Strong Emotions, Stress, and Depression

Some people with asthma say that hard laughing or crying causes asthma symptoms. In fact, doctors trying to diagnose asthma may ask whether emotions cause trouble breathing. Unfortunately, asthma triggered by strong emotions or stress has not been well studied. One reason is that it is hard to create an experiment that causes strong emotions, because everyone reacts to things differently.¹

Much more is known about the effect of chronic stress and depression on asthma. People with asthma are more likely to have depression than people with healthy lungs. For a number of reasons, depression and stress can make asthma harder to control.²

Negative emotions and stressful events

In one experiment, researchers measured lung function while people looked at pictures. They found that people who looked at pictures of catastrophes, injuries, and disgusting things had a harder time breathing. Later, this group of people rated their mood 3 times per day for 3 weeks and measured their lung function with a peak flow meter.³

This study was very small, but it showed that negative emotions can cause lung function to decrease. These results were true for people with and without asthma, but lung function went down more in people with asthma.³

In some studies, having recently had a serious life event was linked to asthma attacks in children and hospital admission for adults.^4,5 However, not all studies have found this link. A large study in Europe showed that job strain did not increase the risk of severe asthma attacks.⁶

One theory is that mood plays a role in how people perceive their symptoms. Interestingly, after a negative experience, everyone–with and without asthma–reports having more respiratory symptoms.⁷

Panic and fear

Panic and fear are strong, negative emotions that can play a particular role in triggering asthma attacks. Especially if a person fears having an asthma attack, it can make the person feel helpless and less likely to self-manage their asthma. Studies have found that people who panic during an asthma attack are likely to use too much medicine and hyperventilate. On the other hand, people who have low levels of panic and anxiety about their asthma are at higher risk of rehospitalization because they are less likely to seek care when it is needed.⁸

Panic attacks may feel like asthma attacks, and it can sometimes be difficult to tell them apart. One study looked at Latino adults with panic disorder who also had a relative who had died of asthma. They found those adults had higher rates of asthma triggered by strong emotions and felt asthma had a greater impact on their daily lives.⁹

Ongoing stress and depression

Depression and anxiety are more common in people who have asthma. Having a mental health condition and asthma together can lead to:¹⁰

• Worse control of asthma symptoms
• More asthma attacks
• More visits to the emergency department

Chronic stress and hardship are also linked to worse outcomes in asthma. Children who are always stressed have more asthma attacks. In adults, more stress often means more symptoms, missing more doses of medication, and worse quality of life.^1,11

The reasons that stress makes asthma worse are not entirely clear. Stress causes your body to produce stress hormones. Having high levels of stress hormones over time could make airways more sensitive to allergens, infections, and pollutants. Your body may not respond as well to asthma medications when it is under stress.¹²

Ongoing stress and hardship may make it difficult to manage asthma. When you are juggling a lot, it can be hard to afford medication, pick-up refills, get to appointments, and remember to take your medication (or give it to children). You might be so busy with other concerns, that you do not notice when your symptoms get worse.¹

How common is stress-induced asthma?

Among people who had serious psychological distress in the past year, the risk of asthma is 50 percent to 70 percent higher than people without distress. Among people diagnosed with depression in the past year, the risk of asthma is also about 70 percent higher. The highest levels of stress are seen in inner-city residents, Puerto Ricans, and African Americans/blacks. Asthma rates in these groups are disproportionately high.^9,13,14

What can I do to reduce stress and manage my emotions?

There are several ways you can reduce or manage the stress that triggers asthma:^10,15

• Identify the things that cause you stress, such as money or relationships, and try to find people who can help with these areas
• Avoid situations that cause you stress and that trigger stress-induced asthma symptoms
• Try relaxation and breathing techniques
• Exercise
• Get enough sleep
• Eat a healthy, balanced diet
• See a mental health provider about anxiety and depression

Have you struggled with strong emotions, stress, and asthma? Share your experience with us.