Friday, December 02, 2011

Is worsening asthma linked to anxiety?

So I've noticed increased asthma symptoms lately.  In October I had a pretty severe asthma attack at hunting camp and I've had two since that time.  Of course my daughter and two of my coworker friends have been having trouble too lately, so perhaps there's something in the air.

Yet something else I've been thinking about also lately is there's been an increase amount of stress in my life too.  Now that I'm working days my job is twice as hard, and the workload is triple of what it is when I work nights. 

There's also been a lot of pressure from my boss to do all these extra projects, such as I'm a Neonatal Resuscitation teacher and I'm a member of the Keystone Committee.  Plus I'm a commissioner on the local township commission and I was -- by default -- nominated as the chairman.  So there's a lot of stress there.

Now is it all a coincidence that my asthma started acting up as all this stress stacked up?  That's possible.  Yet there is also a ton of evidence that links increased stress and anxiety with asthma I can't help thinking about it.

A case in point was mentioned by Andrew Harver and Harry Kotses in their book "Asthma, Health and Society," (2010, New York, page 315).  They mention several studies that link asthma with anxiety and depression, and that link increased stress with worsening asthma.

I've mentioned on this blog a few times that I'm not afraid to say I have social phobia.  I've been diagnosed on more than one occasion with anxiety disorders.  I've been treated too.  Something I'd like to delve into at some point in the future is my medical records where my psychologist when I was a kid wrote how I had anxiety and how it made my asthma worse.

If you met me you may never know it.  I'm not the kind of person who sits in a corner.  Obviously, otherwise I wouldn't have been elected to the commission, and I wouldnt be chair.  And I wouldn't be able to be a teacher in front of classes.  Perhaps therapy helped me there. Or perhaps common sense helps me there. 

Now I wouldn't want to bore you with the details nor embarrass myself for that matter, yet I think this is significant because these studies match up almost to a tee with my own experience with asthma and anxiety and stress and depression.  Coincidence?  Perhaps.  Yet I think the evidence is stacked too high to ignore it. 

And of course there's no way of knowing whether increased stress and anxiety results in worse asthma or the other way around.  Yet I'm digressing.  I'd like to get back to the book I mentioned above and the studies. 

I'm just going to quote the book here and then I'll leave it at that and you can tell me what you think. Of course we know that the link between asthma and psychosocial disorders goes all the way back to written records way back in 200 B.C. 
"The late 19th century and early 20th century William Osler viewed asthma as a 'neurotic affection' in which imbalances of the nervous system and emotional factors played a fundamental role.  Since then a growing # of studies have provided evidence of a link between various psychosocial factors and asthma. Data from both clinical and community settings suggest that psychiatric disorders, and mood and anxiety disorders in particular, are disproportionately more prevalent among asthmatics relative to the general population.  Point prevalence rates of anxiety disorders (eg. panic disorders, general anxiety disorder and social phobia) and mood disorders (eg. major and minor depression disorder) are especially high among asthmatics, ranging from 16-25 percent for anxiety disorders.  One recent study indicated 31% of asthmatics meet criteria for one or more current mood (20%) or anxiety (23%) disorder.  Rates of certain disorders (i.e. panic disorders and major depressive disorder) are as much as six times more prevalent among asthmatics relative to the general population. 
He also notes the following:
  • Studies also link increased psychological stress to increased asthma morbidity
  • Studies observed symptoms of anxiety and depression have been associated with increased asthma severity, increased use of ER visits, increased symptom reporting, poorer PFTs, and lengthier hospital stays
  • Increased anxiety results in poorer adherence to medicine, etc. (this was my problem back when I was admitted to the asthma hospital in 1985)
Henry Hyde Salter was a doctor who wrote several articles and a book in the mid 19th century, and he was convinced that certain stimuli (dust, stress, etc.) stimulated the obdulla oblongota and a message was sent down the pneumogastric nerve to the bronchiole muscles causing them to spasm.  This was why he termed asthma a nervous disorder.  He made this theory mainstream.

The nervous asthma theory made it through great medical minds like William Henry Osler and Frances M. Rackemann, and wasn't debunked until the late 1950s.  Still it was followed by many doctors until the 1980s. 

Yet I still believe there is some truth to the asthma neurosis theory.  I denied it when I was 15 and my psychologist told me I had an anxiety disorder.  I denied anxiety.  I denied it all.  Yet the wiser 40 YO me knows better.  I'm convinced the allergic response doesn't just cause inflammation of the air passages, that it also causes inflammation somewhere in the brain that results in anxiety, social phobia and/or depression.

That's the Rick Frea theory.  Increased inflammation in anywhere, when it lasts long enough, becomes permanent.  This is what asthma is, so experts now beleive.  So could there also be inflammation somewhere in the brain?  We don't know? 

I do PFTs on myself every month at work for fun.  I've noticed my FEV1 had dropped some in the past year, the same time stress has increased.  If you look at the flow volume loop you can see the obstructive pattern on expiratory portion of the loop.  So is this a result exposure to too many other asthma triggers like dust and campfires, or is there some phychosocial issue going on?

I may be way off base and you can tell me so if you want.  Yet it's interesting anyway. It's just a frivolous though perhaps. 

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