Do asthma patients with panic disorder really have worse asthma? A comparison of physiological and psychological responses to a methacholine challenge
Open accessAbstract
Background Panic disorder (PD) has been linked to worse asthma outcomes. Some suggest that asthmatics with PD have worse underlying asthma; others argue that worse outcomes are a result of their tendency to over-report symptoms. This study aimed to measure physiological and psychological responses to a simulated asthma attack (methacholine challenge test: MCT) in asthmatics with and without PD.Methods Asthmatics with (n = 19) and without (n = 20) PD were recruited to undergo a MCT. Patients completed subjective symptom questionnaires (Panic Symptom Scale, Borg Scale) before and after a MCT. Physiological measures including heart rate (HR), and systolic and diastolic blood pressure (SBP/DBP) were also recorded.Results Analyses, adjusting for age and sex, revealed no difference in methacholine concentration required to induce a 20% drop in forced expiratory volume in one second (FEV1: F = 0.21, p = .652). However, PD patients reported worse subjective symptoms, including greater ratings of dyspnea (F = 8.81, p = .006) and anxiety (F = 9.44, p = .004), although they exhibited lower levels of physiological arousal (i.e., HR, SBP/DBP). An interaction effect also indicated that PD, relative to non-PD, patients reported more panic symptoms post-MCT (F = 5.05, p = .031).Conclusions Asthmatics with PD report higher levels of subjective distress, despite exhibiting lower levels of physiological arousal, with no evidence of greater airway responsiveness. Results suggest that worse outcomes in PD patients may be more likely due to a catastrophization of bodily symptoms, rather than worse underlying asthma. Interventions designed to educate patients on how to distinguish and manage anxiety in the context of asthma are needed.
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Individuals with both asthma and elevated anxiety levels have trouble distinguishing between asthma and anxiety symptoms because the symptoms overlap.
“Individuals who have both asthma and elevated anxiety levels have been observed to have trouble distinguishing between them, because the symptoms overlap (Boudreau et al., 2015).”
From Targeting excessive avoidance behavior to reduce anxiety related to asthma: A feasibility study of an exposure-based treatment delivered online (2021) · cites this paper as Boudreau et al., 2015
Subclinical levels of anxiety can affect the perception of asthma.
“Experimental studies suggest that already subclinical levels of anxiety can affect the perception of asthma.”
From Targeting excessive avoidance behavior to reduce anxiety related to asthma: A feasibility study of an exposure-based treatment delivered online (2021) · cites this paper as Boudreau et al., 2015
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- Authors
- Boudreau, M., Lavoie, K. L., Cartier, A., Trutshnigg, B., Morizio, A., Lemière, C., & Bacon, S. L.
- Affiliations
- Université du Québec à Montréal (CA)
- Hôpital du Sacré-Cœur de Montréal (CA)
- Corresponding author
- Bacon, Simon L.
- Venue
- Respiratory Medicine
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 109
- Issue
- 10
- Pages
- 1250-1256
- ISSN
- 0954-6111 (ISSN-L)
- OpenAlex
- W2160437499
- Cited by
- 18
- References
- 60
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 1 · 2022: 3 · 2021: 1 · 2020: 4 · 2018: 1 · 2016: 2
- FWCI
- 0.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Respiratory Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Fonds de la recherche en santé du Québec
- Canadian Institutes of Health Research
- FRSQ Respiratory Health Network
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- asthma, panic disorder, methacholine challenge, airway responsiveness, physiological arousal, heart rate, blood pressure, dyspnea, anxiety
- MeSH terms
- Adult, Aged, Anxiety, Asthma, Blood Pressure, Bronchial Provocation Tests, Dyspnea, Female, Forced Expiratory Volume, Heart Rate, Humans, Male, Middle Aged, Severity of Illness Index, Methacholine Chloride, Panic Disorder
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