were associated with increased episodes of colds and asthma, but only when levels of social support were low." Stress can also devastate immune function and increase the risk of infection in asthmatics. Multiple studies have documented the dramatic negative effects of acute and chronic stress on immune function, particularly impairing the effectiveness of natural killer cells and T lymphocytes. Finally, asthma symptoms are often worse at night, leading to sleep deprivation that results in an increased susceptibility to infection.