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Rees (1) described the importance of and the difficulties in the
control of adult asthma. He delineated that psychological distress and
feelings of decreased control are high in people with asthma and put the
psychological problems as a predictor difficult or impossible to alter in
the control of asthma. Some adult patients with difficulties in the
control of asthma may have comorbid anxiety disorders (2, 3),
predominantly panic disorder (PD). Nascimento et al. (2) evaluated the
frequency of anxiety disorders in 86 subjects in Rio de Janeiro, Brazil.
Forty-five asthmatic patients (52.3%) reported at least one current
anxiety disorder. The frequency of PD with or without agoraphobia was
13.9% and that of agoraphobia without PD was 26.8%. The psychiatric
morbidity of the sample was 61.6 % (n=53). Goodwin et al. (3) provided
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 PD and panic attacks. These
data support the high morbidity of anxiety disorders, particularly panic
and agoraphobic spectrum disorders, in asthmatic outpatients.
Agoraphobia is especially problematic when associated with asthma.
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 (2, 4). The low professional accomplishments due
to PD and/or panic attacks plus agoraphobia associated with 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 (5).
Both PD and asthma constitute major public health problems; they are
related to important social and economic loss, as well as negatively
affecting patients’ quality of life (4). Asthma represents possible risk
factors to the occurrence of PD, since their lifetime prevalence has been
found to be three times higher in PD patients than in other psychiatric
patients (2, 4). An early identification of PD 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 a precise treatment (5), reducing the
burden for patients and health services.
References:
1. Rees J. Asthma control in adults. BMJ 2006; 332: 767-71.
2. 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.
3.Goodwin RD, Jacobi F, Thefeld W. Mental Disorders and Asthma in the
Community. Arch Gen Psychiatry 2003; 60: 1125- 30.
4. Hasler G, Gergen PJ, Kleinbaum DG, Ajdacic V, Gamma A, Eich D,
RösslerW, Angst J. Asthma and panic in young adults: a 20-year prospective
community study. Am J Respir Crit Care Med 2005;171:1224–230.
5. Nardi AE. Where are the guidelines for the treatment of asthma
with panic spectrum symptoms? Am J Respir and Crit Care Med 2005; 172:1055
-56.
Competing interests:
None declared
Competing interests:
No competing interests
03 April 2006
Antonio E Nardi
Associate Professor of Psychiatry
Federal Univ Rio de Janeiro, R. Visconde de Piraja, 407/702. Rio de Janeiro. 22410-003. Brazil.
The control of asthma can be challenging when comorbid with panic spectrum symptoms
Rees (1) described the importance of and the difficulties in the
control of adult asthma. He delineated that psychological distress and
feelings of decreased control are high in people with asthma and put the
psychological problems as a predictor difficult or impossible to alter in
the control of asthma. Some adult patients with difficulties in the
control of asthma may have comorbid anxiety disorders (2, 3),
predominantly panic disorder (PD). Nascimento et al. (2) evaluated the
frequency of anxiety disorders in 86 subjects in Rio de Janeiro, Brazil.
Forty-five asthmatic patients (52.3%) reported at least one current
anxiety disorder. The frequency of PD with or without agoraphobia was
13.9% and that of agoraphobia without PD was 26.8%. The psychiatric
morbidity of the sample was 61.6 % (n=53). Goodwin et al. (3) provided
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 PD and panic attacks. These
data support the high morbidity of anxiety disorders, particularly panic
and agoraphobic spectrum disorders, in asthmatic outpatients.
Agoraphobia is especially problematic when associated with asthma.
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 (2, 4). The low professional accomplishments due
to PD and/or panic attacks plus agoraphobia associated with 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 (5).
Both PD and asthma constitute major public health problems; they are
related to important social and economic loss, as well as negatively
affecting patients’ quality of life (4). Asthma represents possible risk
factors to the occurrence of PD, since their lifetime prevalence has been
found to be three times higher in PD patients than in other psychiatric
patients (2, 4). An early identification of PD 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 a precise treatment (5), reducing the
burden for patients and health services.
References:
1. Rees J. Asthma control in adults. BMJ 2006; 332: 767-71.
2. 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.
3.Goodwin RD, Jacobi F, Thefeld W. Mental Disorders and Asthma in the
Community. Arch Gen Psychiatry 2003; 60: 1125- 30.
4. Hasler G, Gergen PJ, Kleinbaum DG, Ajdacic V, Gamma A, Eich D,
RösslerW, Angst J. Asthma and panic in young adults: a 20-year prospective
community study. Am J Respir Crit Care Med 2005;171:1224–230.
5. Nardi AE. Where are the guidelines for the treatment of asthma
with panic spectrum symptoms? Am J Respir and Crit Care Med 2005; 172:1055
-56.
Competing interests:
None declared
Competing interests: No competing interests