Asthma and anxiety: A practical dilemma for patients and physicians

Dr. Powlin Manuel is retired as of 1/1/2-22

Asthma is common disorder present in 10% of the population in USA (Braman, 2006). Anxiety disorders are also present in about 11% of the population also (Somers, Goldner, Waraich, & Hsu, 2006). There is often a similar impact on airway in asthma as well as anxiety. In asthma airway size (diameter) decreases causing low oxygen delivery leading to symptoms of suffocation. Heart and respiratory rates increase to compensate for the low oxygen levels. In anxiety disorders especially panic disorder, there is a feeling of suffocation even when there is no deficiency of oxygen. Heart and respiratory rates increase in panic attacks as an associated mechanism of fight and fight reflexes. For patients as well as physicians it is often difficult to separate the role of each of the conditions when an asthmatic presents with difficulty in breathing.

Anxiety disorders are more common in asthmatics; coexistence of anxiety can impact the perception of symptoms and severity of feeling of distress (Thoren, & Petermann, 2000). Asthma can be a factor that can contribute to development of panic disorder and panic and anxiety can make asthma symptoms worse (Carr, 1999). The existence of asthma-specific anxiety and anxiety as shown by panic-fear personality scores (of Minnesota Multiphasic Personality Inventory) influence the long term medical outcome of treatment of asthma with poor outcome related to the combination of both (Dirks, Kinsman, Staudenmayer, & Kleiger, 1979). Patients with asthma – children, adolescents, and adults – also seem to have higher incidence of anxiety disorders (Katon, Richardson, Lozano , & McCauley, 2004). Depression is more prevalent in asthmatics than in the general population (Brown, 2003). Parental reports of asthma attacks have been linked the presence of depression and anxiety in children, especially separation anxiety (Ortega, McQuaid, Canino, Goodwin, & Fritz, 2004).

Individuals with combination of asthma and anxiety report worse quality of life (Deshmukh, Toelle, Usherwood, Grady, & Jenkins, 2006). Asthmatics with panic disorder excessively perceive higher level of breathlessness compared to those without anxiety (Peski-Oosterbaan, 1996). Current severe attacks of asthma have been associated with a significantly increased incidence of anxiety disorder, specific phobia, and panic disorder in the preceding four weeks, and life-time severe asthma has associated increased likelihood of similar psychological disorders (Goodwin, Jacobi, Thefeld, wwww2003). Patients with anxiety and asthma often undergo excessive number of tests and higher expenses associated with them, as it is difficult for physicians to exclude other serious medical conditions such as heart disease (Katon, 1996).

The key point to remember is that there is increased chance of over use of asthma inhalers by those with underlying anxiety with asthma presenting with increased chance hospitalization. It is very important for physicians to be aware of the coexisting anxiety in a patient with asthma and it is very important for patients and care takers to inform physicians of presence of anxiety. In addition to traditional treatment of asthma treatment of associated anxiety with antianxiety medications, and cognitive therapy and behavior therapy will result in better management of the patients with asthma as well as anxiety (Clark et. al., 1994).