Psychological factors related to asthma

Why some people develop asthma while others do not is still unknown.  Asthma is thought to be a combination of environmental and genetic factors. Asthma triggers can vary, from respiratory infection, physical activity, smoke, certain medications, to strong emotions and stress.

Since there is no exact data on what exactly causes asthma, because the triggers differ from person to person, we cannot say with certainty to what extent the psychological characteristics of people suffering from asthma are related to the severity of asthma.

However, according to some research, psychological factors that are related to the experience and treatment of asthma are the subjective perception of symptoms, coping strategies, depression and anxiety (Baiardini, I. et al., 2015).

Symptoms’ subjective perception

The way a person presents their symptoms to the doctor is an important factor in determining the diagnosis, and later the further plan and course of treatment. However, a great number of patients report difficulties in recognising their own symptoms.  As a result of inadequate recognition, overuse of reliever medication of the symptoms occurs, with no regard to the objective function of their lungs.  Patients sometimes tend to overemphasize their symptoms, but also to underestimate the severity of their disease, which can lead to a potential risk of delayed treatment.  Many patients also learn to associate negative situations and emotional reactions with difficult breathing, which often leads to their over-perception of dyspnoea (inability to take a deep breath, discomfort in the chest, ‘air hunger’).

Coping strategies

Living with chronic asthma requires continuous cognitive, emotional, behavioural and social adaptation. Patients who have built constructive coping skills for chronic asthma have a sense of greater personal control over the disease and manage it better in the long term.  This way, they can increase the subjective sense of competence and self-efficacy in dealing with a wide range of daily demands and health issues (Dolinar, R.M. et al., 2000).

Depression and anxiety

Asthma has long been associated with symptoms of mood and anxiety disorders. However, the association of mental health issues with asthma severity is controversial.  Some studies have shown significantly higher levels of anxiety and depression in patients with severe asthma as compared to those with milder symptoms, while other studies have not found such differences (Delmas, M.C.  et al., 2011).  Asthma can precede the development of anxiety and mood disorders, but also the presence of psychological behavioural problems can precede the onset of asthma (Tomas, M.  et al., 2011).

Bidirectional influence

Despite numerous data supporting the association of disease severity with the psychological characteristics of asthmatics, the causal relationship between asthma and mental health is not clear.  A hypothesis of a bidirectional influence seems to be more acceptable.  When a psychological problem or difficulty is present, it interferes with optimal disease management and objective recognition of symptoms. When a person faces the symptoms of severe asthma on a daily basis, it also affects their psychological functioning.

What do these research mean for the patient?

Research makes sense when it also has its practical component. So how can we use this research to improve the quality of life of a person suffering from asthma?

  • When we talk about symptoms’ subjective perception, it is important that the individual learns to be more aware and objective when observing their symptoms. Making notes and a check-list of common symptoms can help them with this. When unsure or in doubt, going through the check-list entry-by-entry can contribute to being objective.

  • Coping strategies can improve on a daily basis. It is important to make an effort to search for and try different strategies that can be useful to you.  By actively coping with the disease, you can help yourself change the situation and the meaning you give to a certain experience, or relieve the stress associated with asthma management.

  • Seek support as soon as you notice symptoms of anxiety or depression. It is best to contact a professional who can guide you and help you overcome the challenges you are facing more easily.This type of support may be very important and sometimes even essential to your mental health.

Developed awareness of these and other psychological factors, as well as continuous personal work, can help you to cope with asthma, but it can also improve your psychological functions and contribute to a sense of well-being. As a result, your quality of life, despite the disease, can become better. Body and mind are related and we should not separate them. And why would we?!


Danka Đukanović – Gestalt Psychotherapist & Consultant