Psychological effects of Asthma

Dr Richa Sharma, CNS Correspondent, India
When asked to describe her asthma, Rushali (name changed) says, “It is like a bubble that envelopes me and does not let me breathe. I am always so scared of getting an attack, it makes me very sad.” Asthma, a chronic disease of the airway characterized by heightened response of the trachio-bronchial tree to irritants is often considered a nightmare for the people living with this condition. It is marked by frequent attacks of breathlessness and wheezing.

The risk factors include genetic predisposition, environmental exposure to inhaled allergens or pollution, dust, cold air, emotional upheavals (anger or fear) and strenuous exercises. An estimated 350 million people are affected by it globally and it is commonly seen among children. India has almost 30 million individuals living with asthma as mentioned by Prof (Dr) Surya Kant, President, Indian Chest Society and Head of Respiratory Medicine Department, King George's Medical University (KGMU) in a webinar hosted by CNS. This silent disease often goes unreported, undiagnosed and untreated as highlighted by Dr Jeremiah Chakaya Muhwa, of Forum of International Respiratory Societies (FIRS) and Member, Board of Directors, International Union Against TB and Lung Disease (The Union) in the same webinar.

Untreated asthma often results in sleeplessness, fatigue, reduced levels of activity, and absenteeism from school and workplace. Hence, even though it silently adds to the public health burden, it often goes unnoticed in the world health agendas globally. One aspect of this condition which does not receive adequate attention is the psychological component. Dr Chakaya also mentioned that because mortality rate for asthma is not very high, it goes unnoticed and often results in severe psychological and social consequences, including break up of marriages, and inability to take part in activities like sports. He also highlighted that asthma does not discriminate among people and affects everybody. But the poor people are more unable to cope up with it and hence the consequences are magnified many times over. 

We can only imagine what this condition does to the people who have to endure it for a lifetime— especially those living in economically deprived areas. They live in constant anxiety of enduring another attack and often get depressed because of their sickness. Historically, asthma was considered one of the major psychosomatic illnesses and the etiology was invariably linked with psychological components hence treatment modalities often included psychoanalysis as a treatment strategy. However, with time, as the major etiological picture of asthma became clearer, the psychological part was not given much importance. Research studies have been conducted to explore the link between asthma and depression and the pathway of causality. However, the researchers stand divided on the issue of asthma causing depression or anxiety and vice versa. Chronic physical conditions are reported to be existing with high level of depression. It is a well documented fact that has been proven time and again that people living with asthma tend to experience low health related quality of life .

Hence, the treatment of asthma should include addressing the psychological burden of the individuals. Improved psychological health in the people will help improve their adjustment with this condition, increase treatment compliance, positively affect perceived self competence in symptom management and also lead to increasing awareness of timely reporting of symptoms. Modalities like relaxation therapies and yoga can be used to address these issues. Family therapies can also be conducted to make the family aware of the issues people living with asthma deal with and equip them with the knowledge and skills required to take care of the affected individuals. A recently published systematic Cochrane review provides evidence of some positive effect of Yoga to relieve asthma-related problems. Such supportive systems will ensure a smooth functioning and alleviate the psychological burden of individuals living with asthma.

Dr Richa Sharma, Citizen News Service - CNS
May 14, 2016

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