Kathleen Dougherty, of Keuka Park, N.Y., knows when she’s having too much fun. Caught up in an enjoyable moment, she may find herself short of breath, and then panic sets in — another asthma attack is under way.
After living with asthma for 49 years, Dougherty knows that her emotions — both good and bad — can trigger an attack. “Anytime I’m emotionally involved in a situation and I start getting worked up, whether it’s just that I’m enjoying myself so much at a party or I’m anxious about something, it can cause an attack,” says Dougherty, 52.
While the connection between emotions and asthma is not well understood, most experts agree that there is certainly a link, according to Kim Kelsay, M.D., a pediatrician and psychiatrist at the National Jewish Medical and Research Center in Denver, Colo.
“Strong emotions — anger, happiness, fear — anything extreme can trigger an asthma attack. More commonly, though, the attack has started and emotions make it worse,” she says.
In fact, because of that emotional connection many physicians in the late 1800s believed asthma to be a disease of the nervous system, according to the National Institutes of Health. And even as late as “the mid-twentieth century physicians thought asthma and other chronic diseases were psychosomatic — caused by emotional conflicts.”
Today, scientists are looking more closely at the possibility that stress may trigger neurochemical responses that cause asthmatic symptoms, the NIH reports.
“All illnesses have some psychological component to it, but there’s also a lot of biological changes going on during an asthma attack,” says Kelsay, co-director of the center’s asthma treatment program. But the psychological component of asthma doesn’t mean you should blame yourself for the condition, experts advise.
Christen McHale, 25, of New York, has no doubt that emotions play a part in the disease. Whenever she’s facing a heavy workload or having personal problems, she said she notices a definite increase in how often she uses her albuterol inhaler.
“Asthma is the only disease I know of where you can literally worry yourself to death,” says Kevin D. Hamilton, a respiratory therapist and coordinator of the Asthma Education Management program at Community Medical Center in Fresno, Calif. “And it’s not just anxiety or bad feelings that can trigger an attack, but even something as wonderful as a good, hard laugh,” he says.
In fact, there are about three million people in the United States whose asthma attacks are triggered by physical or emotional factors, like exercise, anxiety or even laughing too hard, according to Hamilton. While exercise-induced asthmatics make up only about 15 percent of patients, emotions can also trigger attacks or make them worse in patients whose asthma is caused by allergies or other factors.
When people with asthma do see a link between emotions and attacks, they often begin avoiding situations they expect will bring on strong emotions — and that can have a devastating impact on their social lives, Hamilton says.
There’s no need for that, he says, explaining that simply using an inhaler 20 to 30 minutes before going out for an evening, and drinking plenty of water throughout the night, can help prevent an attack. If an attack does occur, he says, trying to fight it off only worsens the situation. Instead, use your inhaler immediately. And, when you can, use relaxation techniques like deep breathing to help alleviate stress.
While that might be easy enough advice for adults, it’s more difficult for children and teenagers in an emotional situation.
“Kids especially have a hard time thinking long-term — that’s why it’s important for parents to build a system to monitor their child’s medication. If an adolescent is having a fight with a friend, they may decide they just don’t feel like taking their medicine that day or the next day, and that’s when they can get into trouble,” says Dr. Kelsay.
Monitoring is particularly important in families dealing with an emotional crisis or ongoing stress, she says. “On top of anecdotal and clinical data, there are some studies that have shown that in families with high stress, kids are less compliant and more likely to have an attack. Kids really pick up on everyone else’s anxiety, and that too can worsen their attacks. As parents, you have to think about what you can do as a family to control emotions.”
While Hamilton feels that most parents, patients and doctors understand there is a connection between emotions and asthma, how they treat the situation is not always appropriate.
“Unfortunately, the way parents often approach it is to tell their children, ‘just calm down,’ or adults will just try to calm themselves down. At that point, it’s not going to happen — they’ll likely need medical attention,” he says.
“Many people will start to breathe a little easier and feel it’s passed, even if they are still wheezing. So then they just dismiss it, or their doctors dismiss it. But by then the inflammatory cascade has begun, and it has to be treated. If it’s left untreated, it can cause long-term damage to the lung tissue,” he says. “Lots of doctors and patients are missing the boat on that.”
In the end, the best way to help prevent attacks brought on by emotions is to simply figure out what the triggers can be. “Once you do that,” Dr. Kelsay says, “you can start controlling it.”
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