SHARES
“Sometimes, my mom and I would laugh so hard that we had to use our inhaler. I find myself getting an asthma attack more easily too, when I’m nervous and stressed out. The attack would be worse if I get very upset and start yelling at people.” Cindy has asthma during childhood. She is much better now but still gets an attack once in a while.
Asthma is a long term illness in which the airway constricts when it becomes very reactive and sensitive towards allergens and irritants. This is usually a result of long term inflammation in the lung due to many factors such as genetic predisposition, repeated infections, environmental exposure to irritants etc.
However, emotions are not allergens. Why would they trigger asthma?
Strong Emotions Affect Our Breathing
Any emotion when expressed too strongly can set off an asthma attack. For example, when you are laughing or crying too hard, screaming or yelling angrily, and even panicking in fear. In these situations, what is common to all of them is rapid and irregular breathing.
Normally, when we breathe, our airways warm up the air and moisten it with mucus. By the time it reaches our lungs, the air has almost 100% relative humidity at about 37 degree Celsius. However, when we are breathe too fast and too hard, the air is poorly warmed and moistened when it reaches our lungs.
In people with existing asthma, the airway is more sensitive and tends to overreact. This drier and colder air can readily trigger an asthma attack. For instance, cold air causes the small airway muscles to contract, making the airway narrower. Also, dry air contains more allergens and pollutants that are not filtered by the mucus. Therefore, dry air irritates the lungs more easily. As a result, the lungs inflame, swell up and produce more mucus that block the airway.
On top of that, irregular breathing during strong emotional expression makes the matter worse. More carbon dioxide are trapped in the lungs. This stimulates the nerves to narrow the airways, causing more asthma symptoms.
Photo by Leo Leath from Flickr
Being Emotional – More Likely to trigger Asthma
When we are experiencing stressful emotions including fear, anxiety, frustration and depression, our brain produces more signal output through the vagus nerve to our lungs, heart and gut. This signal can cause the airways to become narrower.
Having said so, this signal is usually balanced out by an opposite signal coming through the “sympathetic nervous system”. This system can be activated directly by the brain or indirectly by hormone.
In asthmatic patients, studies have found an imbalance between these two signals where cholinergic signal dominates (more output to vagus nerve). This also explains why asthma is often associated with anxiety and depression. However, the cause for this imbalance is not well understood. The clue seems to be everywhere from genetics to temperament, to even stress exposure during childhood and before birth.
In this context, studies are also showing that asthmatic person tends to have body resistance towards anti-stress hormone (glucocorticoids). These anti-stress hormone are able to suppress inflammation in the lungs. However, in asthmatic people, the body does not respond readily to them.
Likewise, similar body resistance is also seen in patients with depression, and early exposure to stress during childhood and before birth. Scientists are suggesting and looking at the possibility that early life exposure to stress is making the body less responsive to glucocorticoids.
Photo by info ideal from Flickr
Conclusion
In short, strong emotional states can trigger an asthma attack due to fast and irregular breathing. Also, an asthmatic person’s body tends to respond to stressful emotions in a way that makes it more likely to set off an asthma attack. This may even explain why we have asthma in the first place.
Find a GP/Family Doctor in Malaysia, on GetDoc
Find a GP/Family Doctor in Singapore, on GetDoc
References:
1. Ritz T. Airway responsiveness to psychological process in asthma and health. Front Physiol. 2012; 3:343.
2. Lieshout RJV, MacQueen G. Psychological factors in asthma. Allergy Asthma Clin Immunol. 2008; 4(1):12-28.
by Chang Xian
View all articles by Chang Xian.
