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Impact of panic attacks on bronchoconstriction and subjective distress in asthma patients with and without panic disorder


Boudreau M1, Bacon SL, Paine NJ, Cartier A, Trutschnigg B, Morizio A, Lavoie KL.

Psychosom Med. 2016 Dec 28. doi: 10.1097/PSY.0000000000000443


OBJECTIVES: Panic disorder (PD) is common among asthmatics and is associated with worse asthma outcomes. This may occur due to psychophysiological factors or to cognitive/affective factors. This study evaluated the impact of panic attacks (PAs) on bronchoconstriction and subjective distress in asthmatics with and without PD.

METHODS: A total of 25 asthmatics (15 with PD who had a PA [PD/PA], 10 without PD who didn’t have a PA [noPD/noPA]) were recruited from an outpatient clinic. They underwent a panic challenge (one vital capacity inhalation of 35% carbon dioxide [CO2]) and completed the Panic Symptom Scale (PSS), the Subjective Distress Visual Analogue Scale (SD-VAS) and the Borg Scale before and after CO2. Forced expiratory volume in one second (FEV1) was assessed pre and post CO2; respiratory (i.e., CO2 production [VCO2], minute ventilation [VE], tidal volume [VT]) were continuously recorded, and physiological measures (i.e., systolic and diastolic blood pressure [SBP/DBP]), every two minutes.

RESULTS: Analyses adjusting for age, sex, and provocative concentration of methacholine revealed no significant differences between groups in FEV1 change after CO2 inhalation (F(1, 23)<0.01, p=.961). However, PD/PA patients reported more panic (F(1, 22)=18.10, p<.001), anxiety (F(1, 22)=21.93, p<.001), worry (F(1, 22)=26.31, p<.001) and dyspnea (F(1,22)=4.68, p=.042), and exhibited higher levels of VCO2 (F(1, 2843)=5.89, p=.015), VE (F(1, 2844) =4.48, p=.034), and VT (F (1, 2844) 4.62, p=.032) after the CO2 challenge, compared to noPD/noPA patients.

CONCLUSIONS: Results, presented as hypothesis generating, suggest that asthmatics with PD/PA exhibit increased panic-like anxiety, breathlessness and a respiratory pattern consistent with hyperventilation that was not linked to statistically significant drops in bronchoconstriction.

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