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The Psychology of Asthma

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What is asthma? What causes asthma? What are the symptoms of asthma? What role does psychology play in asthma? What are the psychological effects of asthma? How can psychology be used to minimise the effects of asthma?

Imagine suddenly not being able to breathe. Your anxiety level jumps through the roof. Adrenaline kicks in. That depletes your oxygen level even more. That makes it harder to breathe, which further heightens your anxiety level. That is the escalating reality of an asthma attack.

Asthma is the name given to the disorder where the muscles around the smaller airways in the lungs inflame causing the narrowing of those airways, and thus, breathing difficulties. Symptoms include a tight chest, wheezing, coughing, and a sense of being short of breath, medically known as dyspnea.

Asthma can develop in a person at any age. Some children’s asthma disappears as they enter adulthood. For others, it abates for some years and then returns.

Worldwide, there are approximately 500,000 deaths per year from asthma, of the estimated 300+ million people with the condition. More alarmingly, the number of cases increases year on year, and estimates of the increase vary widely; the highest is 50%.

The incidence of asthma around the world varies from 4% to 12%. Many countries, because they have still developing healthcare systems, seem to underreport the incidence of asthma. That is, the figures cited could be much lower than the reality.

As with many diseases, many possible causal factors have been identified, but no clear cause has been pinpointed. Linked factors include genetics, allergic conditions, living in an urban environment (implicating pollutants), low birth weight, viruses, exposure to tobacco smoke, other toxic chemicals, dust, dust mites, obesity, diabetes, and others. It may be that there are multiple causes of asthma, or that there are multiple environmental triggers that can activate a prior disposition.

Some parents of children with asthma ask themselves if they have done, or not done something, has caused their child’s asthma. We just don’t know enough about the causes of asthma to know if anything could have caused or prevented its development. What can be done, at the present, is to minimise exposure to known asthma triggers.

The triggers vary from person to person and include smoke, dust, fumes, pollen, viral infections, fur and feathers, strong scents, weather changes, stress and anxiety.

Appropriate use of inhaled medication is effective in controlling the worst and most immediate threats from asthma:

  • Bronchodilators relieve symptoms by opening the airways.
  • Steroids reduce the inflammation around the airways 

Alas, a disproportionate number of asthma fatalities take place in developing countries where inhaled bronchodilators and steroids are less available.

The psychological impact of asthma takes on many forms, direct and indirect:

  • Children with asthma can have their education disrupted on an ongoing basis.
  • Concentration is impeded by asthma-induced sleep deprivation.
  • Regular, essential, trips to the physician also play a part.
  • Sleep disturbance is common and leaves some people with asthma fatigued and lacking in energy. In extremis, asthma-induced sleep deprivation can lead to depression.
  • Depression is strongly linked to sleep disturbance.

Anxiety is also common in people with asthma. To understand why, imagine what it is like to know that at any moment your ability to breathe could be impaired. Now take that to a higher level.

Imagine that you have had a severe asthma attack, and felt that your life was nearly taken by asthma. Almost everyone would understand if you developed PTSI, post-traumatic stress injury. Now raise the intensity again, and imagine that experience taking place regularly. What effect would that have on you? That is probably why so many people with asthma also experience stress and anxiety.

Many people, whether they have asthma or not, have a poor ability to describe and
communicate their emotions, and/or have difficulty distinguishing between emotions and bodily sensations. Those are two elements of alexithymia. For many medical conditions, alexithymia is a risk factor both for the development of the condition and its progression.

Imagine what it is like to have asthma, and be unable to communicate what it is doing to you emotionally and physically.

To manage asthma, it is helpful for the patient to have a high level of accuracy in perceiving their level of airway obstruction. Many patients have great difficulty in accurately perceiving, or reporting their symptoms. Their reporting does not match the pulmonary (lung) function measures. Both under and over-reporting the level of obstruction present dangers: leading to a six times increase in the incidence of fatal or near-fatal asthma attacks. There are more cases of under than over-reporting obstruction levels.

When people with asthma are more negative, emotionally, towards life, they report more breathing problems than those with a positive emotional outlook. With the emotional state being related to perceptions of discomfort, it would be reasonable to expect that when people with asthma are feeling good, emotionally, they would underuse their medication, and that has been found by researchers.

With stress and anxiety, and PTSI, being triggered by repeated asthma attacks, it is little wonder that many asthma patients develop a negative emotional state, which can be seen in some patients as avoidant coping strategies, (denying or ignoring problems).

Alas, such a state leads to lower quality of life, and more adverse outcomes, in the long term. In extremis, poor coping strategies increase the chances of needlessly dying.

Those asthma patients who fare best are those who have the most effective coping strategies.

What are those strategies?

  • They maintain a positive outlook on their ability to cope.
  • They have perceptions of more personal control of their asthma.
  • They are aware of their asthma triggers, and early warning signs and take steps accordingly.
  • They expect themselves to control thoughts, feelings and behaviours related to their asthma.
  • They take whatever action is necessary to control their thoughts, feelings, and behaviours to minimise the impact of their asthma.
  • If they are severely impacted by an asthma attack they stay calm and minimise the chances of anxiety worsening the attack.

There is a strong interplay between a person’s psychology and whether they experience an asthma attack, and how severe the attack is. Those people who have learned and best apply the most effective coping strategies can lead normal lives.

Of course, as with many diseases, the level of severity varies from person to person. However severe, the more a person applies the known effective coping strategies, the better they cope with the disease.

If you experience asthma, and you are looking for some role models to inspire you to develop and apply coping strategies, here are some examples.

  • Ambrose Bierce – journalist and author
  • Charles Dickens – author
  • Edith Wharton – author
  • John Kennedy – 35th US President

Some people may be tempted to think that high achievement with asthma is limited only to cerebral activity. Not so. Well-managed, elite-level achievement is possible.

  • Mark Spitz – the winner of nine Olympic gold medals, set multiple world records
  • Paula Radcliffe – world-record-setting marathon runner
  • Kristin Chenoweth – singer and actress
  • Billy Joel – singer, songwriter

If you have asthma, and you decide to adopt the best coping strategies, you will be able to improve your life and find yourself in very good company. You will join those who have found that apart from effective medication, the mind is the best asthma treatment.

Professor Nigel MacLennan runs the performance coaching practice PsyPerform.


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