A review of the research literature suggests that anxiety is more common among patients with asthma than among the general population, yet it does not appear to be given the attention it deserves as part of the overall management of asthma. Having asthma can be a source of anxiety and stress in itself, particularly if it is not well controlled.

According to the results of a large study published in 2009 in the journal Therapeutic Advances in Respiratory Disease:

• A total of 51.5% of the asthma patients who participated were found to have clinically significant levels of anxiety as measured by their anxiety scores. Of these only 21% had already been diagnosed and were receiving treatment.
• There was a positive correlation between the anxiety score and the prescribed dose of inhaled glucocorticoids and a positive correlation between anxiety and the number of medicines taken by patients.
• Women in the study reported significantly higher levels of anxiety than men.
• It has been suggested that the association between asthma and anxiety may be due to the central role of respiratory factors in anxiety disorders.
• Studies related to physician–patient interaction in asthma management have shown that patients’ concerns about anxiety may not be sufficiently addressed due to lack of time and poor communication.

In another study, researchers simply told a group of asthma patients that they were being exposed to pollens and other aggravating agents. Then the researchers stood back and observed. More than half of the asthma patients developed a full-blown asthma attack, even though no pollens or other irritants were actually present. Worry that it would happen triggered the attack.

Recurrent episodes of having to fight for breath are frightening and upsetting. The repeated bouts of congestion, wheezing, and gasping for breath can cause anxiety, a feeling of being overwhelmed, and even a feeling of being defeated. Living with asthma symptoms can result in tremendous stress. Likewise, added stress can trigger asthma symptoms.

When stress increases, asthma patients may notice an increase in anxiety and asthma symptoms. As the symptoms such as wheezing and coughing worsen, an asthma sufferer can become more anxious, and then his/her asthma symptoms worsen. Asthma and anxiety make for a vicious cycle and one that can spiral downwards quickly.

Although stress does not cause asthma, stress and asthma are definitely linked. Asthma causes stress, and stress makes it more difficult to control asthma. Even daily stress can make asthma symptoms worsen. Learning to counteract the ‘stress response’ by eliciting the ‘relaxation response’ will help reduce asthma symptoms. The breathing and relaxation techniques taught during a Buteyko course can elicit the relaxation response. To access my article on counteracting stress with the relaxation response click here and see page 24 of the publication.

Although stress won’t prompt a new case of asthma, it may worsen it in people who already have it. During periods of stress and anxiety, asthma attacks occur more frequently, and asthma control is more difficult. During periods of stress and anxiety, people might forget to take their asthma medications, making an attack more likely. Anger can trigger an asthma attack and can worsen asthmatic symptoms. To access my article on controlling anger and hostility click here and see page 22 of the publication.

The brain-body link between asthma and anxiety is starting to be better understood. Researchers have found that certain areas of the brain cause worsening asthma symptoms when a person is under stress. Biological testing shows that worry (the thinking part of anxiety) causes the body to produce the chemical acetylcholine, which causes the airways to contract; thus excess acetylcholine worsens asthma. The muscles around the bronchioles constrict so tightly that air can no longer flow freely through them. Another important mechanism by which anxiety can trigger asthma involves the serotonin system, which can also trigger smooth muscle spasm in the airways. Serotonin (also known as 5-hydroxytryptamine, often abbreviated to 5-HT) is a neurotransmitter. Neurotransmitters are chemical substances that transmit nerve impulses across synapses (the spaces in between nerve cells).

When central nervous system serotonin function is low, it leads to smooth muscle spasm, which occurs not only in the airways, but also in blood vessels, the bowel and the bladder. Stress and anxiety can also trigger the release of chemicals, such as histamine and leukotrienes, which can trigger the narrowing of the airways. Stress-related hormones also reduce the body’s ability to fight off colds and other respiratory infections. Viral infections are very important causes for triggering asthma.

Fewer asthma attacks will generally mean fewer anxiety attacks, and less worry overall helps reduce the instance of stress-induced asthma attacks. When asthma and anxiety are handled in combination, an asthma sufferer can have a much-improved quality of life. He/she won’t have as many asthma attacks, which will help to reduce his/her likelihood of being anxious or panicking over an asthma attack. Because they are not as anxious, he/she will also be likely to have fewer asthma attacks. In most cases, a dual treatment plan allows an anxious asthma sufferer to live much more fully.

Cordina M et al, Anxiety and the Management of Asthma in an Adult Outpatient Population, Therapeutic Advances in Respiratory Disease, 2009;3(5):227-233

Karren K J et al, Mind Body Health: The Effects of Attitudes, Emotions, and Relationships, Chapter 8, Boston: Pearson, 2014

Buteyko Breathing Clinics (Dublin and County Wicklow)