The cause of the higher prevalence of anxiety and depression in individuals with asthma is unknown but these have practical implications for the treating physician.
Several studies have clearly demonstrated that anxiety and depression are more common in asthmatics when compared to the general population. The reasons for this increased prevalence is not clear. Explanations include hypothesis ranging from asthma increasing the risk of developing anxiety disorders to the other way round; depressed and anxious individuals are more prone to develop asthma to somewhere middle; there is a common underlying pathology that causes both.The prevalence of anxiety is more common in asthma compared to other chronic diseases like chronic hepatitis C and rheumatoid arthritis. Among asthmatics females are more likely to suffer from psychological distress.
It is also known that acute asthma may be triggered by psychological and emotional factors. On the other side studies also show that an episode of near fatal asthma can lead to life long anxiousness about their disease and possible acute worsening. Anxiety was also associated with worse subjective (patients perception of disease) asthma outcomes even though the objective parameter like pulmonary function testing was not severe.
Physicians should be aware of this aspect as many asthmatics with predisposition to anxiety and depression may seek medical help with asthma related symptoms. Their symptoms may not be related to poorly controlled asthma but to their underlying anxious nature. Pulmonary function testing and exhaled nitric oxide test may throw insight into the condition of the airway inflammation and obstruction. Exhaled breath nitric oxide is an inflammatory marker which can quantify the extend of airway inflammation. The common tendency is to prescribe more asthma medications when patients present with symptoms of uncontrolled asthma. In asthmatics with possible anxiety/depression, the physicians need to consider all aspects before deciding to step up the asthma medications.
Reference
Current Opinion in Pulmonary Medicine:
January 2011 - Volume 17 - Issue 1 - p 39–44
doi: 10.1097/MCP.0b013e328341005f
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