Depression and Asthma

When a person has asthma, a bout of depression or anxiety can trigger attacks and make the disease much harder to manage, according to recent research. Studies have found that asthmatic children suffering from psychological distress need higher doses of medication and spend more time in the hospital than other children with asthma. "When I see patients who are having severe attacks, I always ask them, 'What's gone wrong in your life?'" says H. James Wedner, chief of allergy and immunology at Washington University School of Medicine in St. Louis. Almost invariably, he notes, the attacks go hand in hand with stressful events or emotional distress.

But is there a more fundamental link between asthma and emotional turmoil? More than 15 years ago, researchers at the Centers for Disease Control and Prevention published a study that provided strong evidence that depression and anxiety can actually help cause the respiratory disease. Investigators gave psychological tests to more than 5,000 asthma-free people aged 25 to 74 and then checked their health records 13 years later. After adjusting for age, sex, race, and other factors, the researchers found that severe depression and anxiety more than doubled a nonsmoker's risk of developing asthma.

Why does depression trigger attacks of asthma?

Nobody knows exactly why asthma seems to thrive on psychological distress. Both anxiety and depression disturb the body's normal balance of hormones and brain chemicals, and this disruption might somehow set the stage for the disease. Once a person has asthma, feelings of sadness or distress can cause subtle physiological changes that may help fuel attacks. Researchers at the State University of New York at Buffalo tested this theory by showing the movie ET: The Extraterrestrial to a group of children with asthma. During the sad parts (you know which ones they are) the children's heart rates and blood oxygen levels became erratic -- reactions that could set the stage for an asthma attack.

Depression can also contribute to the likelihood of asthma attacks by hampering the immune system. People suffering from emotional distress often have trouble fending off the viruses that cause bronchitis and other respiratory infections. Once such an infection takes hold, it can inflame the airways and trigger a severe attack.

Finally, depression may take a toll by sapping people's ability to care for themselves. Asthma patients who feel helpless might not see the point of monitoring their breathing and taking medication. Conversely, if these patients (or their parents) are overly anxious, the result may be too many medications and unnecessary trips to the emergency room.

Can treating depression help fight asthma?

Although the possibility hasn't been fully studied, Wedner and other experts are certain that treatment for depression can improve an asthma patient's breathing as well as his or her outlook. Wedner's asthma clinic employs a full-time counselor who helps patients cope with their emotions, and Wedner has seen the therapy work wonders. "Many children think they're the only people in the world with asthma, and that can be very depressing," he points out. Counseling helps them understand that they're not alone, a revelation that bolsters their mood and the ability to fight the disease.

References

Wright, Rosalind J et al. Review of psychosocial stress and asthma: an integrated biopsychosocial approach. Thorax.

Biller, BD. Influence of specific emotional states on autonomic reactivity and pulmonary function in asthmatic children. J Am Acad Child Adolesc Psychiatry, Vol. 36(5):669-77

Jonas, Bruce S. et al. Symptoms of Anxiety and Depression as Risk Factors for Development of Asthma. Journal of Applied Biobehavioral Research.

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