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Triggers
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Well,
you can cry! Weep to tears! This may be your personal affair. But if you
are an asthmatic patient, then you need to be careful enough to
understand a friendship of asthma with cry, laugh, tears, sadness,
stress, grief and or fear.
Emotional stress, family disputes, psychological illness, marital
issue, mental shock and excitement are well known to aggravate
asthma. These psychological factors can trigger symptoms in an
asthmatic patient but can not induce asthma in a healthy person.
Emotional stress can also complicate asthma even in young children,
though both parents and children deny it. Many times parents are
over protective and a child cannot live a normal and natural life,
and their over-caring can aggravate asthma. There was a well talked
study by English scientist Purcel. He selected a group
of children having moderately severe asthma. Parents
of the children were separated for two weeks. In this
duration, the children led a normal and natural life
instead of an environment of over-protection. Asthma improved in majority of these
children. This proves that psychological factors are important in
modifying the severity of asthma symptoms
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How
psychological stress aggravates asthma?
Psychological
stress can trigger asthma through different mechanisms.
Some of these mechanisms are as follows:
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Nerves
from brain
If I want to lift an objects from the ground my
thought energy will be carried through nerves and then
to muscles. Muscles will contract as per message from
the nerves and lift the object. Muscles of the limbs are
under our control but there are large number of muscles
in the body such as those in our windpipe and heart that
are not under our voluntary control and are termed as
involuntary muscles. Muscles of windpipe are controlled
by a nerve called Vagus. Emotional stress activates
Vagus nerve in the brain which in turn causes
contraction of the muscles of windpipe leading to
narrowing of the of windpipe and thereby producing
asthma.
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Hyperventilation
When a person is tense, the pattern of his breathing
changes and he takes faster and deeper breath called
hyperventilation. Hyperventilation is known trigger
factor for aggravating asthma.
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Laughing
and crying
Both laughing
and crying are symptoms of emotional stress. "Hansi
main Khansi" is an old proverb started from
asthmatic patient. When an asthma patient laughs it can
aggravate asthma especially if he laughs repeatedly. Not
only laughing but also crying can also trigger asthma.
Some children use it as a protective method. When
confronted with an angry parent or teacher the child
cries and induces asthma, which generate sympathy and
extra favour for that asthmatic child. Usually crying
and laughing aggravate asthma in children where asthma
is not controlled properly. Over-protective parents are the greatest danger to healthy development of a chronically ill child.
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Non-compliance
of the drugs
Not only emotional stress exacerbates asthma but in
many patients an asthmatic attack induces emotional
stress in the form of anxiety and depression. The
usual notion of most asthmatic patients is that tendency
of his/her
disease will be cured for ever. Despite taking drugs
when an asthmatic patient gets recurrence of episodes of
asthma it causes anxiety, depression, frustration and
shock both to him and to the other family members. In
this state of mental trauma many a times the patients
decides to stop the treatment. This action deteriorate
the condition of the patient further. Attention should
be paid so that the problem of asthma should not become
a central focus of the family. A regular treatment
should be given without undue expression of
emotions. |
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Factors
and misconceptions responsible for non-compliance of the
drug
- Asthma
drugs are harmful.
- Inhalers
are addictive.
- With
regular use tolerance develops for asthma drugs.
- Inhalers
are last resort drugs.
- Inappropriate
expectation such as cure of tendency of asthma.
- Peer or
family pressure.
- Frustration.
- Inconvenient
regimen such as 4 times a day.
- Distant
pharmacy or doctor.
- Poor
perception of symptoms.
Due to the factors mentioned above a patient
may leave the medicine and in turn suffer from
asthma. A dynamic interaction with the patient and
family members discussing various issues can solve
the problem. Regular preventive therapy for long
periods is essential for patients of asthma.
Therefore taking medicine should be incorporated
in routine and it should not be taken
occasionally.
Exercise
intolerance
Due to illness a sense of incapability creeps in the mind of children and that hampers the growth. The
asthmatic child must be encouraged to enjoy a full life.
Children who have avoided activities because of the fear
of asthma or parental over-protection may be exercise
intolerant, only because of poor conditioning. Gradual
increase in exercise improves efficiency of asthmatic
children. Activity involvement is critical in
development of self esteem.
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Following
indicate that psychological factors are
playing a role in asthma
- Aggravation
of asthma in absence of exposure to any allergic
factor or throat infection. Such a situation
indicates the possibility of an emotional factor.
Most of the times the patient is not aware of this
emotional stress.
- If
your symptoms improve when you are away from
home, it indicates that emotional stress is
of home origin.
- If
your symptoms improves when you are away
from the office it indicates that the
emotional stress is in the office.
- Under-sensing
the symptoms of asthma: Many a times patient has
severe airflow obstruction as measured by peak
flow meter but the patient does not feel it and
therefore does not take medicine. In the absence
of medication asthma aggravates damage in airways
and body.
- Over-sensing
the asthma symptoms. Despite improvement in
asthma, patient is not convinced. High anxiety,
extreme awareness of slightest symptoms with
depression and wish to die are some of the
feelings expressed by such asthmatic patients.
- Inappropriate
triggering of asthma. A child inducing asthma by
crying as a coping strategy to face anger of
teacher or a parent.
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TRIGGER:
STRESS |
ASTHMA
STYLE |
| Fear,
nervousness and anxiety |
- Try
to search a factor constantly bothering you.
- Introspect,
analyse pros and cons and discuss it with your
doctor.
- Work
is the best medicine of anxiety. So make yourself
so busy that you do not get time to think and live
lonely.
- Yoga
is found useful in reducing anxiety and mental
stress. "Savasan" is a special yogic
asan found useful in body relaxation. Various
yogic breathing exercises called "Pranyama"
have also been useful in asthma.
- DRUGS for
emotional stress: There are large number of
drugs available for anxiety disorders but the
problem is that these drugs lead to depression
of respiration. Hence may prove fatal if taken
at the time of severe asthma. Though, in
stable asthma lower dose of sleeping pills
does not pose an increase risk. The basic rule
is to avoid anxiolytic drugs if problem is
solved with psychotherapy and reasoning. If
necessary these can be taken for short periods
and in minimal dose.
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| Laughing |
- Laughing
aggravates asthma, but it does not mean that you
should not laugh. You should but in asthmatic
style. Take a deep breath and laugh till half of
breath comes out. Avoid spasmodic laugh causing
complete emptying of lungs.
- If
you are going to a party with your friends and
expect lot of fun and laugh it is always advisable
to take an extra dose of inhaler before going to
party.
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| Emotional
swings, elation and depression |
- An
asthmatic patient should control emotional swings
and must continue medicines regularly despite
these swings.
- Parents
of an asthmatic child should make introspection to
assess their interference or overprotection in the
life of the child.
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| Stress
induced asthma in children |
- Parents
should observe a child and try to find out whether
the child is using asthma to get extra-favour and
sympathy. In case of doubt, try to measure asthma
in morning and evening by a peak flow meter.
Normal range reading will indicate psychological
problem.
- Uncontrolled
asthma despite medicines and avoidance of triggers
at school with friends or within family. Search
and solve the problem, it would improve asthma.
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| Over
sensing
& under sensing Asthma. |
- Both
under-sensing & over-sensing the problem of
asthma are wrong. The solution of problem lies in
regular measurement of asthma with the help of
peak flow meter. Patients should learn to
correlate symptoms with peak flow measurements.
- A
patient should realise that if peak flow is low
but they do not feel any symptoms, it means asthma
is progressing & he should take medicines.
- If
you are over-sensing the problem of asthma, peak
flow measurement would be near normal. You can
take a record of peak flow whenever you sense a
problem. If reading is near his personal best, he
should assure himself that it is not the disease
but the psychological and instead of taking drug
should get busy in the work.
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Over
caring parents: a trigger of asthma?
Example:
One such example of Bablu, an eleven year
old boy suffering with not only asthma but
with over-caring by his aspiring parents.
Like every other child Bablu was also fond
of sweets, pastries, chocolate bars,
ice-creams and hot stuffs; samosa-kachori.
He always stood ready to play outdoor games,
if not allowed inside ones. Whenever his
parents dictated him to mend his hobbies of
games and eating habits, the little boy got
upset! Got angry, tense or started crying in
sadness! These factors triggered his asthma.
Curiosity:
-
What should
be done to improve asthma of Babloo?
- How the
problem was solved?
A great heave of sigh came when the
boy was admitted to a boarding school. He
was relieved from tension, sadness, crying
or weeping habits. Asthma did present in the
inactive mode but the friendship between two
major factors got discontinued. That means a
happy beginning at the end.
Expert
Comments:
This interpretation may sound very simple but
psychiatrists feel that it was a case of
"Over Protection" by parents, who always
put their boy on tenterhooks. "Do this, Do
that". Psychological stress and emotional
weakness encircled the boy. All
these mental condition/factors used to stimulate
particular brain nerve called "Vagus".
This vagus nerve has a control over muscles of
windpipe (respiratory tract). This very nerve
governs the contraction and expansion of the
windpipe. When it acts more due to any kind of
psychological factor or emotions, windpipe muscles
get squeezed to cause narrowing, less intake of
oxygen, uneasiness, restlessness and
breathlessness leading to asthma. On the contrary
widening of wind pipe improves asthma. Laughing
endlessly can also trigger it. Watch out these,
before you call a doctor!
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how
mental
Trauma triggers Asthma?
Example:
Premlata never had
asthma till the age of 55. Only at the time
of changing climate she had problem of
allergic rhintis. On one day she went to
Rambagh lake with her family. Her two sons
started taking bath in the lake. Suddenly,
she saw her younger son started drowning.
Premlata had a terrible sensation of shock.
Though, the boy was saved by timely action
of her elder son but she had severe mental
trauma. In the night she develops the
difficulty in breathing and on consultation
with doctors she was found to have asthma.
Since then for last five years she has been
suffering from asthma, though under control
with regular inhaler drugs.
Curiosity:
-
What induced asthma in Premlata?
- How the
problem was solved ?
Expert
Comments:
The lady was having an atopic disease (allergic
disease) of nose in a form of allergic rhintis.
Persons having atopic disease are susceptible to
develop asthma when comes in the contact with an
adverse environment. In this patient emotional
trauma gave the adverse environment which
precipitated her asthma. Once started asthma
continued with the help of other trigger factors.
Drugs are to be continued for long period in such
a situation.
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HOW
FEAR CAUSES ASTHMA?
Example:
Neha, 15 years, was suffering from asthma.
She was particular about her studies. Her
asthma used to worsen on weekend. This
situation continued for 3-4 weeks. On close
observation, it was found that Neha was week
in the subject of physics and its class
period fell on Friday and Saturday. The
physics teacher was very strict. The fear of
attending physics class aggravated her
asthma.
Curiosity:
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What should be done to improve asthma of
Neha?
- How
the problem was
solved.
Extra attention towards preparation
of physics at home with the help of a tutor
generated confidence in the child. With that
confidence she was able to face the physics
teacher without aggravation of asthma.
Expert Comments:
Though, the psychological stress can not induce
asthma in a healthy person without tendency of
developing asthma yet it can aggravate severity of
asthma. In such a situation in addition to
adequate medication proper strategy should be
planned to solve the psychological problem.
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