Stress and Asthma: What's the Connection?

Most experts would agree that there is a connection between emotional stress and asthma but beyond that, a great deal of controversy still exists. Does emotional stress trigger asthma or make an attack worse? Or is emotional stress the result of asthma symptoms?

"I believe there's a link between people's emotions and asthma attacks," observes Stuart A. Tousman, Ph.D., associate professor of psychology at Rockford College in Rockford, IL. Nationally recognized for his work in this area, he conducted a workshop on the connection between asthma/allergies and stress at the 56th Annual Meeting of the American Academy of Allergy, Asthma and Immunology in San Diego

While studies show a clear relationship between emotional stress/anxiety, frequency of attacks, amount of medication needed to control symptoms and hospitalizations due to asthma, there are several possible explanations for this. Emotional stress could act as a trigger for asthma, and it could also make an attack worse as it is occurring. At the same time, symptoms and other factors associated with the disease could interfere with an individual's life to the point of damaging his or her self-esteem, and that can be very stressful.

Some researchers believe that individuals with asthma experience much of their stress as a result of asthma attacks or poorly controlled asthma. Many of these experts worry that seeing stress primarily as the trigger might lead health care providers to underestimate the impact that an individual's asthma symptoms are having on his or her emotional health.

On the other hand, researchers who believe that stress can trigger asthma symptoms or make them worse sometimes fear that other healthcare professionals aren't doing enough to help patients with asthma manage the stress in their lives.

While individual experts might focus on one explanation over others, the reality may be a combination of each, and recent studies suggest that adding psychological techniques such as muscle relaxation training and asthma self-management training to conventional asthma treatment can further improve a patient's response to asthma treatment.

Such programs work because they help patients identify and cope with stress related to their disease, and they provide education about asthma and its treatment so that patients can take better care of themselves. In addition, programs like this help patients and their health care providers to identify factors that might be keeping the patient from complying with treatment-- such as an inability to pay for prescriptions or the presence of unpleasant medication side effects.

Patients in one study experienced a reduction in asthma symptoms and anxiety level and an increased quality of life with the addition of psychological techniques to their treatment plan.

Another study, conducted by Dr. Tousman and his colleagues, examined 13 patients who completed a seven-week program that included interactive education, social support, relaxation training and humor therapy. Each week during the study, patients were asked to make a specific behavioral change such as exercising for 30 minutes or practicing relaxation for 30 minutes.

Study participants reported that the program relieved the tightness in their chest, made them feel less tired, improved their ability for achievement and improved their ability to control their asthma. These patients felt they had benefited most from education about medication options for their illness and learning how others cope with their asthma. The study also indicated that patients adhered to their medication plan better and felt more empowered to make lifestyle changes likely to improve their health.