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Asthma is a chronic disease of the airways. Asthma attacks are almost always triggered by some external or internal factor. External factors are allergens, cold air, physical activity, etc. Stress is one of the internal factors which can trigger attacks.

Until recently, the predominant belief among scientists was that patients with asthma developed stress and anxiety disorders as a consequence of asthma attacks. The notion that asthma can be triggered stressful events has been neglected for a long time. Today, after collecting a vast amount of evidence, it has become obvious that asthma attacks can be induced by negative emotions in children, and stressful events in both children and adults.

The main source of divided opinions between scientists lies in the pattern of activation of the autonomic nervous system during stress. Namely, epinephrine and norepinephrine are produced when a person is under stress, and these neurotransmitters are supposed to reduce the obstruction of the airways, rather than worsening asthma symptoms. Furthermore, cortisol is a hormone which gets increased in long-term stress. Both epinephrine and cortisol analogues (glucocorticoids) are used in the treatment of asthma attacks. Some researchers point out that the activity of the vagal nerve is also increased during stress, and its activation could be the cause of stress-induced asthma attacks.

The mechanism of stress-induced asthma is — in other words — very complex, and probably involves a combination of hormonal and immunological responses to stress.

Symptoms of stress and anxiety induced asthma attacks

According to current evidence, stress does not cause asthma, but in some patients, it trigger an asthma attack.

Regardless of the cause, asthma symptoms are pretty much the same. They include:

  • Cough
  • Wheezing
  • Breathing difficulties (especially difficulty exhaling)
  • Sensation of pressure or even pain and tightness in the chest
  • Hyperventilation (fast breathing)

The symptoms can last until the stressful event is eliminated or until the patient receives the appropriate treatment.

How are asthma attacks related to stress and anxiety diagnosed?

It is sometimes very hard to conclude whether the asthma attack occurred due to a stressful event or the stress and anxiety resulted from the asthma attack itself. In some cases, there is a vicious circle in which stress induces an asthma attack, which then produces more intense stress, thus making the symptoms even worse.

The most important step in the diagnosis of the stress induced asthma attack is a detailed anamnesis, which can be taken by the patient or persons who were around when the attack had started. Parents should follow the situations in which their children experience asthma attacks, and report that to the doctor.

The triggers that can lead to asthma attacks can be short or long-term, and they include:

  • Acute stress (due to any stressful event)
  • Long-term problems at school or work
  • Financial problems
  • Conflicts with other people
  • Basically anything else that can cause stress
In persons who suffer from asthma and panic attacks, the differential diagnosis is even more difficult, because both disorders include hyperventilation, chest tightness, breathing problems, and other symptoms. The doctor should check the patient’s medical record, take a detailed anamnesis, and determine the treatment plan in such complicated situations.

Treatment of stress and anxiety induced asthma attacks

After making the diagnosis, the first thing to manage is airways obstruction. That is achieved by using inhalatory bronchodilators, which can be beta-adrenergic agonists (albuterol), or anticholinergics (ipratropium bromide). Corticosteroids are often used in moderate to severe cases of asthma attacks. For very persistent cases, intravenous or oral administration of aminophylline is the next line treatment. Rarely, if airways get obstructed to the life-threatening point when the person cannot breathe at all, intravenous administration of epinephrine can be used. Epinephrine can cause fatal arrhythmias, so this measure should be used as a last resort and with great caution with constant monitoring of electrical activity of the heart by using ECG.

After eliminating the airways obstruction, it is important to make sure that the patient takes their prescribed therapy. This chronic therapy usually includes using inhalers with corticosteroids on a daily basis. There are also inhalers containing a combination of a corticosteroid and bronchodilatatory medications, in order to decrease the frequency of asthma attacks as much as possible. Some patients will never experience asthma attacks if they use the prescribed treatment appropriately.

Last but not least, if doctors conclude that stress or an anxiety disorder was the trigger for the attack, consultation with a psychologist or a psychiatrist is required in order to learn how to control the emotional response. Your doctor may prescribe anti-anxiety medications if they think that they will lower the chances of new asthma attacks provoked by stress and anxiety.

Conclusion

There are multiple problems associated with stress and anxiety induced asthma. Differential diagnosis can be hard, and the treatment has three tasks:

  • To stop the acute asthma attack
  • To determine the therapy plan for reducing frequency of asthma attacks
  • To deal with psychological issues and emotional responses which can trigger asthma attacks
An important message to the parents would be to notice if their child’s asthma attacks are related to some stressful events and to report those notions to the doctor.

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