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    1 Comment for this article
    Asthma and panic disorder spectrum
    Antonio E Nardi, MD, PhD | Federal University of Rio de Janeiro, Brazil
    Goodwin et al. (1) provided the first available 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 panic disorder and panic attacks. Studies with asthma have shown rates of panic disorder varying from 8 to 24% (2). On the other hand, respiratory diseases represent possible risk factors to the occurrence of panic disorder, since their lifetime prevalence has been found to be three times higher in panic disorder patients than in other psychiatric patients (3). Both panic disorder and obstructive pulmonary diseases, such as asthma, constitute major public health problems all over the world; they are related to important social and economic loss, as well as negatively affecting patients’ quality of life (2).
    Agoraphobia can be even more problematic if the phobic disorder is associated to a respiratory disease. 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 (3). The low professional accomplishments due to panic disorder and/or panic attacks plus agoraphobia associated to 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.
    Nascimento et al. (4) evaluated the frequency of anxiety disorders in 86 subjects from an outpatient asthma clinic. Forty-five asthmatic patients (52.3%) reported at least one current anxiety disorder. The frequency of panic disorder with or without agoraphobia was 13.9% and that of agoraphobia without panic disorder was 26.8%. The psychiatric morbidity of the sample was 61.6 % (n=53). The data tend to support the high morbidity of anxiety disorders, particularly panic and agoraphobic spectrum disorders, in asthmatic outpatients.
    The obstructive pulmonary diseases could trigger panic attacks in predisposed individuals by the stimulation of the central chemoreceptors hypersensitive to pCO2 and/or the locus ceruleus (3). Recurrent episodes of hypercapnia may also work by the same mechanism. This hypothesis was equally reinforced by the hypersensitivity to CO2 false suffocation alarm theory (5). Moreover, somatic symptoms associated with respiratory diseases could exacerbate catastrophic cognitions and panic attacks in patients vulnerable to anxiety.
    The high prevalence of panic disorder in primary care settings is verified but panic disorder is conversely underdiagnosed and so under treated in patients with other medical illnesses (2, 4). An early identification of panic disorders 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 better treatment, improving their health and quality of life.
    References: 1.Goodwin RD, Jacobi F, Thefeld W. Arch Gen Psychiatry 2003; 60: 1125- 1130. 2.Carr R. Panic disorder and asthma: causes, effects and research implications. J Psychosom Res 1998; 44: 43–52. 3.Perna G, Bertani A, Politi E, Colombo G, Bellodi L. Asthma and panic attacks. Biol Psychiatry 1997; 42: 625–30. 4.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. 5. Klein DF. False suffocation alarms, spontaneous panics and related conditions. Arch Gen Psychiatry 1993; 50: 306–317.
    Financial disclosure : Brazilian Council for Scientific and Technological Development (CNPq), Grant 300500/93-9.
    Original Article
    November 2003

    Mental Disorders and Asthma in the Community

    Author Affiliations

    From the Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany (Drs Goodwin and Jacobi); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (Dr Goodwin); and the Robert-Koch-Institut, Berlin, Germany (Dr Thefeld).

    Arch Gen Psychiatry. 2003;60(11):1125-1130. doi:10.1001/archpsyc.60.11.1125

    Objective  To determine the association between asthma and mental disorders among adults in the community.

    Setting  Germany.

    Participants  Representative sample of the general population aged 18 to 65 years.

    Main Outcome Measures  Diagnoses of current (the past 4 weeks) and lifetime asthma were based on physician diagnosis; current and lifetime DSM-IV mental disorders were assessed using the Composite International Diagnostic Interview.

    Results  Current severe asthma (the past 4 weeks) was associated with a significantly increased likelihood of any anxiety disorder (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.35-5.18), specific phobia (OR, 4.78; 95% CI, 2.35-4.05), panic disorder (OR, 4.61; 95% CI, 1.09-9.4), and panic attacks (OR, 4.12; 95% CI, 1.32-12.8). Lifetime severe asthma was associated with the increased likelihood of any anxiety disorder (OR, 2.09; 1.3-3.36), panic disorder (OR, 2.61; 95% CI, 1.29-5.25), panic attacks (OR, 2.84; 95% CI, 1.66, 4.89), social phobia (OR, 3.28; 95% CI, 1.42, 7.59), specific phobia (OR, 2.93; 95% CI, 1.71-5.0), generalized anxiety disorder (OR, 5.51; 95% CI, 2.29-13.22), and bipolar disorder (OR, 5.64; 95% CI, 1.95-16.35). Current nonsevere asthma was associated with the increased likelihood of any affective disorder (OR, 2.42; 95% CI, 1.03-5.72); and lifetime nonsevere asthma was associated with increased odds of any anxiety disorder (OR, 1.51; 95% CI, 1.0-2.32), anxiety disorder not otherwise specified (OR, 2.08; 95% CI, 1.03-4.23), and any somatoform disorder (OR, 1.7; 95% CI, 1.14-2.53).

    Conclusions  To our knowledge, these findings are consistent with and extend the findings of previous reports by providing the first available information on the association between physician-diagnosed asthma and DSM-IV mental disorders in a representative population sample of adults. Our results suggest an association between asthma and a range of mental disorders. Longitudinal studies that can examine the sequence of onset and the role of genetic and environmental factors in the association between asthma and affective and anxiety disorders are needed next to further elucidate possible shared causative mechanisms.