Panic and Asthma: Roles of Panic Disorder Diagnosis, Symptom Confusion, and Respiratory Panic Symptoms

Abstract

Introduction: High rates of comorbid asthma and panic disorder (PD) have been repeatedly documented. Women and individuals of Puerto Rican ethnicity may be at increased risk. Though the exact mechanisms linking these conditions are uncertain, cognitive, biological, and social/environmental factors have been proposed. Studies have suggested that PD negatively affects asthma management and morbidity. Individuals with PD may over-perceive or confuse asthma and PD symptoms, and a respiratory subtype of PD may amplify confusion. Objectives: To examine the relationships between PD and asthma severity, asthma control, and asthma-related quality of life in a sample of Latino adults, and to consider the roles of asthma-panic symptom confusion and cardiorespiratory panic symptoms. Methods: Adult Latino(a) participants with asthma were recruited from four Bronx, NY hospitals. Pulmonary function, asthma severity, asthma control, asthma-related quality of life, PD, asthma-panic symptom confusion, and depressive symptoms were measured. Fifty-nine participants met criteria for asthma and PD (Asthma-PD) and 22 for asthma but not PD (Asthma-NoPD). Logistic and linear regression analyses were conducted. Results: Assignment to the Asthma-PD group predicted greater odds of moderate/severe asthma (OR = 4.49, CI = 1.24, 16.22; p < .05) and more quick-relief medication use (x 2(4) = 28.67, p < .01); PD group did not predict pulmonary function. Asthma-panic symptom confusion predicted greater activity limitation, while cardiorespiratory symptoms during panic attacks predicted greater symptom confusion and more severe asthma. High rates of depressive symptoms and agoraphobia were found. Discussion: Results support a cognitive pathway between asthma and PD whereby anxiety alters the subjective experience of pulmonary dysfunction, in turn affecting asthma management. Asthma-panic symptom confusion and cardiorespiratory panic symptoms were related, and predicted asthma-related quality of life and severity respectively. Elevated rates of agoraphobia and depressive symptoms could present additional challenges to asthma management in this inner-city, Latino population. Limitations of this study include the use of self-report measures and high rates of psychiatric comorbidity.