Looking at the anatomy of the airways, it is obvious that psychological triggers play a role in the development of asthma. Based on the pathomechanisms of bronchial asthma, a psychosomatic specialist explained which psychosocial and psychosomatic aspects are involved and gave insight into how risk factors can be countered by means of support and patient education.
Genetic and predisposing factors are involved in the development of bronchial asthma – and it is still considered a psychosomatic disease. However, this view has changed considerably in recent decades with regard to diagnostic and therapeutic concepts.
The causes and influencing factors of asthma include primarily allergens (pollen, animal dander, house dust, mold, etc.), but also a number of non-allergens such as food, medications, aerogenic irritants (tobacco smoke, fog, cold), physical exertion or excitement, or psychogenic stress. The diagnostic and therapeutic focus has changed radically in the past 30 years, stated PD Dr. Cora Stefanie Weber, Charité – Universitätsmedizin Berlin and Hennigsdorf Clinic, Department of Psychosomatic Medicine and Psychotherapy, Oberhavel Kliniken (D) [1]. “We used to have the concept of a psychoanalytic/psychodynamic view of the asthma patient, there was an attempt to do a personality analysis, there was an assumption of a specific psychological etiopathogenesis, which cannot be held that way. We can say instead that anxiety and also depression are definitely comorbidly linked and also emotional triggers play a role according to recent studies, but cannot be considered as the sole trigger situation.”
According to the new German National Health Care Guideline (NVL) on asthma from 2018, the main diagnostic focus today is on the patient’s psychosocial risk factors. Therapeutically, patient education does not play an essential role, and attention is also paid to aspects such as physical training/body weight control, respiratory physiotherapy and tobacco cessation. Other psychosocial aspects such as stress or mobbing factors or partnership/family problems should also be recorded by the physician. Referral to a psychosomatics specialist is recommended when the conventional methods of a family physician, internist, and pulmonary specialist are not sufficient. Dr. Weber used a number of examples from her empirical experience to illustrate what particular attention should be paid to in diagnostics and therapy.
Psychological triggers in upper respiratory tract
The larynx as a boundary between upper (nose and sinuses, pharynx) and lower airways symbolizes an inside-outside boundary, which from a psychosomatic point of view can be associated with the processes of incorporation, defense, autonomy, trust and security.
When swallowing, it is known that patients often experience anxiety and panic attacks. The resulting shortness of breath further intensifies the state of anxiety. With the common cold (acute as well as chronic), sufferers often have difficulty concentrating and sometimes have headaches. Mucus production and throat clearing play a role in psychosomatic medicine: frequent throat clearing, for example, can be interpreted as restrained anger/aggression.
In the lower respiratory tract (bronchi, trachea), bronchoconstriction, spasticity, wheezing and humming, dyspnea, and anxiety are significant factors. For vagal activation, deep abdominal breathing occupies an important place in psychosomatic treatment. “Relaxation methods are incorporated, where our physical and physiotherapists often see cramps and blockages that prevent deep abdominal breathing,” Dr. Weber explained. Regular training and feedback would then be used to try to activate and resolve the blockages.
Psychological triggers in lower respiratory tract
Psychoneuroimmunological processes occur in the inner lining of the bronchi. Obstruction by foreign bodies, as well as mucus formation, can produce dyspnea, which in turn triggers anxiety. Fear of suffocation/existential anxiety sometimes leads to emergency situations.
Regarding the pulmonary alveoli and the gas exchange of oxygen and CO2, the expert referred to respiratory therapy and its importance in today’s asthma treatment. The teaching of breathing techniques (conscious deep breathing, “mindfulness”) should ensure unhindered gas exchange and prevent hyperventilation, for example. Dr. Weber cited singing or humming as helpful in defocusing from anxiety when respiratory problems arise.
For chest and abdominal breathing, the psychosomatics specialist tries to teach her patients diaphragmatic breathing: “We use feedback methods here, e.g. in feedback of heart rate variability. Progressive muscle relaxation, autogenic training and meditation are used to try to achieve vagal activation.” Aromatherapy is also used in some psychosomatic settings, he said, although Dr. Weber cautions here not to trigger allergies/respiratory reactions in some particularly anxious patients.
Take-Home Messages
- Patient education is at the heart of modern asthma treatment.
- Psychotherapy of psychological symptoms (adherence, anxiety, depression) should be given to patients at risk.
- The offer of behavior change therapy (smoking, obesity, exercise, respiratory physiotherapy) is considered useful in individual affected patients.
- The training, clinic, and practice of physicians practicing psychosomatics with this group of patients would need to be adapted to these needs.
Congress: DGIM 2023
Source:
- Session “Bronchial asthma from a biopsychosocial perspective”, lecture “Bronchial asthma and psyche”. 129. Congress of the German Society for Internal Medicine (DGIM), 25.04.2023.
InFo PNEUMOLOGY & ALLERGOLOGY 2023; 5(3): 34 (published 8/14-23, ahead of print).
