Article

Stress-induced breathlessness in asthma

Leiden University, Leyden, South Holland, Netherlands
Psychological Medicine (Impact Factor: 5.94). 11/1999; 29(6):1359-66. DOI: 10.1017/S0033291799008958
Source: PubMed

ABSTRACT

A majority of patients with asthma believe that psychological factors (particularly stress) can induce asthma attacks, but empirical support for actual stress-induced airways obstruction is controversial. This study tested the hypothesis that stress induces breathlessness and not airways obstruction.
Stress was induced by a frustrating computer task in 30 adolescents with asthma and 20 normal controls, aged 14-19 years. Stress measures were self-reported emotions, heart rate, blood pressure. Respiratory measures were respiratory rate (RR), end tidal CO2, deep inspirations and sighs. Asthma measures were lung function, wheeze, cough, breathlessness.
All measures confirmed high levels of negative emotions and stress. None of the participants developed airways obstruction; they had no reduction in lung function, wheeze was absent and cough negligible. However, breathlessness increased in all participants with asthma and excessively in many. The mean breathlessness was higher than during induction of actual airways obstruction with provocative agents in previous studies. End tidal CO2 showed that breathlessness could not be explained by hypocapnia.
Stress can be sufficient to induce breathlessness in patients with asthma.

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    • "Two of three film studies that showed no significant change or low effect sizes have relied on pre-post assessments only (Table 2). An additional number of studies that showed weak or no effects have also relied on discrete assessments (Miklich et al., 1973; Rietveld et al., 1999; Kang and Fox, 2000; McQuaid et al., 2000; Put et al., 2004; Aboussafy et al., 2006; von Leupoldt et al., 2006). However, emotions have been conceptualized as phasic, transient events of a short duration (Levenson, 1988). "
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    • "Stress has been linked to asthma-related morbidity (Wright et al., 1998, Rietveld et al., 2000) and negative life events have been linked to poorer asthma-specific quality of life (Archea et al., 2007)ยจ Wright and co-authors propose a biopsychosocial model in which environmental demands (stressors or life events) lead to negative emotional responses, then physiological responses, and, finally, an increased risk of more severe physical disease. Clinical reports have suggested connections between an individual's experiences of stress, upset, anxiety and asthma attacks (Rietveld et al., 1999, Rumbak et al., 1993). Depression is associated with increased steroid use and greater health care utilization in asthma (Eisner et al., 2005, Stein et al., 2006, Kullowatz et al., 2006). "
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