How Stress flffects fl S T H ITI fl

M " ost experts believe that there is a link between stress and asthma. Many believe that stressful events can lead to

. an increase in asthma symptoms. And when a person has asthma, it is widely acknowledged that this can

cause stress for that person and, in many cases, the person's family. However, beyond this broad association, it is unclear

and somewhat controversial how specifically the two are linked.

In the early twentieth century Walter Cannon, a physiologist at Harvard Medical School, was the first person to

describe the body's reaction to stress, portraying it as the "fight or flight" response. This is the reaction of the body,

when confronted by a threat, preparing to either stand ground and fight, or to run away. Ultimately, stress is not what

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happens to us, but how we react to what happens. Regardless of what stresses us, the body experiences the same physiological changes, which may include elevated blood pressure, increased muscular contractions, and secretions of hydrochloric acid in the stomach. When the stress is chronic or prolonged, it can take a toll on the body. It may lead to illness or disease, or perhaps maintain or worsen an already existing chronic condi- tion, such as asthma.

T h e E f f e c t s o f S t r e s s o n A s t h m a

When a person's asthma is out of control or treatment seems not to be effective, there are some stan- dard reasons to explain why this is happening. Perhaps the person is not taking medications as pre- scribed. He or she may not be successfully avoiding environmen- tal asthma triggers. However, one contributing factor that may be overlooked is whether the person is being affected by stress.

There are a number of ways that stress may work to trigger asthma episodes. Research has found that chronic stress can sup- press our immune system's ability to ward off disease (O'Leary, A: Psychological Bulletin. 1990; 3:362-382). Therefore, if a per- son's asthma is triggered by cer- tain allergens and he or she is undergoing chronic stress, expo- sure to these allergens may cause a greater increase in asthma symptoms than it normally would. In addition, an immune system suppressed by stress may make one more susceptible to colds, flu, or other respiratory tract infections, which themselves are potent asthma triggers for many peo- ple. Intense emotions may trigger asthma for some people and they may be more prone to asthma episodes during stressful situations or periods

of ongoing stress. According to Weinstein et al. (Journal of Asthma 1997; 34: 345-352), stress-induced asthma results from stimulation of the central nervous system in the brain, which contains the autonomic nervous system. The autonomic ner- vous system, over which we have no voluntary control, can trigger a chain of events that results in producing the symptoms associated with asthma.

One recent study showed that when children with asthma experi- ence stressful events in their lives, they are at significantly increased risk of having an asthma episode within the next four weeks. In children liv- ing with chronic levels of stress who then experience a stressful life event, this risk is greater and more immedi- ate (Lancet2000; 356: 982-87).

Researchers at Brigham and Women's Hospital in Boston,

Massachusetts, took a different approach in investigating the cause and effect between stress and asthma. The researchers, focusing on children living in the inner city, looked at the relationship between exposure to vio- lence (such as hearing gun shots or witnessing physical violence) and the occurrence and severity of asthma. At the 1997 International Conference of the American Thoracic Society and

American Lung Association, the researchers reported that children exposed to violence were almost three times as likely to be diagnosed with asthma after age 2. (The researchers adjusted the fig- ures to be independent of poor socioeconomic status and exposure to cigarette smoke, both risk factors for the development of asthma.)

A s t h m a C a u s e s S t r e s s

Asthma has been referred to as a family disease for, undoubtedly, asthma is both affected by and affects family dynamics. When a family member has a chronic ill- ness, such as asthma, it can create stress for that person as well as the family and may affect the way in which the family functions. In turn, family stress can play a role in poor asthma manage-

ment in children and adolescents. Clearly, there is the potential for an unhealthy cycle of events.

In some cases, the functioning of a family may actually contribute toward maintaining asthma symp- toms in a child. The parents may focus intently on the child's condi- tion, creating a situation where the asthma is a significant source of atten- tion for the child. Furthermore, the parents' total focus on the child's

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asthma may then enable the parents to avoid addressing or resolving other problems that they may be experienc- ing, such as marital conflicts. Dysfunctional patterns of family functioning can lead to stress and reduce coping and problem-solving capacities. This can then interfere with adherence to the proper medical regimens necessary to effectively man- age asthma.

Asthma sometimes causes restric- tions or limitations to be placed on a family, such as the inability to own a pet, or restrictions on where a family can go on a vacation and the activities that can be included. This can breed resentment among other family mem- bers, which increases stress. Asthma also can cause absences from school for a child or absences from work for the caretaker or for an adult with asthma. Any of these scenarios has the potential to increase stress on the family, especially when financial issues are involved.

The anxiety that may result from a family member having asthma can also negatively influence family rela- tions and increase stress levels. Mothers of children with asthma have been known to experience more stress than those with healthy children (Carson D. & Schauer R.: PsychologicalReports. 1992; 71: 1139- 1148). They were also indicated as having higher divorce rates and more severe marital problems than in non- asthmatic families. Many inner-city youths with asthma belong to families who are headed by single mothers (Weiss. K.B.: Chest. 1992; 362S- 367S). This, combined with the many other psychosocial stresses of inner-city living, may well be a con- tributing factor in the high asthma rates among inner-city kids.

C o n t r o l l i n g S t r e s s

No one is immune to stress. At one time or another, we all encounter sit- uations that seem to tax or exceed our

resources. Learning to positively cope with stress can be beneficial for both our psychological and physical health. Positive coping strategies include recreational exercise, developing hob- bies or interests, and involvement in religious activities or meditation. Other forms of managing stress that have proven effective are having sup- portive social networks; employing various stress-management tech- niques, which include relaxation training, assertiveness training, and biofeedback (King, N.J: Journal of Behavioral Medicine. 1980; 3: 169- 187); group and/or family therapy; and medication and behavioral approaches. It has even been shown that, in people with mild to moderate asthma, writing about stressful events in their lives can lead to improvement in their asthma symptoms (JAMA. 1999; 281: 1304-1309).

Unfortunately, it is quite com- mon to develop negative strategies to cope with stress, which can prove to be detrimental to one's health. These

may include excessive eating, drink- ing, smoking, reliance on tranquiliz- ers or similar medications, or the use of street drugs. Some of these coping mechanisms can have a particularly harmful effect on people with asthma.

For many people, stress may well play a role in their asthma condition and may be viewed as a potential asthma trigger. Thus, as one would attempt to avoid other triggers, such as pollen, dust or a respiratory infec- tion, taking steps to avoid or reduce stress may contribute to one's overall ability to manage asthma. However, it is important to remember that med- ications are the mainstay of asthma treatment. Therefore, stress manage- ment strategies should be used in addition to one's prescribed medical treatment plan.

Linda Russell, PhD, lives in Austin, Texas, and has a doctorate in health education. She has a special interest in asthma as she has a son with the condition.

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