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The interaction between asthma and anxiety: a first-hand experience

by Frida Frøyland, Psychology Intern

One year ago I was diagnosed with asthma. To say I was relieved is an understatement. The diagnosis came after a long period of countless doctors’ visits and tests due to an uncontrollable dry cough that kept me up at night and took all my energy. The diagnosis felt comforting as it confirmed that I had an issue, and it was something that could be better controlled with the help of medications.

At first, the medication was really helpful as the cough slowly, but surely went away. I was finally able to sleep through the night and sit through my lectures without having to run out of the class to cough. I felt more energized and felt happy about the change I was seeing after many months of low energy and constantly feeling sick. However, after a while of me steadily getting better by the day, my recovery stopped progressing. It was around this time that I realized being diagnosed with asthma meant that I was not going to get back to how I was before I was diagnosed. After all, I had developed a chronic illness, and with that came some notable changes in what my body could, and couldn’t do.

The most notable change for me, living in Copenhagen, was that I no longer found cycling fun and easy. In fact, I had a couple of asthma attacks when I tried cycling again after being sick for so long, and it completely deterred me from biking. For some time, I purposely walked or took the metro everywhere I went to avoid having asthma attacks. Studying psychology, I knew I was practicing avoidance behaviors that only fueled my anxiety of what could happen if I biked somewhere. However, when I started associated cycling with uncomfortable asthma attacks, it felt easier to leave the bike at home than to risk it.

I, personally, came to a point where the thought of having to bike somewhere made me anxious. Because I knew that the avoidance would make me more anxious in the long run, I would occasionally try to bike somewhere. The few times I tried I would get anxious and start to hyperventilate the moment I could hear myself getting a bit out of breath. Most of these times I could not tell if I was starting to have an actual asthma attack or a panic attack, due to my anxiety of going into an asthma attack. But from my research I suspect the latter, as most individuals with asthma and anxiety tend to overperceive symptoms of asthma and overreact during asthmatic episodes (Favreau et al., 2014; Janssens et al., 2009; Yii & Koh, 2013). As a psychology student I was able to identify that I had developed some anxious thoughts and maladaptive behaviors such as avoidance and anticipatory anxiety. Hence, I started to read up on what research had been made on anxiety and asthma.

My experience is not uncommon. Asthma is often accompanied by anxiety, and the interaction between the two can lead to exacerbations for both conditions (Pateraki & Morris, 2018). In fact, anxiety has a greater association with asthma-related health outcomes compared to lung function (Lavenziana et al., 2006), and is the most significant predictor of breathlessness in individuals with asthma (Spinhoven et al., 1997). Anxiety can enhance symptom perception (Thomas et al., 2011), and negatively impact cognition and coping behavior (Lavoie et al., 2010). One clinical review found that approximately 34% of adults with asthma suffer from anxiety disorders, of which panic attacks are the most common (Weiser, 2007). For children with asthma, the risk of meeting the criteria for anxiety disorders is significantly higher (Lu et al., 2012; Vuillermin et al., 2010). Experiencing asthma attacks is especially aversive and can reinforce anticipatory anxiety or avoidance (Feldman et al., 2009).

Given the percentage of people with asthma who meet the criteria for anxiety disorders I felt the need to write about my own experience to help inform others who may relate. For me, understanding that this is quite a common experience and reading about it helped more than any medication. I knew I had to start challenging my maladaptive behaviors to stop both the anxiety and asthma from becoming worse. After all, my doctor told me regular exercise, such as cycling to and from work, would help improve my lung function and health.

I started challenging my avoidance behavior by cycling once a week without putting pressure on myself. I found that having to be somewhere at a certain time would fuel my stress and anxiety, so starting out it had to be shorter distances when I did not have anywhere I needed to be. After a while I found that I never had any asthma or anxiety related attacks when there was no time pressure, so I started cycling to work once a week. This did not always go well, and sometimes I had to take breaks or bring my bike on the metro halfway to make it to work on time.

Slowly, it’s getting easier and I’m starting to have less anticipatory anxiety (anxiety associated with anticipating a behavior before one engages in that behavior). I understand that there’s no quick fix and I’m taking it all one day at a time. Asthma, as many other chronic illnesses can take a toll on your body physically as well as mentally. Living with a chronic illness is a journey, and it’s important to remember that progress is not always linear. As for my journey with asthma, taking small steps to challenge avoidance behaviors has helped improve my physical and mental health. If you are struggling with asthma or any other chronic illness, know that you’re not alone, and that finding ways to manage the psychological effects of the condition may be just as important as managing the physical effects.

Sources:

Pateraki, E., & Morris, P. G. (2018). Effectiveness of cognitive behavioural therapy in reducing anxiety in adults and children with asthma: A systematic review. The Journal of Asthma, 55(5), 532–554. https://doi.org/10.1080/02770903.2017.1350967

Laveneziana, P., Lotti, P., Coli, C., Binazzi, B., Chiti, L., Stendardi, L., Duranti, R., & Scano, G. (2006). Mechanisms of dyspnoea and its language in patients with asthma. The European Respiratory Journal, 27(4), 742–747. https://doi.org/10.1183/09031936.06.00080505

Spinhoven, P., van Peski-Oosterbaan, A. S., Van der Does, A. J., Willems, L. N., & Sterk, P. J. (1997). Association of anxiety with perception of histamine induced bronchoconstriction in patients with asthma. Thorax, 52(2), 149–152. https://doi.org/10.1136/thx.52.2.149

Thomas, M., Bruton, A., Moffatt, M., & Cleland, J. (2011). Asthma and psychological dysfunction. Primary Care Respiratory Journal, 20(3), 250–256. https://doi.org/10.4104/pcrj.2011.00058

Lavoie, K. L., Bouthillier, D., Bacon, S. L., Lemière, C., Martin, J., Hamid, Q., Ludwig, M., Olivenstein, R., & Ernst, P. (2010). Psychologic Distress and Maladaptive Coping Styles in Patients With Severe vs Moderate Asthma. Chest, 137(6), 1324–1331. https://doi.org/10.1378/chest.09-1979

Weiser, E. B. (2007). The prevalence of anxiety disorders among adults with asthma: A meta-analytic review. Journal of Clinical Psychology in Medical Settings, 14(4), 297–307. https://doi.org/10.1007/s10880-007-9087-2

Lu, Y., Mak, K.-K., van Bever, H. P. S., Ng, T. P., Mak, A., & Ho, R. C.-M. (2012). Prevalence of anxiety and depressive symptoms in adolescents with asthma: A meta-analysis and meta-regression. Pediatric Allergy and Immunology, 23(8), 707–715. https://doi.org/10.1111/pai.12000

Vuillermin, P. J., Brennan, S. L., Robertson, C. F., Carlin, J. B., Prior, M., Jenner, B. M., & South, M. (2010). Anxiety is more common in children with asthma. Archives of Disease in Childhood, 95(8), 624–U75. https://doi.org/10.1136/adc.2009.166967

Feldman, J. M., Siddique, M. I., Thompson, N. S., & Lehrer, P. M. (2009). The role of panic-fear in comorbid asthma and panic disorder. Journal of Anxiety Disorders, 23(2), 178–184. https://doi.org/10.1016/j.janxdis.2008.06.005

Favreau, H., Bacon, S. L., Labrecque, M., & Lavoie, K. L. (2014). Prospective Impact of Panic Disorder and Panic-Anxiety on Asthma Control, Health Service Use, and Quality of Life in Adult Patients With Asthma Over a 4-Year Follow-Up. Psychosomatic Medicine, 76(2), 147–155. https://doi.org/10.1097/PSY.0000000000000032

Janssens, T., Verleden, G., De Peuter, S., Van Diest, I., & Van den Bergh, O. (2009). Inaccurate perception of asthma symptoms: A cognitive–affective framework and implications for asthma treatment. Clinical Psychology Review, 29(4), 317–327. https://doi.org/10.1016/j.cpr.2009.02.006

Yii, A. C. A., & Koh, M. S. (2013). A review of psychological dysfunction in asthma: affective, behavioral and cognitive factors. The Journal of Asthma, 50(9), 915–921. https://doi.org/10.3109/02770903.2013.819887