The Anxiety of Asthma: Emotions Can Trigger Attack

Reviewed by Jacqueline Brooks, MBBCH, MRCPsych
From the WebMD Archives

April 7, 2001 -- A tear-jerking movie, a fight with your spouse, or even a joyous reunion -- for some people with asthma, these are emotional triggers that can leave them gasping for air.

"It's long been suspected that emotions can make asthma symptoms worse," psychiatrist Glenda MacQueen, MD, tells WebMD "If you look back in history, Hippocrates said that people who have what we now call asthma should stay away from strong emotions."

And people who struggle with asthma are likely to know this as well as anyone. MacQueen recalls a woman who told her about an asthma attack triggered by watching the burning of Atlanta in the movie Gone With The Wind.

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"Many who have the illness know all about it, but there isn't much data to back it up in the medical literature," MacQueen says. "If it's true, it may explain why medication alone doesn't work very well in some patients."

Monday, at the annual meeting of the American Psychiatric Association, in New Orleans, MacQueen presented preliminary data from a small study that would seem to validate the long-suspected connection between emotion and asthma. In that study, MacQueen tested 80 patients with mild to moderate asthma using a standard questionnaire to identify those who were highly "suggestible" -- that is, who were highly responsive to cues and suggestions in their environment -- and those who were not suggestible.

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To the nine people identified as suggestible and the eight identified as nonsuggestible, MacQueen administered a mock solution of salt water, using the kind of inhaler typically used to administer asthma medications. But prior to administration, MacQueen actually told the subjects it was a solution that would cause their airway to constrict.

The result: even though the solution was harmless, six of the patients actually experienced constriction of the airway. And of those six patients, five were in the suggestible group, says MacQueen.

What this means is that for at least some patients with asthma, emotional triggers can lead to an actual physical effect in the body. "The suggestion definitely led people [in the suggestible group] to perceive that their airways were getting tighter, that they were short of breath, and it also led to changes in lung function," MacQueen tells WebMD.

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The role of emotion in asthma is underscored by another study presented at the APA meeting showing a high rate of anxiety disorders among patients with asthma. Of 86 patients with asthma in an outpatient clinic, 45 had at least one anxiety disorder, according to Isabella Nascimento, MD, of the department of psychiatry at Federal University in Rio de Janeiro, Brazil.

So what can patients with asthma do?

MacQueen says the most important step is to reflect on the emotional triggers -- the settings and circumstances and the kinds of feelings associated with those situations -- that seem to precede asthma attacks. Simply knowing what those situations are can lend people a sense of mastery over a condition that is often terrifying, she says.

"People with asthma like the notion that there are some aspects of the illness they can control, by looking for triggers," she says.

But she says specific behavioral interventions once an asthma attack has begun have not been developed, and would likely vary from person to person. And she cautioned that emotion might play a role in only some patients, while being completely unrelated in others. Finally, no behavioral or emotional strategy should replace the appropriate use of medication, MacQueen says.

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Asked to comment on the topic, experts echoed the widely acknowledged -- though largely undocumented -- connection between emotion and asthma.

"It means that in addition to getting good medical care, people who have asthma should pay attention to their psychological state, particularly those who have asthma that is difficult to control," Michael Blumenfield, MD, professor of psychiatry at New York Medical College, tells WebMD.

Recognition of emotional factors in asthma may be especially useful in children, says child psychiatrist David Fassler, MD, chair of the APA's Council on Children, Adolescents and their Families.

"Asthma has a clear biologic component, and there is no question that episodes can be triggered by exposure to either pollution or toxins in the environment," Fassler tells WebMD. "But it is equally clear that the disorder is also heavily influenced by emotional factors. Conversely, we believe there may be some emotional and behavioral interventions that can successfully help kids."

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Fassler says excitement and agitation in kids can increase risk for and severity of asthma attacks. As with adults, he says the most important thing that parents can do -- with the help of a pediatrician, family doctor, or psychiatrist -- is help children identify those feelings and situations that trigger an attack in their kids.

"If we can help kids learn to recognize the early warning signs we can actually reduce the extent to which their bodies respond," he says. "We try to do work with the pediatricians and family physicians who are treating the asthma to help kids develop a sense of master and control over their illness, so it's not a mystery."

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