Asthma, Stress, and Anxiety: A Risky Cycle

Stress-induced asthma attacks not 'all in your head', expert says.

You’ve been battered by a recent layoff, and high-stakes job interviews are taxing your nerves. As your financial worries mount, so do your attacks of shortness of breath, coughing, and wheezing. Is there a relationship between asthma and stress? 
Yes, says Peter Gergen, MD, MPH, a senior medical officer at the National Institute of Allergy and Infectious Diseases. Although stress won’t prompt a new case of asthma, it may worsen the disease in people who already have it, Gergen says. “During periods of stress and anxiety, asthma attacks occur more frequently, and asthma control is more difficult,” he says.

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Stress-induced asthma attacks or anxiety asthma is not “all in your head,” as asthma patients were once told. Stress and anxiety can actually make your asthma symptoms worse.
“Asthma is an inflammatory disease of the airways,” says Bradley Chipps, MD, a pediatric pulmonologist and allergist in Sacramento, Calif. As a physical disease, it requires medication to prevent symptoms or rescue medications to open airways during an attack.

What Happens in Stress-Induced Asthma?

Scientists have documented a range of stressful events that have been associated with asthma symptoms. These include school exams, public speaking, family conflict, public disasters, and exposure to violence. Stress may directly affect the body or cause people to manage their asthma less effectively.
First, stress and anxiety can cause physiological changes that may provoke an attack. These strong emotions trigger the release of chemicals, such as histamine and leukotrienes, which can trigger the narrowing of your airway.
During periods of stress and anxiety, people might forget to take their asthma medications, making an attack more likely, Gergen says. Stress-related hormones also reduce the body’s ability to fight off colds and other respiratory infections.  “Viral infections are very important causes for triggering asthma,” Gergen says.

How to Manage Your Asthma and Stress

Having asthma is stressful. Patients may not  know when or where they’ll have another attack, or what triggers their asthma attacks. Furthermore, stress is simply an inescapable part of life. However, experts tell WebMD that when you take steps to reduce your stress, you may also lessen your number of asthma attacks.
Some tips from the Cleveland Clinic:

• Identify the biggest causes of stress in your life: financial problems, relationship conflicts, lack of social support, a jam-packed schedule, or too many deadlines. If you can’t find solutions to these problems on your own, seek professional advice.
• Delegate responsibility. Give up being a perfectionist and let others pick up part of the workload. At home, make a list of tasks, assign responsibilities to others, train them to do the job, and give clear, specific instructions with deadlines. Allow others to do a job in their own way and express appreciation. You can modify this strategy for your workplace, too.
• Exercise. It’s a great way to burn off the effects of stress.
• Get enough sleep. Tired people simply don’t cope with stress as well.
• Learn relaxation exercises, such as deep breathing, progressive muscle relaxation, or clearing of negative thoughts. If you practice these exercises regularly, you can summon them to ease the effects of stress.

Coping with Anxiety During an Asthma Attack

When people struggle to breathe during an attack, anxiety can escalate into panic. “It is a significant labor to take your next breath,” Chipps says.
Having rescue medication on hand at all times, understanding how long it takes for drugs to work, and knowing when to call for help will prevent confusion during an attack, Gergen says. Create an “action plan” with your doctor, he suggests. “The best stress reliever is having your medications and an action plan and knowing how to use it.”
An asthma attack typically subsides in 5 to 10 minutes. If it doesn’t ease in 15 minutes or gets worse, it’s time to get medical help.
Another big stressor for people with asthma: “the fear of their asthma preventing them from leading a normal life,” Gergen says. But that fear may be a strong signal; it’s probably time to see a doctor to adjust treatment and medications for better asthma control.  
When the disease is managed well, people don’t have to live in fear, Gergen says. “They restrict their own activities -- not wanting to exercise or participate in certain things -- without the understanding that if they receive proper evaluation and adequate treatment, they can lead normal lives and participate in normal activities in the vast majority of cases,” he says. “The self-limiting isn’t really necessary.”