© 2009 American Thoracic Society
Panic Disorder Is Closely Associated with Respiratory Obstructive IllnessesTo the Editor:The increasing evidence that respiratory illnesses and panic disorder (PD) may exacerbate each other has led to recent calls for a combined treatment approach (1). In their article, Dr. Livermore and colleagues (2) have demonstrated that psychological factors, including PD, may influence the perception of inspiratory resistive loads. They showed that PD patients with COPD have a heightened sensitivity to inspiratory loads. The importance of this study is that they demonstrated that the combination of PD and COPD may worsen the severity of the patient's respiratory symptoms. The relationship between respiratory obstructive disorders and PD was earlier highlighted by Goodwin and colleagues (3), whose 2003 study provided information on the association between physician-diagnosed asthma and mental disorders in a representative population sample of adults. Current severe respiratory obstructive disorders were associated with a significantly increased likelihood of any anxiety disorder, including PD and panic attacks. In 2005, Hasler and colleagues (4) presented the first long-term follow-up study on asthma and PD. They showed dose–response-type relationships between PD and asthma and bidirectional longitudinal associations between the two conditions. The necessity of therapeutic protocols for PD patients with respiratory disorders has also been included in clinical trials with antipanic medication alone or in association with asthma treatment, investigating the influence of such treatment on respiratory function and daily activities. The recommended treatment approaches for the two disorders sometimes conflict, for example, exposure to body sensations for PD versus avoidance of such triggers for asthma; relaxation to ameliorate anxiety, which could produce bronchoconstriction through a parasympathetic discharge, versus β-sympathetic agonists for asthma that could trigger panic; treatment of overperception and catastrophic interpretation of body sensations for PD versus improving poor symptom sensitivity and encouraging appropriate anxiety about symptoms for asthma. The presence of asthma may increase the risk of developing PD through a variety of cognitive and behavioral mechanisms, including producing threatening bodily sensations that could trigger panic among susceptible individuals, agoraphobic avoidance, and aversive conditioning to cues for respiratory impairment (5). Lehrer and colleagues (6) used a treatment approach that incorporated components of panic control therapy and asthma self-management programs. Both programs were adapted for the comorbid group, teaching participants to recognize the differences between asthma and panic symptoms and to engage in appropriate self-care for each (6). They observed significant therapeutic effects, presumably from early attention to teaching participants to distinguish asthma from panic symptoms, and treating each disorder appropriately.
Federal University of Rio de Janeiro FOOTNOTES Conflict of Interest Statement: A.E.N. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript. REFERENCES
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