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Published ahead of print on March 11, 2005, doi:10.1164/rccm.200412-1669OC

Am. J. Respir. Crit. Care Med., Volume 171, Number 11, June 2005, 1224-1230

A more recent version of this article appeared on June 1, 2005
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Submitted on December 10, 2004
Accepted on March 4, 2005

Asthma and Panic in Young Adults. A Twenty Year Prospective Community Study

Gregor Hasler1*, Peter J Gergen2, David G Kleinbaum3, Vladeta Ajdacic4, Alex Gamma4, Dominique Eich4, Wulf Rossler4, and Jules Angst4

1 Mood and Anxiety Disorders Program, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA; Psychiatric University Hospital, Zurich, Switzerland, 2 Asthma, Allergy, Inflammation Branch, Division of Allergy, Immunology, Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA, 3 Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA, USA, 4 Psychiatric University Hospital, Zurich, Switzerland

* To whom correspondence should be addressed. E-mail: gregor.hasler{at}nih.gov.

Rationale: Psychological factors are increasingly recognized to influence the onset and course of asthma. Previous cross-sectional community-based studies have provided evidence for a relatively specific association between asthma and panic. Objectives: To examine concurrent and longitudinal associations between asthma and panic in young adults. Measurements and Main Results: Prospective community-based cohort study of young adults (N=591) followed between ages 19 and 40. Information was derived from six subsequent semi-structured diagnostic interviews conducted by professionals. Cross-sectionally (over the whole study period), asthma was more strongly associated with panic disorder (OR = 4.0 [95% CI 1.7, 9.3]) than with any panic, which included panic disorder and panic attacks (OR = 2.1 [1.1, 4.5]). Longitudinally, after adjusting for potentially confounding variables, active asthma predicted subsequent panic disorder (OR = 4.5 [1.1, 20.1]), and the presence of panic disorder predicted subsequent asthma activity (OR = 6.3 [95% CI 2.8, 14.0]). Asthma predicted any panic (OR=2.7 [1.1, 7.1]), while any panic did not predict subsequent asthma activity. Associations were stronger in smokers than in non-smoker, and stronger in females than in males. Smoking, early childhood anxiety and a family history of allergy were important confounders of the asthma-panic association. Conclusions: This is the first long-term follow-up study on asthma and panic. It showed dose-response type relationships between panic and asthma, and bi-directional longitudinal associations between the two conditions. It provided evidence for familial factors and smoking as possible shared etiologic explanations.
Key words: respiratory tract disease, anxiety, child development, sex, smoking




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