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How Stress Makes Asthma Worse

A woman taking her inhaler at home at the living room

Unlike other breathing problems, if asthma is well controlled, breathing can be normal most of the time. But when a person is exposed to a trigger, it can flare up unexpectedly. Common asthma triggers are different for everyone but may include: infections like cold or flu, allergens, cigarette or fire smoke, dust, mold, all types of perfumed or scented products, air fresheners and exercise.

Stress is also a common asthma trigger. “Studies have shown that when people with asthma are under a lot of stress they have worse asthma control and more flare-ups,” says University Hospitals pulmonary and critical care specialist Layla Sankari, MD.

Stress as a Trigger

Asthma is a condition that affects breathing. Airways in the lungs get inflamed, usually because of exposure to a “trigger” or irritant. When that happens, the airways narrow, making it difficult to breathe. This brings on symptoms of coughing, chest tightness, wheezing and even exhaustion. The inflammation can also cause mucus to build up in the airways, causing a breathing crisis.

Stress-induced asthma occurs when stress triggers or worsens asthma symptoms that are already occurring. Dr. Sankari explains that stress can affect asthma in two ways: directly and indirectly.

Asthma can be directly caused by the biological effects of stress on the body. When a person experiences stress, the body increases production of stress hormones. Higher levels of stress hormones have been shown to make asthma symptoms feel more severe.

A stressful event can also indirectly increase the risk or severity of an asthma flare-up, because your mind is preoccupied. You may forget to take asthma medications on time or to have rescue medications handy. You may also be less focused on avoiding triggers such as allergens, aerosols or perfumed products.

The Relationship Between Asthma and Anxiety

Asthma and anxiety are interrelated. In fact, the relationship can be a vicious cycle. When an asthma attack occurs, you can’t breathe which triggers anxiety. The anxiety then causes an increase in stress hormones, which worsens asthma symptoms, and the cycle continues.

“It’s important to learn to recognize when anxiety is playing a role in asthma symptoms and slow down your breathing to help break the cycle,” says Dr. Sankari.

Controlling Asthma

Because stress-induced asthma is simply asthma that’s triggered and/or worsened by stress, its treatment is the same. Dr. Sankari recommends:

  • Have regular checkups and talk with your doctor about your asthma triggers, symptoms and challenges.
  • Learn how to use your inhaler correctly.
  • Control your symptoms with the proper timing and use of your inhaler and rescue medications.
  • For anxiety-affected asthma, work on techniques to slow down your breathing.
  • Avoid known triggers.
  • Ask your doctor or respiratory therapist or look online for asthma support and information. The American Lung Association has good resources.
  • Be prepared with an asthma action plan, as defined below.

Make an Asthma Action Plan

Having an asthma action plan is especially important when stress and anxiety create feelings of helplessness during an asthma attack. When this happens, you need to be prepared with a reminder to help you focus on solutions. An asthma action plan is simply a list with helpful information to remind you what to do when you’re not thinking clearly. Try making a list and keeping it in your smartphone so it’s always handy. Include details about the following:

  • What actions to take when your symptoms get worse.
  • How often to use an inhaler or rescue medication.
  • When to go to the Emergency Room if self-treatment doesn’t improve symptoms.

How to Reduce Stress and Asthma Distress

There are many ways to relieve stress. Do something you enjoy. Temporarily step away from an overwhelming circumstance. Take a few deep breaths. You can even look online for techniques or videos about how to slow down breathing.

However, if stress and anxiety begin to take control of your life, talk with your doctor about management options such as talk therapy or medication. Finally, to help reduce asthma risk and severity, stay up-to-date on vaccinations for the flu, pneumonia and COVID-19.

Related Links

At University Hospitals our team of board-certified pulmonary/critical care physicians work alongside other specialists to provide comprehensive respiratory services in a variety of settings. Learn more.