Stress and Asthma

When stress levels go up, asthma symptoms can go into overdrive. What’s the link, and how can asthma and anxiety be managed?

From the WebMD Archives

When stress levels start to creep upward -- whether it's over bills, work, or your kids -- jam-packed calendar -- asthma symptoms can kick into overdrive. As the wheezing and coughing gets worse, your health becomes one more reason to worry. Asthma and anxiety make for a vicious circle, and one that can spiral downward quickly.

"Asthma is triggered by many things, and one of them is stress," says Pramod Kelkar, MD, a fellow with the American Academy of Asthma Allergy and Immunology (AAAAI).

"So look at the big picture: just as you manage exposure to triggers like cigarette smoke and pet dander to keep symptoms from getting worse, stress -- as a trigger -- needs to be managed as well."

Stress and Asthma: What's the Connection?

"Stress can affect the cardiovascular, gastrointestinal, musculoskeletal, immune, and central nervous systems," says Paul Rosch, MD, president of the American Stress Institute. "In fact, it's difficult to think of any disorder in which stress has not been shown to have an aggravating role.

Asthma is no exception.

Stress can create strong physiologic reactions that lead to airway constriction and changes in the immune system, which can worsen asthma symptoms.

"The mechanism between asthma and anxiety is many-fold," says Kelkar, a physician at Allergy and Asthma Care in Maple Grove, Minn. "Uncontrolled emotions can work the nerves and cause constriction of muscles, like the smooth muscles of the airways in the lungs. They tighten up and constrict, which can worsen wheezing, coughing, and chest tightness in people with asthma."

Although stress and anxiety start in your mind, asthma is a physical disease of the lungs.

"It is important to note that asthma is not a psychosomatic disease," Kelkar tells WebMD. "It's not in your head. Stress can trigger symptoms if you already have the disease, but if you don't have it, stress does not all of a sudden cause a person to develop the disease of asthma."

The Brain's Impact on Asthma and Stress

The brain-body link between asthma and anxiety is starting to be better understood. Led by researchers from the University of Wisconsin, a group of scientists found that certain areas of the brain cause worsening asthma symptoms when a person is under stress.


Researchers exposed a group of people with mild asthma to triggers that caused both inflammation and muscle constriction. When symptoms flared, the participants were asked to read words that were either emotionally charged, such as "lonesome"; neutral, such as "curtains"; or asthma-related, such as "wheezing."

They found that the words linked with asthma increased inflammation and activity in parts of the brain that control emotions.

The results, published in the Proceedings of the National Academy of Science, show a possible link between emotions and asthma. Although it's only preliminary research, it does start to connect the dots. Until researchers find a clear link between anxiety and asthma, keep symptoms in check by managing stress and treating asthma with appropriate medication.

When Treatment Makes Asthma and Stress Worse

Persistent asthma means you have symptoms more than once a week, but not constantly. Treating persistent asthma requires long-term maintenance therapy, such as an inhaled corticosteroid, plus rescue therapy when something triggers symptoms. And when your symptoms are out of control, an anti-inflammatory, such as the oral steroid prednisone, might be necessary. The problem is that prednisone can cause mood swings as a side effect, adding fuel to the anxiety fire.

"The good news is that prednisone is only a short-term treatment," explains Kelkar. "When a course of oral steroids ends, a person should go back to a long-term maintenance therapy like inhaled steroids, which do not have an impact on mood and anxiety."

Sometimes a long-term asthma medication doesn't work well, and wheezing and chest tightness occurs all too often. Then, a vicious circle can begin, where anxiety worsens asthma, and asthma worsens anxiety, says Kelkar.

The solution is to talk to a health-care provider about your symptoms, triggers, and stress. Also discuss other treatment options that can help get your asthma under control again.

Managing Asthma and Anxiety

"There are numerous stress-reduction techniques, ranging from meditation, yoga, and Pilates to jogging, listening to music, and hobbies," says Rosch. "You have to find out what works best for you."

Here are stress-reduction tips from the Cleveland Clinic. They can help you make anxiety one less asthma trigger for you to worry about:

  • Keep your mind free of stressful thoughts. Use the power of positive thinking to keep your mind going in the right direction. When you feel anxious about something, try to stay positive. How you think and what you think both play a role in managing stress levels.
  • Identify your stressors. What stresses you out? Is it money, your mother-in-law, a hectic lifestyle? Once you know what your stress triggers are, work on resolving them. If you can't do it on your own, get help from a professional. This might be a financial counselor, psychologist, or family therapist. Link your health-care providers together, as well. Let your allergist know that stress is a trigger, so she or he can keep your anxiety in mind when treating your symptoms.
  • Don't try to do it all. Manage your time wisely. Don't cram two days' worth of errands into one day. If you know you need to get everything done before a deadline, delegate so you can take some time for yourself. With more hands pitching in, you can avoid being overburdened.
  • Say ohm. Practicing relaxation exercises can help lessen the negative effects of stress and asthma. Try deep breathing, progressive muscle relaxation, and clearing negative thoughts.
  • Eat right and exercise. Exercise is a great way to let go of stress. Also, eat right and avoid junk food, coffee, and soda -- which can make you feel drained after the sugar-high and caffeine effects wear off. This can help your overall health, give you more energy to combat stress, and put you in a better position to manage asthma.
  • Get by with a little help from your friends and family. When it comes to asthma and anxiety, no one should go it alone. Having support from your loved ones can help you tackle stressful situations. They can provide an emotional hand when things get tough as well as offer friendly reminders when it's time to take your medication.
  • Get a good night's sleep. Sleep helps you recharge your batteries -- physically, emotionally, and even cognitively -- according to the National Sleep Foundation. Without a solid night's sleep, mood, behavior, and performance can be affected, and so can asthma.
WebMD Feature Reviewed by Charlotte E. Grayson Mathis, MD on March 01, 2007


SOURCES: Pramod Kelkar, MD, Allergy and Asthma Care, Maple Grove, Minn. Paul Rosch, MD, president, American Stress Institute. Proceedings of the National Academy of Sciences, Sept. 13, 2005; vol. 102, no. 37; 13319-13324. AAAAI: "Tips to Remember: Asthma triggers and management, Stress and Asthma." The Cleveland Clinic: "Stress and Asthma." Sleep Foundation: "Sleep Is Important When Stress and Anxiety Increase." Food and Drug Administration: "Breathing Better: Action Plans Keep Asthma in Check."

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