A new study has found a significant link between asthma and Anxiety Disorders, particularly Post Traumatic Stress Disorder (PTSD).
Other research has shown a positive link between Anxiety Disorders and asthma, but this is the first to focus on Post Traumatic Stress Disorder and to take into account genetic, demographic, and environmental factors. The research was published in the second issue for November 2007 of the American Journal of Respiratory and Critical Care Medicine, from the American Thoracic Society.
Although the link was proven, the causes of the relationship between asthma and the Anxiety Disorders is not known. There are common risk factors with both asthma and the Anxiety Disorders, but how they operate is unknown, nor is whether the asthma comes first or the Anxiety Disorder comes first.
This post discusses this new research and its implications under the following headings:
- How was the research conducted?
- What the research discovered
- What are the Anxiety Disorders most closely associated with asthma?
- What are the reasons behind the link between asthma and Anxiety Disorders?
- Summary: More questions than answers
How was the research conducted?
The VET registry: one of largest twin samples
The research used the Vietnam Era Twin Registry (VET registry) to examine the association between PTSD symptoms and asthma.{{1}} The VET registry is one of the largest national samples of twins in the United States.{{2}}
The study included 3,065 male twin pairs, who had lived together in childhood, and who had both served on active military duty during the Vietnam War.{{3}} The study included both identical twins, who share all the same genetic material, and fraternal twins, who share only half of the same genetic material.{{4}}
To filter out causes of asthma other than PTSD, the study group was adjusted for cigarette smoking and body mass index, which are both associated with anxiety disorders and asthma.{{5}}
What the research discovered
Those with PTSD 2.3 as likely to have asthma
The study found that among all twins, those who suffered from the most PTSD symptoms were 2.3 times as likely to have asthma compared with those who suffered from the least PTSD symptoms.{{6}} The overall prevalence of asthma was 6 percent.{{7}} The researchers found the association between asthma and PTSD existed even after they took into account factors such as cigarette smoking, obesity and socioeconomic status, all of which are associated with both Anxiety Disorders and asthma.{{8}}
The research had three main results:{{9}}
- The data suggest a strong and significant association between asthma and PTSD symptoms among males in the community.
- The results indicate that the association between PTSD symptoms and asthma is not explained by its coexistence with depression, cigarette smoking, or demographic factors.
- The results of the within-pair analysis show that the link between PTSD symptoms and asthma is not explained by common familial or genetic influences.
The study also found evidence of a significant link between asthma and depression. This is consistent with growing evidence that there is a relationship between asthma and depression among adults.{{10}}
What are the Anxiety Disorders most closely associated with asthma?
Anxiety Disorders 6 times more prevalent with asthma
Studies have shown that psychiatric disorders, especially Anxiety Disorders and depression, are about six times more prevalent in patients with asthma compared with the general population.{{11}}
Lead researcher in this study, Renee D. Goodwin, Ph.D., M.P.H., Assistant Professor of Epidemiology at the Mailman School of Public Health at Columbia University in New York City, says,{{12}}
[A]nxiety disorders are the mental disorders most strongly and consistently associated with asthma … More specifically, evidence to date suggests that panic disorder and post–traumatic stress disorder (PTSD) are the anxiety disorders most strongly associated with asthma in clinical samples. … Studies have also shown a strong link between asthma and panic disorder among adults in the community
What are the reasons behind the link between asthma and Anxiety Disorders?
Little is known about the link
At this point, little is known about the reasons for the relationship between Anxiety Disorders and asthma, though there are some good clues that are being researched.{{13}} Renee Goodwin says,{{14}}
Although findings are relatively consistent in showing a link between anxiety disorders and asthma, the underlying mechanism remains unclear.
There is a sort of chicken-egg problem with asthma and Anxiety Disorders. Asthma could increase the risk of Anxiety Disorders, or Anxiety Disorders might cause asthma, or there could be common risk factors for both asthma and Anxiety Disorders.{{15}} Asthma and Anxiety Disorders do share a number of common social and environmental risk factors, which may play a role in their relationship. {{16}} Goodwin states:{{17}}
One possibility is that asthma causes mental disorders; a second possibility is that mental disorders cause asthma. Few studies have examined the temporal relationship [which comes first] between mental disorders and asthma. One study demonstrated that asthma leads to an increased prevalence of panic attacks and suicidal behavior and completion, whereas another study found that panic attacks lead to increased asthma activity.
Several studies have documented higher rates of respiratory disease in relatives of people with panic disorder and depression, suggesting a potential family or genetic link.{{ 18}} One of the risk factors for asthma is genetic; if a mother or father has asthma, there is a strong chance that their child will have it, too. However, this study found that the association between asthma and PTSD does not appear to be primarily due to common family genetics.{{19}} Goodwin states:{{20}}
If there had been a strong genetic component to the link between asthma and PTSD, the results between these two types of twins would have been different, but we didn’t find substantial differences between the two.
One environmental factor that might contribute to both mental disorders and asthma is exposure to trauma. Specifically, several studies show a link between exposure to trauma earlier in life and increased risk of asthma or respiratory disease in adulthood.{{21}} Traumatic exposure is a potential risk factor for asthma and is definitely associated with symptoms of PTSD.{{22}} Goodwin says,{{23}}
It is conceivable that traumatic stress, which has been associated with compromised immune functioning, leads to increased vulnerability to immune-system–related diseases, including asthma. … Alternatively, it may be that having asthma places adults at increased risk for PTSD as it increases the likelihood that they will be exposed to a traumatic situation because they have a life-threatening chronic medical condition.
Summary: More questions than answers
Little research has been done on link causes
Although this research proves a link between asthma and PTSD, it raises more questions than it answers. As with so much related to the Anxiety Disorders, there has been little research on the causes, precedence, and the common risk factors between it and asthma. A quick review of the literature shows that more research is ongoing, so maybe these questions will be answered in the near future.
In summary, here is what the study found:
- There is a strong link between asthma and Anxiety Disorders, especially PTSD and Panic Disorder.
- It is not known what causes the association of asthma and the Anxiety Disorders.
- It is not known whether the asthma occurs first, or the Anxiety Disorders.
- There are several risk factors that asthma and the Anxiety Disorders have in common.
- There is a genetic risk factor for asthma, but no genetic link was found for asthma with PTSD.
- Trauma might be a common risk factor between asthma and PTSD.
The research findings suggest that a person with asthma who experiences a traumatic event might be more vulnerable to developing Post Traumatic Stress Disorder. In addition, they may be having panic attacks associated with the asthma. In either case, the help of a mental health professional will help them to control the symptoms of the Anxiety Disorders.
What do you think?
I had severe asthma as a child, but “grew out of it” in my early 20’s. Maybe when I moved from home, I was away from the things that aggravated it. After researching this article, I’m curious if some of those same aggravating factors sowed the seeds of the mental conditions I already was beginning to develop.
- Do you or someone you know have asthma? Is there a history of PTSD or panic attacks as well?
- What do you think might be some common risk factors between asthma and Anxiety Disorders?
- Do you thinks that there are other physical conditions that share risk factors with Anxiety Disorders?
As always, your comments are welcome!
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[[1]]Goodwin, Renee D.; Fischer, Mary E.; Goldberg, Jack. (2007, November). A Twin Study of Post-Traumatic Stress Disorder Symptoms and Asthma. Retrieved December 2, 2008 from American Journal of Respiratory and Critical Care Medicine: http://ajrccm.atsjournals.org/cgi/content/full/176/10/983 ¶10[[1]]
[[2]]Goodwin. ¶11[[2]]
[[3]]Nauert, Rick. (2007, November 15). Link Between Asthma and PTSD. Retrieved July 1, 2008 from PsychCentral: http://psychcentral.com/news/2007/11/15/link-between-asthma-and-ptsd/1539.html ¶2[[3]]
[[4]]Nauert. ¶4[[4]]
[[5]]Goodwin. Discussion ¶2[[5]]
[[6]]Nauert. ¶2[[6]]
[[7]]Goodwin. Results ¶1[[7]]
[[8]]Nauert. ¶8[[8]]
[[9]]Goodwin. Discussion ¶1[[9]]
[[10]]Goodwin. Discussion ¶2[[10]]
[[11]]Miller, Karl E. (2007, May 15). Depressive and anxiety disorders can affect asthma control. Retrieved December 3, 2008 from American Family Physician: http://findarticles.com/p/articles/mi_m3225/is_/ai_n27236248 ¶1[[11]]
[[12]]Goodwin. ¶7[[12]]
[[13]]Nauert. ¶6[[13]]
[[14]]Goodwin. ¶8[[14]]
[[15]]Nauert. ¶7[[15]]
[[16]]Goodwin. Discussion ¶2[[16]]
[[17]]Goodwin. ¶8[[17]]
[[18]]Goodwin. ¶9[[18]]
[[19]]Nauert. ¶7[[19]]
[[20]]Nauert. ¶5[[20]]
[[21]Goodwin. ¶9[[21]]
[[22]]Goodwin. Discussion ¶3[[22]]
[[23]]Goodwin. Discussion ¶4[[23]]