Asthma Subgroups: Psychiatric Induced Asthma
Stress, anxiety, and depression have all been shown by studies to induce asthma. When this happens, it may lead to a diagnosis of the loosely defined asthma subgroup called Psychologically Induced Asthma (PIA). Here’s all you need to know.
These are changes inside you in response to changes in the environment around you that may both trigger asthma or make your asthma worse.
- Stress. It involves a series of chemical reactions inside of you in response to stimuli known as stressors outside of you. These chemical reactions are necessary in that they make you increasingly vigilant to your surroundings and ready to respond to them as appropriate. These chemical reactions have been shown by science to trigger asthma, make a person more responsive to asthma triggers, and blunt the effects of the medicines used to treat and control asthma. This is most likely to occur as a result of severely stressful events (such as a death in the family or the loss of a job) or long-term exposure to stress (prolonged unemployment or an abusive family member).1-2
- Anxiety. It’s feelings of fear or anticipation of upcoming events, or even guilt or regret about past actions. These can be normal in that they, like stress, prepare you to take necessary actions. Chemicals similar to those released during stress may cause the release of mediators of inflammation like leukotriene and histamine. These can directly trigger asthma symptoms.
- Depression. It’s feeling sad, dejected, or even suicidal, making a person lose interest in activities once found enjoyable. It has been often linked with both stress and anxiety, and therefore may also contribute to asthma.
These are thoughts that a person might have that are not conducive to healthy living. I think I can give you some examples that pertain to our condition. This applies only to some asthmatics, although should always be ruled out when asthma is poorly controlled.2, 3
- Poor adherence to an asthma treatment program. People might become so focused on what they are stressed or anxious about that they forget to keep their scheduled doctor’s appointment, or to even make one in the first place. They may overlook taking their asthma controller medicines. They also might inadvertently expose themselves to asthma triggers they would otherwise avoid. 2, 4
- Inability to recognize symptoms. People might become so focused on dealing with stress, anxiety, or depression that early warning symptoms are overlooked. This may lead to missed opportunities to end asthma attacks before they begin, potentially leading to more severe asthma episodes.2
- Rejection of the role of the sick person. People focused on psychological issues, whether they are aware of them or not, may fail to accept that they have asthma, and therefore fail to see doctors and take medicine that is necessary to obtaining ideal asthma control.2
- Adoption of the role of the sick person. On the other hand, people might exaggerate their symptoms (either consciously or subconsciously) in an effort to gain sympathy, or to get out of stressful situations at home or work. This may cause doctors to step up treatment, which may result in even more anxiety due to the medicine used to treat asthma.2, 4
- Development of a low self esteem. Feeling shame or guilt about past actions may result in a less than ideal impression of one’s own standing in life. They feel like they said something or did something stupid, even though they did not. They may feel they are inferior to the people around them, even though they are of equal standing. 2
- Abuse of as needed asthma medicine. Anxiety has been linked to abuse of asthma rescue medicine. Rather than using it when you need it, you use it when you think you need it, or simply because you’re anxious. Worse, rescue medicine may exacerbate anxiety.4
Poor Asthma Control Various studies have shown that asthmatics diagnosed with a psychiatric disorders have an increased risk for developing worse asthma control, increased rescue medicine usage, and a reduction in overall quality of life.4
What is causing PIA?
Once poorly controlled asthma is determined to be due to PIA, the next step might be to rule out psychological barriers as a potential cause of poorly controlled asthma. In such cases, treating these alone might result in improved asthma control.
In these cases, simple change may be all that is needed to improve asthma control. This may entail teaching strategies for helping them remember to take their medicine on time, such as taking medicine just prior to brushing their teeth. It may entail placing pills in a pill box. It may entail marking doctor’s visits on the calendar, or setting reminders on their iPhone. It may also entail individual or family counseling. It may simply entail educating them about their asthma and how best to treat it.
Severe Asthma. Once psychological barriers are ruled out as a potential cause of PIA, or once poor treatment adherence is ruled out, a diagnosis of severe asthma may be made. This is asthma that responds poorly to traditional asthma medicine. In this case, it may be due to ongoing stress, anxiety, or depression.
Treatment. In the case of PIA induced severe asthma, treatment may include individual counseling, family counseling, education, breathing retraining exercises, and relaxation exercises. Anxiolytics and antidepressants may also be indicated, if needed. And, of course, their asthma should be treated as appropriate. But, often, the asthma improves when the underlying cause is diagnosed, treated, and improved.2
Conclusion. Again, I note here that this remains a loosely defined asthma subgroup. What’s important to understand here is not all asthmatics experience stress or psychiatric induced asthma. However, when they do, they must be properly diagnosed and treated in order to obtain ideal asthma control.
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