Asthma Brings Surprising Challenges

The cycle of breathlessness and mental health difficulties

Posted Mar 21, 2019

 Free-Photos at Pixabay, Creative Commons
Source: Free-Photos at Pixabay, Creative Commons

During the summer of 2017, Adrian and his partner, Kayla, ventured out to explore the dense forest in a remote area of south-eastern Canada where they were vacationing. Hiking on a trail that took them deep into the woods, Kayla shouted back at Adrian, urging him to catch up. Turning to him, Kayla could instantly tell something was wrong. After a wave of panic, he collapsed to the ground, gasping for air.  

As Adrian began to fade in and out of consciousness Kayla frantically dialed 911, despite knowing there was no cellphone service within miles of their location. They were completely isolated. Trying to provide comfort, all Kayla could say was, “This is not the end.” 

Approximately 300 million people worldwide suffer from asthma. This inflammatory lung disease, which causes swelling of the airways and constricted breathing, can be life-threatening. Globally, 250,000 people die each year from the condition, and researchers have yet to find a cure.  

Asthma is a common health concern, and the traumatic experience of an asthma attack can affect the emotional well-being of the sufferer and loved ones.

A Canadian study by Renee Goodwin and colleagues published in the Journal of Psychosomatic Research found that asthma is related to numerous mental health conditions, with the greatest links between asthma and posttraumatic stress disorder (PTSD), mania, and panic disorder. Using data from the World Health Organization, Kai On Wong and a team of researchers found that, globally, asthma is associated with depression and anxiety. 

Alex Watford is not surprised by these findings. In an interview with the Trauma and Mental Health Report, he discusses the toll his asthma has had on his mental health and provides insight into what it is like to experience an asthma attack: 

“It feels like you’re drowning. All of a sudden, you’re not getting enough oxygen despite how much you try to breathe. While attempting to breathe, you can hear phlegm rapidly filling your lungs, slowly suffocating you. You then become light-headed and begin to lose vision while your body becomes weak and lifeless.” 

With diagnoses that include PTSD, anxiety, and depression, Watford believes his psychological distress is largely due to the terrifying flashbacks that cause him to live in constant fear of the next attack; a fear which in turn provokes a level of anxiety that makes breathing difficult.

Clinical health psychologist Laura Flower, and Senior Research Fellow at the University of Southampton, Ben Ainsworth, describe Watford’s experience as the ‘cycle of breathlessness,’ a factor that contributes to the “complex and bi-directional” association between asthma and mental health challenges: 

“The experience of breathlessness is distressing, and it’s a normal reaction to be anxious about it. This anxiety then leads to an increased chance of breathlessness – which causes more anxiety.”

According to Flower and Ainsworth, the association between asthma and mental illness is further complicated by the complex relationships asthma sufferers have with their symptoms: 

“Some people are deconditioned to them (e.g. “it’s just my lungs, it’s just me”) and therefore aren’t motivated to manage them. Other people find them really uncomfortable and are unable to work or enjoy a satisfactory quality of life. Both of these can lead to social isolation, poor lifestyle factors, such as fitness, which in turn worsen asthma symptoms.”

Watford describes how his daily life has been impacted by the disease:

“Having asthma affects my everyday life, as it makes having to walk long distances, such as across campus, really tough. This often deters me from going to class because I will feel so exhausted afterward that attending feels useless. I often find myself avoiding many other activities for this same reason.” 

In a UK-based asthma community forum, members offer further insight into asthma’s invasive nature and speak to the unpredictability and uncertainty of life with asthma. 

“You don’t know what to expect tomorrow. Will you be able to breathe? Will there be someone there wearing strong perfumes or aftershave? Is there dust in the air? Oh, and just the sheer tiredness of it all, the worrying, not being in control of your surroundings…”

Some members say they are unable to perform simple tasks, such as walking up staircases or showering. Asthma sufferers describe the impact of the disorder as “genuinely life destroying and heartbreaking”. 

Complicating matters further is the stigma associated with asthma, resulting from a lack of awareness and understanding. The stigma can lead to improper management of the disease, as well as social isolation that creates further mental health challenges in asthma sufferers. 

This is a theme that comes up in the asthma community forum:

“…sometimes we trivialize asthma as a society. It makes us think our illness isn’t that bad and so all the problems associated with it aren’t genuine.”

Clinical health psychologist Stacy Thomas shares some of the ways psychologists, like herself, help asthma sufferers cope with the mental health aspects of chronic disorders, including asthma: 

“Using therapeutic interventions, health psychologists help to eliminate the psychological barriers that moderate the experience of asthma. For example, cognitive behavioral therapy considered the ‘gold standard’ in terms of therapeutic approach, examines the thoughts and beliefs that contribute to problems with mood or anxiety, the tools one can use to find more balance in their thinking, and the behaviors that might need to be changed.”

Adrian survived his close call that summer hiking in the woods.  But like many others, he continues to re-live the attack with great intensity and struggles with the anxiety that such an experience leaves. Sometimes Adrian forgets that he suffers from asthma. For now, Adrian tries to remain positive, while patiently hoping for a cure. 

-Julia Martini, Contributing Writer, The Trauma and Mental Health Report.

-Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

-Copyright Robert T. Muller