A recent study by M. Brumpton et al., published in the International Journal of Epidemiology has shed light on the complex interactions between asthma development the joint effects of anxiety, depression and obesity.
Approximately 300 million people suffer from asthma, amounting to nearly 1% of the total global disease burden, worldwide. Historically, asthma was often been viewed as a ‘psychosomatic’ condition.
This dates back to Hippocrates, who stated that the “asthmatic should guard himself against his own anger”, and Maimonides, in the 11th Century suggesting that “mental anguish and fear” may cause asthma, while, more recently, Sir William Osler (1892) referring to asthma as ‘‘a neurotic affection” (cf. J. Douwes et al., 2011).
Several studies on the association of anxiety or depression symptoms and asthma have been conducted. Cross-sectional studies have found that anxiety or depression symptoms are more prevalent in asthmatic patients, whereas others have observed that asthma patients were no more anxious or depressed than any other participants.
A limited number of prospective studies have investigated this association. Jonas and Wagener found a moderate association of anxiety or depression symptoms with incident asthma in non-smoking adults. Scott et al. found that early-onset worry and depression (at <21 years of age) had a moderate association with adult-onset asthma.
Much of past research has found an association of anxiety or depression with the prevalence of asthma, whereas obesity has also been related to an increased risk of asthma.
Obesity has been found to be associated with an increased risk of asthma in a number of prospective studies. One of the potential pathways for the obesity-asthma association is also via inflammation. If worry or depression symptoms and obesity exacerbate a common pathway, we might expect to see a substantially elevated risk of asthma in people with both of these exposures.
Previous studies have also discussed that the obesity-asthma correlation or the impact of worry and depression may be due to inflammation. This indicates that a common underlying pathway may link these conditions with asthma. However, the combined effects of anxiety, depression and obesity on asthma development has not been previously investigated.
Brumpton et al. (2013) in their prospective cohort study conducted over the period of 11 years included 23 599 adults, 19–55 years old and that were free from asthma at baseline. Their findings show that individuals that had reported incidents of worry or depression at baseline had an increased risk of incident asthma during the follow-up, and this effect was increased even more when obesity was involved.
This large prospective study indicates that obesity may interact with worry or depression to further increase the risk of asthma in adults. The study provides further insights into the pathogenesis of asthma, and also supports previous research indicating that psychological factors influence the onset of atopic disorders.
The association between anxiety or depression symptoms and incident asthma may have biological plausibility. Two main pathways have been suggested, including changes in health behaviours and inflammatory processes.
Lifestyle-related behaviours such as smoking, and less physical exercise due to distress, may be mediators leading to the development of asthma. On the other hand, these health behaviour variables may also be confounding factors that cause both psychological distress and asthma.
The authors do acknowledge the difficulty in determining causality, but they put forward a strong argument suggesting the involvement of a common pathway, such as inflammation, that may bring together all three conditions – anxiety, depression and obesity.
This is substantiated by a previous research showing that anxiety is related to increased production of pro-inflammatory cytokines, whereas both depression and obesity are characterized as conditions of low-grade chronic inflammation.
Source: Int J Epidemiol, 2013, 42:1455. doi: 10.1093/ije/dyt151. Epub 2013 Sep 5
Read more: ije.oxfordjournals.org
An Update
A 2022 study by Michelle A. Stubbs et al. reports that symptoms of anxiety and/or depression are present in almost 50% of people with severe asthma. The study also reports clinical characteristics that are associated with symptoms of either anxiety or depression, as well as symptoms of both anxiety and depression in a severe asthma population.
These characteristics include dyspnea, which is associated with symptoms of depression, and dysfunctional breathing which is associated with symptoms of anxiety. In the presence of symptoms of both anxiety and depression, the authors found that dysfunctional breathing and obesity were related.
The authors also confirm the burden of anxiety and/or depressive symptoms, reporting their significant associations with impaired HRQoL and poor asthma control. These important data highlight the need to improve assessment and treatment of anxiety and/or depressive symptoms in the management of people with severe asthma to improve health-status.
Given the prevalence of anxiety and depression in this severe asthma population and its significant relationship to health-status and asthma control these authors recommend that symptoms of anxiety and depression be included as a standard assessment of severe asthma and that interventions to effectively manage these symptoms are explored.
A 2025 review by João Freitas and Filipa Novais discussed the increasing body of evidence suggesting a bidirectional relationship, where asthma may exacerbate mental health conditions and vice versa. Several hypotheses may explain these connections, including overlapping inflammatory pathways, altered interoceptive perception, and shared psychosocial stressors.
The authors of this review also explored how asthma phenotypes, different asthma treatment modalities, and breathing patterns may mediate the relationship between asthma and mental disorders such as anxiety and depressive disorders.
Cover Image Credit: Is It Asthma or Anxiety? Women. Wisdom. Wellness; Premier Health, https://www.premierhealth.com/your-health/articles/women-wisdom-wellness-/is-it-asthma-or-anxiety-
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