Stress And Asthma: What’s The Deal?
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Various studies over the past 30 years may have forever linked stress with asthma. Surely asthma might induce stress, but there is also clear evidence now that stress might induce asthma.1-2 Here is all you need to know about the links between stress and asthma.

What is Stress?

Hans Selye (1907-1982) According to Dictionarycom, that’s pronounced Zel-ye. He was a brilliant Austrian-Canadian endocrinologist who first coined the term stress. Early in his career he recognized that people who were chronically sick with different diseases displayed similar symptoms, such as having a pale disposition. So, he defined stress as “the nonspecific response of the body to any demand for change.” He even proved stress could cause certain diseases, such as arthritis, heart attacks, and allergies.3

Unpleasant His definition struck a chord that lead to a frenzy of people defining stress as something that was unpleasant or unwanted. It was caused by your work. It was caused by someone stressful in your home. It made you feel chest pain, even caused you to develop ulcers.3

Beneficial Selye did not believe that all stress was unpleasant, and this inspired him to redefine it. He still believed that stress caused changes inside your body that made you to feel a certain way. He defined this feeling as distress. However, he believed that, up to a certain point, these feelings were good in that they prepare you to deal with stressful events, or they motivate you to take necessary actions in your life, such as looking for work or dealing with whatever was causing your stress at home.3

Stressors So, this inspired Selye to coin a new term: stressor. Merriam-Webster defines a stressor as “a stimulus that causes stress.” A stressor would be a bear charging at you. It could be losing your job, experiencing death, having to deal with a stressful boss, or having to deal with a disease like asthma. It could be something good, like anticipation of an upcoming event.

Stress Merriam-Webster defines it as “a state of mental tension and worry caused by problems in your life, work, etc.; something that causes strong feelings of worry or anxiety; physical force or pressure.” It could be pressure you feel about work or having to deal with kids. Or, it could be pressure you put on yourself, such as what you experience by talking to yourself inside your head. It could be pressure caused by a self-challenge to ask for a raise, or to work harder than everyone else so you would be noticed by your boss.

UniqueFacing stressors, and coping with stress, are things that we all must do throughout the courses of our lives. Similar to asthma being unique from one person to the next, each person has a unique way of dealing with stress. Some develop coping strategies for dealing with it on their own, while others have trouble coping and require the assistance of experts.

How is stress linked with asthma?

StatisticsVarious studies showed that 15-30% of asthmatics exposed to “stressful experiences,” such as solving math problems or watching emotional movies, displayed asthma symptoms.  One particular study showed that acute stressful events doubled the risk of having asthma attacks in children, and another showed that when an acute stressful event was followed by prolonged stress, the risk of having asthma attacks tripled in the two weeks following it.  Studies show that stress also suppresses the immune response offering resistance against respiratory viruses, thereby increasing the risk of developing respiratory infections, which may also trigger asthma.1-2

What happens during acute (it’s happening now) stress?

Your body releases hormones such as epinephrine and cortisol. The immediate reaction is to constrict blood vessels to speed up the flow of blood to meet your body’s increased metabolic needs. Among other things, these hormones increase your heart rate, blood pressure, and keep your airways open so you can breathe easy. These are all measures necessary to prepare you take quick actions. So, short term stress may actually improve asthma.2

What happens when stress is severe or chronic (ongoing)? However, severely stressful events (such as strong emotions due to a death of a loved one or losing your job), and long-term exposure to stress (such as having an abusive family member or long-term unemployment) may cause mast cells lining airways to release their contents, which include histamine, leukotrienes, and cytokines that are responsible for allergy and asthma symptoms. Stress may also cause epinephrine and cortisol to remain elevated long-term. This is especially true in people with poor coping skills.1-2, 4

Epinephrine It’s attracted to beta 2 (b2) adrenergic receptors that line smooth muscles wrapped around airways, causing them to relax and dilate. This assures easy breathing during a stressful event. Short term exposure is good. Epinephrine, albuterol, and levalbuterol are medicines that mimic this effect to rapidly end asthma attacks.

When stress is severe or chronic, epinephrine remains elevated. Your body responds to this by reducing the number of b2 receptors. This might actually induce asthma. Plus, since rescue medicine like albuterol and levalbuterol work by attaching to b2 receptors, stress can make them less effective. This may also explain why abuse of b2 adrenergic medicine like albuterol may result in tolerance to the medicine.1-2, 5

Cortisol It’s attracted to cortisol receptors that line your airways to reduce airway inflammation to help keep airways open. Short term exposure during a stressful event is good. Daily use of Inhaled corticosteroids mimic this effect to keep airways open long term.

When stress is severe or chronic, cortisol remains elevated. Your body responds by reducing the number of cortisol receptors. This doesn’t directly trigger asthma, although it makes airways increasingly sensitive to asthma triggers. When this happens, exposure to your asthma triggers may result in frequent, long-lasting, and severe asthma episodes. To make matters worse, inhaled corticosteroids used to control asthma are less effective or not effective at all.1-2, 5

AcetylcholineThis is a third chemical impacted during the stress response. It’s a neurotransmitter that causes smooth muscles wrapped around airways to constrict. Anticholinergic medicines like ipratropium bromide and tiotropium bromide block this effect. While stress in healthy people reduces this response, stress in asthmatics may enhance this effect, resulting in asthma attacks and more severe asthma. So, this is another way stress might trigger asthma.  When anticholinergics are tried they aren’t effective.1, 2

What can we conclude form this?

Selye struggled to define stress the rest of his life, and researchers continue to debate how to define it to this day. So, if you don’t fully understand it that’s completely understandable. Still, there appears to be a clear link between stress and asthma. While it surely doesn’t happen in all asthmatics, stress may pose a challenge to obtaining good asthma control. This spotlights the need for asthma physicians to consider stress as a possible roadblock to good asthma control, especially among those with poorly controlled or severe asthma.

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