Abstract
Asthma has long been considered a condition in which psychological factors have a role. As in many illnesses, psychological variables may affect outcome in asthma via their effects on treatment adherence and symptom reporting. Emerging evidence suggests that the relation between asthma and psychological factors may be more complex than that, however. Central cognitive processes may influence not only the interpretation of asthma symptoms but also the manifestation of measurable changes in immune and physiologic markers of asthma. Furthermore, asthma and major depressive disorder share several risk factors and have similar patterns of dysregulation in key biologic systems, including the neuroendocrine stress response, cytokines, and neuropeptides. Despite the evidence that depression is common in people with asthma and exerts a negative impact on outcome, few treatment studies have examined whether improving symptoms of depression do, in fact, result in better control of asthma symptoms or improved quality of life in patients with asthma.
Highlights
Asthma has long been considered a condition in which psychological factors have a role
Given that there are time-limited psychotherapies that are acceptable to patients, safe and effective treatments for major depressive disorder (MDD), it is unfortunate that no information exists on whether use of such therapies would improve asthma as well as depressive symptoms
Another study reported that children who died of asthma had states of hopelessness in the days preceding their deaths, postulated to have contributed to mortality via autonomic nervous system (ANS) dysregulation manifested as increased cholinergic/ vagal activation in sad and hopeless individuals.[202]
Summary
Asthma has long been considered a condition in which psychological factors have a role. Asthma and major depressive disorder share several risk factors and have similar patterns of dysregulation in key biologic systems, including the neuroendocrine stress response, cytokines, and neuropeptides. The notion that emotional stress can precipitate or exacerbate acute and chronic asthma[1] has been recognized anecdotally for many years Psychological barriers, such as faulty symptom attribution, adoption or rejection of the sick role, and low self-esteem, may negatively impact treatment adherence. The second part of the review addresses the limited literature on whether the presence of psychiatric illness, primarily major depression or an anxiety disorder (AD), has a negative impact on asthma outcome and whether treatment of the psychiatric condition improves these outcomes and considers the epidemiologic evidence of an association between asthma and depression. We discuss a nascent literature examining the central nervous system (CNS) correlates of an asthmatic response
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