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Anxiety and depression in asthma

Di Marco, Fabianoa; Santus, Pierachilleb; Centanni, Stefanoa

Current Opinion in Pulmonary Medicine: January 2011 - Volume 17 - Issue 1 - p 39–44
doi: 10.1097/MCP.0b013e328341005f
Asthma: Edited by Nicola A. Hanania

Purpose of review There is growing awareness of the correlation between psychological factors, the course of asthma, and the outcomes of asthma treatment. However, the implications of this correlation are still poorly understood. Here, we review the role of anxiety and depression in asthma with a focus on recent literature.

Recent findings Recent studies suggest an interaction between behavioral, neural, endocrine, and immune processes and suggest that psychological factors play an active role in the genesis of asthma. Notably, the role of chronic stress has been investigated, including the parental psychological state during pregnancy. There is evidence that in patients with asthma, such stress may induce hyporesponsiveness of the hypothalamus–pituitary–adrenal axis, resulting in reduced cortisol secretion.

Summary Even though it is generally accepted that anxiety and depression are more common in asthmatic patients and that there is a close correlation between psychological disorders and asthma outcomes, such as poorer control of asthma symptoms, the implications and practical consequences of this link remain weak. New studies are introducing an intriguing model of the links between emotional stress, brain centers, the immune system, and the hypothalamus–pituitary–adrenal axis that is far removed from the original concept of ‘asthma nervosa’.

aRespiratory Medicine Section, Dipartimento Toraco-Polmonare e Cardiocircolatorio, Università degli Studi di Milano, Ospedale San Paolo, Italy

bRehabilitation Respiratory Unit, Università degli Studi di Milano, Dipartimento Toraco-Polmonare e Cardiocircolatorio, Fondazione Salvatore Maugeri, Istituto Scientifico di Milano, IRCCS, Milan, Italy

Correspondence to Fabiano Di Marco, Via di Rudinì 8, 20142 Milan, Italy Tel: +39 02 81843036; fax: +39 02 81843037; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.