Goodwin et al. (1) provided the first available information on the
association between physician-diagnosed asthma and DSM-IV mental disorders
in a representative population sample of adults. Current severe asthma was
associated with a significantly increased likelihood of any anxiety
disorder, including panic disorder and panic attacks.
Studies with asthma have shown rates of panic disorder varying from 8
to 24% (2). On the other hand, respiratory diseases represent possible
risk factors to the occurrence of panic disorder, since their lifetime
prevalence has been found to be three times higher in panic disorder
patients than in other psychiatric patients (3). Both panic disorder and
obstructive pulmonary diseases, such as asthma, constitute major public
health problems all over the world; they are related to important social
and economic loss, as well as negatively affecting patients’ quality of
life (2).
Agoraphobia can be even more problematic if the phobic disorder is
associated to a respiratory disease. Economic, familial and social
problems, together with low self-esteem and conjugal conflicts, are
usually associated to asthma/agoraphobia, even of mild or moderate
severity (3). The low professional accomplishments due to panic disorder
and/or panic attacks plus agoraphobia associated to asthma are directly
related to job instability, greater absenteeism or job changes (2). These
stressors and the use of corticosteroids, beta-2-agonist bronchodilators
and antihistaminics could increase the risk for the development of anxiety
and depressive disorders.
Nascimento et al. (4) evaluated the frequency of anxiety disorders in
86 subjects from an outpatient asthma clinic. Forty-five asthmatic
patients (52.3%) reported at least one current anxiety disorder. The
frequency of panic disorder with or without agoraphobia was 13.9% and that
of agoraphobia without panic disorder was 26.8%. The psychiatric morbidity
of the sample was 61.6 % (n=53). The data tend to support the high
morbidity of anxiety disorders, particularly panic and agoraphobic
spectrum disorders, in asthmatic outpatients.
The obstructive pulmonary diseases could trigger panic attacks in
predisposed individuals by the stimulation of the central chemoreceptors
hypersensitive to pCO2 and/or the locus ceruleus (3). Recurrent episodes
of hypercapnia may also work by the same mechanism. This hypothesis was
equally reinforced by the hypersensitivity to CO2 false suffocation alarm
theory (5). Moreover, somatic symptoms associated with respiratory
diseases could exacerbate catastrophic cognitions and panic attacks in
patients vulnerable to anxiety.
The high prevalence of panic disorder in primary care settings is
verified but panic disorder is conversely underdiagnosed and so under
treated in patients with other medical illnesses (2, 4). An early identification of panic disorders without restricting the diagnosis to the classification’s criteria, allowing a clinical judgment based on symptoms, criteria and the spectrum concept, could decrease the use of drugs in the absence of any precise psychiatric diagnosis in asthmatic patients and thus lead to better treatment, improving their health and quality of life.
References:
1.Goodwin RD, Jacobi F, Thefeld W. Arch Gen Psychiatry 2003; 60: 1125-
1130.
2.Carr R. Panic disorder and asthma: causes, effects and research
implications. J Psychosom Res 1998; 44: 43–52.
3.Perna G, Bertani A, Politi E, Colombo G, Bellodi L. Asthma and panic
attacks. Biol Psychiatry 1997; 42: 625–30.
4.Nascimento I, Nardi AE, Valença AM, Lopes FL, Mezzasalma MA, Nascentes
R, Zin WA. Psychiatric disorders in asthmatic outpatients. Psychiatry Res
2002; 110: 73-80.
5. Klein DF. False suffocation alarms, spontaneous panics and related
conditions. Arch Gen Psychiatry 1993; 50: 306–317.
Financial disclosure : Brazilian Council for Scientific and
Technological Development (CNPq), Grant 300500/93-9.
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