Ask The Advocates: Can Anxiety Trigger Asthma?

Many community members have wondered if anxiety is something that can cause asthma symptoms to occur. We asked our advocate team of respiratory therapists and asthma educators to explain more to the question, "Can anxiety trigger my asthma?" See their responses below:

Anxiety can worsen asthma symptoms

Response from Theresa Cannizzarro, Respiratory Therapist:

Anxiety can most definitely make asthma symptoms worse. Stress and anxiety can cause physiological changes which can provoke and worsen an asthma flare up. Strong emotions can cause your body to release leukotrienes and histamine which cause narrowing of the airways. It is a pretty normal reaction to have anxiety when your asthma is flaring up. I know I experience it. It's almost impossible to remain calm, cool & collected when you can't breathe.

What I like to do when my asthma is acting up and I teach my asthma patients, is to focus on your breathing. There are also plenty of relaxation exercises you can try that can help tremendously. I would recommend trying one of them when your asthma isn't flaring until you're comfortable with it and will know what to do when you'll need to be able to try & calm your anxiety.

Yes, including other strong emotions

Response from Lorene Alba, AE-C:

Anxiety, along with other strong emotions can trigger asthma. Strong emotions can include anxiety, stress, fear, excitement, crying and even laughing too hard, and they often cause asthma symptoms. This does not mean, however, that asthma is “all in your head” or psychosomatic. Asthma is a real, physical disease. Managing and reducing your stress, just like your other triggers such as dust mites or cigarette smoke, is key to managing your asthma. Try belly or pursed-lip breathing to reduce stress and anxiety.

Anxiety and asthma can trigger each other

Response from Lyn Harper, MPA, BSRT, RRT:

Although anxiety doesn’t cause asthma, it can certainly worsen symptoms. In fact, the two conditions can actually make each other worse. Any strong emotions can have an effect on our respiratory system and our airways and particularly so when a person has hypersensitive airways, as is the case with asthma. Strong emotions can trigger a chemical response in the body that may release histamine and leukotrienes – both of which can trigger narrowing of airways. Stress and anxiety can also weaken the immune system, making a person more susceptible to viruses and illnesses that in turn lead to asthma problems.

So, if you have asthma it’s important to reduce anxiety as much as possible. You would certainly want to discuss options with your doctor. They may suggest an anti-anxiety medication that can be taken regularly or only when needed depending on the severity and frequency of your anxiety. If you decide to try a natural remedy, of which there are plenty, you would also want to speak to your doctor to determine what may or may not interfere with medications you already take.

Yes, so seeking support is important

Response from Leon Lebowitz, RRT

The hallmark of asthma is hypersensitivity of the airways. For people who have asthma, various triggers can set off an 'asthma attack' or exacerbation, based on this hypersensitivity. The severity of the episode can vary from individual to individual and even within the same individual.

It is well known that stress is a common asthma trigger. Stress and anxiety sometimes make you feel short of breath and may even cause your asthma symptoms to become worse.1 Laughing hard, crying, becoming upset, or feeling stressed or anxious can trigger asthma in some people. You cannot always avoid or control these emotions easily but you can develop ways to deal with them better.

In order to reduce the impact stress may have on asthma, make sure your asthma is well controlled so these triggers can become less of a problem. For example, if you find yourself frequently coughing and wheezing when you laugh hard, this could be a clear signal that your asthma is not being controlled properly.

It is not always easy to exert control over various emotions that cause stress in one’s life, but every effort should be made to be aware of those stressors and do whatever you can to control them. Ask for support from your family members, friends and even work colleagues where possible. Relaxation exercises and breathing strategies can be helpful in reducing stress. There are many audiotapes and online programs available that teach you these techniques. Making certain to get sufficient sleep can help. Lack of sleep leads to being overtired and can result in less energy being available for you to deal with daily stressors. Be sure to include exercise in your routine. Being active is a great way to deal with stress and keep your mind clear.

It enhances the immune response

Response from John Bottrell, RRT:

This is the age-old question, as asthma was -- for many years -- considered a psychological/nervous disorder -- it was caused by anxiety and stress. This was because asthmatics were observed to be nervous or anxious. This theory was extensively studied and modified by the 1950s, and by the 1980s was changed to: "While anxiety cannot cause asthma, it can act as an asthma trigger." Modern science has pretty much confirmed the link between asthma and anxiety. However, it also appears that anxiety neither causes new-onset asthma nor triggers asthma. What it does do is enhance the immune response responsible for asthma.

Anxiety causes stress. You are in a situation that makes you feel uncomfortable or stressed, and your body releases cortisol and epinephrine. The combination of these initially reduces airway inflammation and open airways. However, when the stressful situation continues long term -- you lost your job, someone you loved passed away, you live in abject poverty -- your body responds by decreasing cortisol receptors. This is fine for non-asthmatics, and might even be good. However, in asthmatics, it makes it so that they are more likely to have an asthma attack when exposed to their asthma triggers. It also makes it so their airways are less responsive to the effects of corticosteroids, making their asthma increasingly difficult to control.

Editor's Note: These suggestions may or may not be a good fit for you, depending on your asthma action plan assembled by your healthcare provider. Always consult your doctor before beginning, ending, or changing treatments.

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