It is also increasingly clear that panic disorder patients suffer from ingrained cognitive abnormalities by which they misconstrue and catastrophize a host of trivial somatic sensations. Recent advances have been made to develop specific cognitive and behavioral psychotherapies that directly address this problem and that work well in conjunction with pharmacologic treatment.
Yellowlees and Kalucy postulate convincingly that asthma may involve the same two problems. Like the patient with panic disorder, at least one set of asthmatic patients undoubtedly inherits an organic respiratory hypersensitivity leading to episodic bronchoconstriction. At the same time, asthmatic patients appear to suffer from anxiety disorder and to exaggerate the significance in some instances of respiratory sensations to the point that they “cognitively” induce an asthma attack.
It is intriguing that imipramine appears to have some efficacy in treating asthma. While this may in part be due to an intrinsic bronchodilator effect of the tricyclic drug, Yellowlees and Kalucy suggest that it may also represent the re-regulation of the same autonomic hyperactivity postulated to occur in panic patients. By the same token, it appears worthwhile to consider the possibility that the same kind of cognitive/ behavioral treatments now being tested for panic patients may be efficacious in controlling some aspects of asthma. Perhaps asthmatic patients should be taught how to systematically control their respiration at the first suggestion of worsening asthma and to avoid the cognitive triggering of unnecessary anxiety and hyperventilation.
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In recent years we have learned that the central nervous system functions to affect and even control a variety of peripheral systems. We know, for example, that most organs of the immune system are directly innervated by the brain and that stimulation of specific brain centers can routinely induce arrhythmias in experimental animals. Yellowlees and Kalucy add to the growing list of diseases that undoubtedly have central nervous system involvement by pointing to the overlap between anxiety disorder and asthma and the effect of stress on asthmatic symptoms. Their suggestions for future research should be eagerly acted upon.