Stress is an emotional and physical state that can contribute to the onset of asthma. It can also worsen flare-ups in people who already have an asthma diagnosis. Doctors categorize both types of cases as stress-induced asthma.
This comes from a study in Annals of Allergy, Asthma & Immunology.
Stress causes a number of changes in the body, including faster breathing, that may trigger or exacerbate asthma. However, it is possible to treat stress-induced asthma and to reduce its cause.
People can keep a quick-acting inhaler with them at all times to relieve symptoms. It is also possible to learn to manage and relieve stress.
Keep reading to learn more about stress-induced asthma, including symptoms, treatment, and management.
Yes — according to the Asthma and Allergy Foundation of America (AAFA), any strong emotion can trigger asthma symptoms. This is not a trigger for everyone, but it is common.
Stress can trigger asthma symptoms in people with a diagnosis. It may also contribute to the development of asthma. A 2020 study states that long-term stress is correlated with the new onset of asthma, particularly if it takes place during childhood or adolescence or someone has multiple sources of stress.
Stress is a mental and physical response to adversity. It happens when someone feels a sense of pressure, threat, or that they cannot cope.
Research suggests stress may contribute to asthma symptoms in several ways:
The body interprets stress as a sign of danger, which then activates the sympathetic nervous system. This is the part of the nervous system that responds to emergencies.
When this occurs, the body prepares to fight or flee, as though someone is in physical danger. This causes faster breathing, muscle tension, and other changes.
This helps people survive dangerous situations, but it can also make someone feel as though it is difficult to breathe. It can also trigger asthma symptoms.
However, the reverse is also true. Relaxation and breathing exercises can help manage stress and activate the parasympathetic nervous system, calming the body down. This may improve asthma symptoms, according to the American College of Asthma, Allergy & Immunology.
Another way stress may contribute to asthma is through inflammation. The 2020 study states that stress is among several asthma triggers that elevate inflammation. The others include:
- exposure to tobacco smoke
- living close to traffic noise
- indoor and outdoor allergens
Older research from 2006 also notes that stress increases cytokine and eosinophil levels. Cytokines are chemicals involved in airway inflammation, while eosinophils are white blood cells also associated with inflammation. Both could increase the symptoms and severity of asthma.
Impact on medication
The 2020 study adds that stress can reduce a person’s response to certain asthma medications. These include inhaled beta-2-agonists, such as albuterol (Ventolin), and inhaled corticosteroids, such as fluticasone (Flovent HFA).
The symptoms of stress-induced asthma are the same as asthma that occurs due to other triggers. They include:
- wheezing, or a whistling sound in the chest
- shortness of breath
- chest pain/tightness
- waking at night due to asthma symptoms
However, people with stress-induced asthma may also notice other symptoms related to the stress response, such as:
- faster breathing
- faster heartbeat
- muscle tension
Becoming mindful of these signs may help someone address stress before it starts to affect their asthma.
Treatment for stress-induced asthma involves medication to stop asthma symptoms. It may also include techniques to help someone reduce stress and activate the “relaxation response.”
An array of asthma medications can help a person breathe more easily. Options include:
Beta-2 agonists are a type of bronchodilator. These medications open the airways wider.
Beta-2 agonists work by relaxing the muscles that surround the airways. There are short-acting beta-2 agonists (SABAs), which work fast and relieve symptoms quickly, and long-acting ones that last a long time but do not provide quick relief.
Be aware that some SABAs can activate the sympathetic nervous system, causing symptoms of anxiety. This may be a concern for people with stress-induced asthma. If a person finds their inhaler makes them feel more stressed, they should speak with a doctor.
These medications are also bronchodilators. They work by preventing muscle bands from tightening around the airways, which helps keep the air passages open.
A person inhales anticholinergics, often with a corticosteroid. Doctors prescribe them for long-term control. An example is ipratropium (Atrovent).
These reduce mucus production and swelling in the airways, which makes it easier to breathe. They include corticosteroids, which doctors can prescribe in inhaler form. An example is fluticasone (Flovent HFA).
These are a combination of bronchodilators and corticosteroids. An example is fluticasone and vitanterol (Breo Ellipta).
If someone knows that stress can trigger their asthma, they may benefit from stress reduction. This involves learning techniques that activate the parasympathetic nervous system, which helps the body return to a calmer state.
The first step in managing stress is identifying the cause. It may help to start keeping a diary or log of times when someone feels stressed. They can take note of the situation or event, how it made them think, and how it made them feel. Over time, a person may start to notice common themes or patterns.
For example, a diary may show that a person often feels stressed when they get caught in traffic on the way to work because it makes them late. Knowing this empowers them to take action.
The person can take steps to leave home earlier, or get another form of transport. Since traffic is not always avoidable, they may also learn relaxation techniques they can practice in the car.
Step by step, they may be able to reduce the stress they experience day-to-day, which could improve their asthma.
It is worth noting that stress can often seem similar to anxiety. However, while stress
A person does not need to have a mental health diagnosis to seek help with either stress or anxiety. Anyone who feels overwhelmed can speak with a therapist for support.
Learn more about the differences between stress and anxiety.
Here are some tools people can use to manage their stress-induced asthma:
Asthma action plan
Asthma action plans are customized plans for managing asthma that a doctor can help someone create. They have
- feeling good
- having a flare-up
- experiencing serious symptoms
- how to recognize asthma attacks
- what medications to take and when
- when to call a doctor and when to go directly to an emergency room
It is important to have doctor-prescribed medications on hand at all times. Using an automated prescription refill service can help ensure a person always has what they need.
Techniques to reverse the stress response
The AAFA recommends the below techniques for stress-induced asthma:
Select a nearby object from nature, such as a tree or flower, and focus on it for 1–2 minutes. Try to look at it as if seeing it for the first time, noticing the shapes, colors, and texture. Relax into the observation for a while until feeling better.
Begin by slowly breathing in through the nose and out through the mouth. If it helps, try inhaling for 7 seconds, holding the breath for 7 seconds, and exhaling for 7 seconds. Bring attention to breathing and try to let go of everything else.
Repeat this pattern three times or until feeling an improvement.
General self-care practices can help reduce stress and improve overall well-being. The American Lung Association recommends:
- getting enough sleep
- eating three balanced meals per day, where possible
- exercising most days of the week
- reducing or avoiding caffeine
- spending time with friends and family
A person with asthma should speak with a doctor if they experience an asthma flare-up that:
- does not go away with their usual asthma medication
- improves with medication but keeps coming back
- disrupts daily activities or sleep
The AAFA also recommends speaking with a doctor if positive emotions or laughter cause asthma symptoms.
A person should dial 911 or the number of their nearest emergency department if they develop any of the following:
- severe shortness of breath
- blue or white lips or fingernails
- difficulty moving or talking due to breathlessness
- difficulty staying awake
An asthma action plan
Stress-induced asthma refers to asthma that develops or flares up due to stress. Experts believe that stress causes physical changes in the body that may trigger the symptoms, including faster breathing and a rise in inflammation.
However, it is possible to control stress-induced asthma. A doctor can create an asthma action plan and prescribe fast-acting inhalers a person can carry with them at all times.
Support is also available for learning how to manage and reverse the stress response. This may involve breathing exercises, mindfulness, or any other activity that helps someone relax. Some may find it beneficial to seek additional support from a therapist if stress feels overwhelming.