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Asthma Articles and Research Abstracts |
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ANXIETY, DEPRESSION, AND ASTHMA
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Anxiety, and certainly panic together with asthma, can be a very bad combination in New Zealand. In the UK, anxiety seems to be helpful! Depression is bad anywhere—but anti-depressant treatment works wonders for asthmatics. Anxiety in New Zealand: In Auckland, Kolbe found that high levels of anxiety can impair ability to make correct self-management decisions, and to put into practice what the asthmatic actually knows [1]. Panic during an attack of asthma was found to be a risk factor for a severe life-threatening attack (SLTA); hence the importance of concerned, but calm and confident approach to people with acute asthma [2]. Kolbe's studies, unlike some others, were reliably based upon examination and interviews close to the time of the attacks, since psycho-social problems are frequently not mentioned in routine medical records—only in 13% in one investigation of patients admitted for acute asthma, whereas 33% were subsequently found to have received treatment or counselling for an emotional problem [4]. Anxiety in the UK: A recent UK study [5] centred around 533 asthma deaths (and controls) amongst subjects under 65, and had many good points besides its size. It included 78% of all asthma deaths in the large geographical area covered, 52% of which occurred outside hospital; and psycho-social problems were identified by researchers, 'blinded' as to 'cases' or 'controls', who studied patients' general practice notes going back 5–10 years! Rather tedious but unlikely in most cases to miss such problems. (Dr Kolbe is not so sure!). There was general agreement with Kolbe's finding of high anxiety levels amongst asthmatics —whether ever or never admitted to hospital for asthma. But in surprising contrast, they found significantly less anxiety recorded in the notes of the asthmatics who died, compared with controls admitted to hospital. The authors suggest that in the UK, anxiety about asthma, and perhaps a predilection for obtaining hospital admission, could be beneficial. Dr Kolbe has kindly commented: “The paradox of anxiety and asthma being a bad combination in NZ, while in the UK anxiety seems to be helpful, may be explained by a certain level (surveillance) anxiety being helpful in monitoring a chronic disease such as asthma. Too little (denial) has been shown a risk factor for severe life-threatening attacks. Too much (panic) is also a risk factor, compromising ability to make correct decisions in an acute exacerbation”. Psychosis and prescription of anti-psychotic drugs were associated with nearly twice the risk of death from asthma, and learning difficulties with three times the risk. Anti-depressant drug prescription: The UK study found an apparent protection of one-third against death from asthma amongst patients on anti-depressant drugs [5]. In fact, 12 papers have already described beneficial effects of Tryptanol™ on asthma, when it is prescribed for concurrent depression—a concurrence which should be borne in mind when treating asthma. It is postulated that depression is accompanied by a shift in “…central and peripheral autonomic tone …towards the cholinergic side” (which would favour a nerve-mediated degree of bronchoconstriction) [3]. However, whatever benefit may accrue from relief of the depressed state, it has been established that Tryptanol is actually a direct-action bronchodilator (seemingly the best amongst anti-depressants). Ten minutes after a 25 mg intramuscular injection, it was found to produce an increase of between 11% and 47% in the FEV1; it also causes bronchodilation in experimental animals [6]. [I am unclear how I have managed to miss this connection throughout the past 16 years of interest in asthma!]. Untreated depression (especially amongst children), has on the other hand been described as “…a potentially lethal mixture … depressive illness may be an under-recognised, but critically important, interactive factor in childhood asthma.” [3] About 25% of children with difficult asthma admitted to a hospital in Denver, Colorado, (not a random sample), were depressed, and anti-depressant treatment was frequently followed by improvement in asthma and reduction in needed medication. References:
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(Published in Open Airways - Journal of the Wanganui Asthma Society Inc. Abstracts and comment by Dr Kenneth Thomson) |
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