Psychological Factors in Pulmonary Disease

Psychological Factors in Pulmonary Disease

Although asthma was once regarded as a classic psychosomatic disorder, it is currently viewed as a primary respiratory disease with varying immunological and autonomic pathophysiological changes. Many physicians still believe that psychological fac-tors play an important role in the precipitation and aggravation of asthma, particularly anxiety. One must remember, however, that respiratory distress itself causes a wide array of anxiety symptoms (panic attacks, generalized and anticipatory anxiety, phobic avoidance), and most of the drugs used to treat asthma have anxiety as a potential side effect. Brittle asthmatic patients, like brittle diabetic patients, are more likely to have current or past psychiatric disorder (particularly anxiety disorders) than are other asthmatic individuals, but which came first is not estab-lished. There is no typical personality type susceptible to devel-opment of asthma. Studies have shown that anxiety and depres-sion are associated in asthmatic patients with more respiratory symptom complaints but no differences in objective measures of respiratory function. However, psychological factors and psycho-social problems in hospitalized asthmatics were a more powerful predictor of which ones required intubation than any other ex-amined variable (e.g., smoking, infection, prior hospitalization, etc.) (Le Son and Gershwin, 1996). Psychological morbidity is associated with high levels of denial and delays in seeking medi-cal care, which may be life-threatening in severe asthma as well as less medication adherence and consequently poorer control of the condition. Not surprisingly then psychopathology in severe asthmatics is associated with increased health care utilization including hospitalizations, and outpatient and emergency room visits, independent of asthma severity.

Similar problems exist in interpreting relationships be-tween anxiety or depression and other chronic obstructive pul-monary diseases (COPD) (chronic bronchitis, emphysema). De-pression and anxiety are common in COPD though this partly reflects their increased prevalence in past or current smokers. As in asthma, psychological distress in COPD amplifies dyspnea without usually causing changes in objective pulmonary func-tions. Depression and anxiety do lead to lower exercise tolerance, noncompliance with treatment, and increased disability in COPD. Anxious COPD patients can improve their exercise tolerance through cognitive–behavioral therapy and pulmonary rehabilita-tion. Smoking is a well-established maladaptive health behavior causing and exacerbating chronic obstructive pulmonary disease, and its elimination is the most beneficial intervention available.