Links Between Asthma and Anxiety

I have both asthma and a diagnosis of anxiety, which has always left me wondering: Is there a link between the two, or is it just a coincidence that I have both? As I began researching this a few years ago, I was surprised to learn that 6-24% of people with asthma also have anxiety (1, 2). This means I'm not alone, and it's likely not a coincidence that I have both conditions. So, what exactly is anxiety, and why are people with asthma more likely to experience it than the general population? Here’s some of what I’ve learned.

What is Anxiety?

Imagine walking into a room and seeing someone you've always wanted to meet standing there. You’ve anticipated this moment and prepared things to say. But suddenly, you feel a wave of discomfort: your heart races, your breathing rate increases, and you struggle to focus. You start to fear unlikely outcomes, like the person not liking what you have to say, or worse, forgetting what to say or saying something foolish. Your mind might even convince you that you’re going to say something irrational. Prolonged exposure to these situations can cause physical symptoms like stomach discomfort, nausea, and headaches.

Can Anxiety Impact Your Life?

This irrational fear can make you avoid these situations altogether, or if you do attend, you might go out of your way to avoid the person. While it may feel safer, it has certainly impacted my life, probably even leading me to quit journalism and become a respiratory therapist instead.

Can Anxiety Trigger Asthma?

When certain people or groups make me feel uncomfortable, I tend to keep to myself and avoid engaging. If you're wondering why I didn’t come up to talk to you at that meeting last night, now you know: it’s easier if you approach me. Fortunately, I received counseling for my anxiety in the past and have educated myself on the subject. I know it’s irrational. These people aren't dangerous, and they're not thinking, “Look, there's John. What an idiot!” Those are the types of irrational thoughts anxiety creates. I’ve learned that action cures fear—just go about your business, sit with people you feel comfortable with, and calm yourself. Eventually, people realize I have something intelligent to say, and they begin to like me. This is how I manage those irrational anxiety moments. It’s not easy, but it’s part of what I have to deal with.

Why Are Asthmatics More Likely to Have Anxiety?

I’m not an expert on anxiety—I'm a respiratory therapist, writer, and researcher, not a psychotherapist. However, I’ve come across some interesting theories about why people with asthma might be more likely to develop anxiety.

1. Dyspnea-Fear of Suffocation Theory
   You may have heard of Pavlov’s dogs. Ivan Pavlov, a Russian physiologist, discovered that dogs salivated not only when they were fed but also when they anticipated food. Similarly, during a severe asthma attack, when you can barely catch your breath, panic and anxiety may set in due to the perceived fear of suffocating and dying. This is a rational fear, but it can cause anxiety or panic attacks in response to a wide range of stimuli (such as certain people or situations) later in life. Ronald Ley proposed this theory in 1989 (3, Ley).

2. Biomarkers Theory
   Although this theory doesn’t have a formal name yet, it suggests that the chemicals released during asthma and allergy attacks (such as histamine, leukotrienes, cytokines, and chemokines) might also cross the blood-brain barrier. These chemicals could potentially cause changes in the brain, making someone more predisposed to anxiety or panic disorders. Further research into this theory could either support or challenge the dyspnea-fear theory.

3. Medication-Induced Anxiety
   Certain medications, like bronchodilators and theophylline, can cross the blood-brain barrier and have been linked to anxiety (2). This connection should be considered when evaluating the relationship between asthma and anxiety disorders.

Conclusion

There is still much to learn about the brain, and it will take time before researchers fully understand the link between asthma and anxiety. That said, it seems clear that there is a connection, and future asthma guidelines should consider anxiety as a potential comorbidity. Physicians should be aware of this link and either rule it out through testing or properly diagnose and treat it so that all people with asthma can live normal, healthy lives.

References:

1. Katon, W.J., et al. “The relationship of asthma and anxiety disorders.” Psychosomatic Medicine, 2004 May-Jun;66(3):349-355.
2. Deshmukh, V., et al. “Anxiety, panic, and adult asthma: a cognitive behavioral perspective.” Respiratory Medicine, 2007 February, 101(2):194-202.
3. Ley, R. “Respiration and Emotion.” Springer, 2001, pages 65-74.