The powerful connection between stress and asthma

Strong emotions—positive and negative—are a part of life. For most people, emotions like joy, stress, or fear can come with bodily sensations, such as feeling lightheaded or jittery.

For people with asthma, however, stressful moments can come with potentially dangerous physical effects, including sudden changes to breathing. The effect that stress has on asthma can act like a powerful feedback loop: As emotions become more intense, asthma symptoms can worsen. As asthma symptoms worsen, emotions can become even stronger.

When this cycle starts, having asthma can feel overwhelming. But understanding the relationship between stress and asthma can help you break the cycle. Here’s what you should know about emotions and asthma, plus ways to breathe easier in challenging situations.

Which emotions make asthma symptoms worse?

Every person with asthma has their own “triggers.” An asthma trigger is something in the environment (like pollen or tobacco) that can cause symptoms to arise.

It’s not only physical substances that can cause asthma flare-ups, however. Almost any emotion can bring on asthma symptoms, though not every person with asthma will be triggered by all (or any) emotions.

If you’re not sure whether emotions may be affecting your breathing, consider keeping a symptom journal. Write down what you did, ate, felt, and experienced before, during, and after asthma symptoms start. This can help you identify possible causes of flare-ups.

If strong feelings—such as anger or anxiety—are a trigger for you, an important part of your asthma action plan will be to learn ways to ease those emotions when they occur.

What if your asthma is affected by positive feelings, like joy? Rather than trying to stop these emotions, you might work with an asthma specialist to focus on reducing the symptoms that happen as a result. That may involve taking daily asthma medication or keeping your rescue inhaler available during fun activities.

The connection between stress and asthma

When you feel stressed, your body releases a chemical called adrenaline (also known as epinephrine). Adrenaline is the “fight or flight” hormone that prepares your body to respond to threats in your environment.

Adrenaline causes your blood pressure and heart rate to increase so that oxygen-rich blood can reach your limbs and essential organs fast. Adrenaline also makes you breathe harder and faster. It causes your muscles to tense up and prepare for action.

Stress also increases the amount of cortisol, another stress hormone, in your bloodstream. Cortisol tells your body to release blood glucose (blood sugar), which gives your brain and muscles a jolt of energy. This can serve you well if you need to flee a threat (or power through an all-night study session) but it’s less helpful if you have asthma.

Just as the muscles in your arms and legs tense up during a stressful situation, so do the muscles around your airways. This tensing also happens when you feel asthma symptoms start. Add to that an increase in your breathing rate, and stress can bring about a severe asthma attack.

Meanwhile, the excess blood glucose that floods the body can cause inflammation in organs and tissues. Inflammation contributes to conditions like heart disease, diabetes, stroke, and asthma. It can make your lungs more sensitive to allergens, increase lung congestion, and make your asthma medication less effective.

Racism, trauma, and their links to asthma

Certain societal stressors can put some groups of people at increased risk for severe asthma. People who experience racism, violence, abuse, and other forms of trauma are especially prone to developing asthma and having life-threatening asthma symptoms.

Members of marginalized groups, like people of color and members of LGBTQ+ communities, are more likely than members of non-marginalized groups to experience stressors like racism, discrimination, and violence. They’re also more likely to have severe asthma. A large body of research shows how racism and discrimination directly affect people’s health.

“Asthma is 1.3 times more common in Black people compared to people who are not Black,” notes Gerald Lee, MD, associate professor of pediatrics at Emory School of Medicine in Atlanta, Georgia. What’s more, emergency department visits for asthma are twice as high among Black people and hospitalizations are roughly four times higher. “Unfortunately, people are still dying of asthma—and that number is three times higher among Black people.”

Many factors contribute to disparities like these, Dr. Lee explains. “Differences in social and economic opportunities, the history of systemic racism, and exposures to environmental hazards are all interrelated and impact asthma risk.”

The health impacts of unjust systems

Experiences with discrimination can contribute to a host of mental, physical, and emotional effects that increase people’s risk for various illnesses. In particular, experiences of discrimination can prompt the asthma-stress response. Such interactions aren’t the only contributors to asthma risk, however.

Broader systems—like housing, health care, education, and transportation—often have built-in biases that tend to work against marginalized groups. Inequities in the way resources are shared throughout society can create environments that increase the risk of asthma and other conditions even further.

“For instance, redlining was a federal home-loan program that designated certain areas as being at high risk for mortgage loan failure,” explains Lee. “Neighborhoods considered by banks to be at greatest ‘risk’ for people to not pay their mortgage bills were labeled red. Those areas tended to be highly enriched with communities of color.”

People living in historically red-lined districts are affected by the practice to this day. They’re more likely to experience poor air quality, for example, from nearby highways, factories that release harmful chemicals, and housing developments with unsafe construction materials, among other hazards to lung health.

“Beyond air quality, environmental factors can contribute to asthma and other illnesses via exposure to toxic stress,” says Lee. (Toxic stress is severe stress that persists over a long period of time, contributing to issues with health and development.) “That may involve the stress of racism, not being able to access the health services you need, higher levels of premature death among family and friends, exposure to violence, and other forms of trauma.”

Making change

Environmental racism refers to the way in which some groups of people are more likely than other groups to face environmental hazards. The societal systems that give rise to environmental racism—such as housing, policy, and law—can often feel too big to fix.

But there are real steps that people can take to help protect members of communities affected by environmental injustices.

Connect with your regional PEHSU

Each region of the United States has its own Pediatric Environmental Specialty Unit (PEHSU) and each unit has a focus based on local environmental issues. These government-sponsored networks bring together families, physicians, nurses, scientists, and advocates to promote environmental health. Your PEHSU can tell you about the environmental risks in your region and local advocacy efforts underway. The PEHSU website also offers resources, like nearby clinics that can test you or loved ones for exposure to environmental hazards—and provide treatments if needed. Use this interactive map to find the regional PEHSU nearest you.

Reach out to your elected representatives

Tell them about issues you care about that affect your community and be sure to vote in local, state, and national elections.

Learn more about how racism affects health

Understand the complex connections between racism, stress, and health—and learn how to be an ally for others.

Small steps to help ease stress

Voting, speaking up for issues that matter to you, and playing an active role in your community can help protect you and your community from shared stressors. To counteract stress on a more personal level, consider these steps:

Weave physical activity into your daily routine

Exercise is a known stress-reliever. Even if you don’t have time for or access to a gym, try to build extra movement into your day. Walk around the block on work breaks, take the stairs instead of the elevator, or do simple exercises around the house. If you watch TV, get up and move during each commercial break.

Love a pet

Spending time with an animal friend can improve your mood. It can also reduce levels of cortisol, lower blood pressure, and protect against loneliness. Even if you have asthma, there are ways to breathe better with asthma and a pet.

Spend time with friends and loved ones

Loneliness is an epidemic in America. If you feel lonely and are interested in meeting new people, volunteering is a great way to start.

Practice grounding exercises

In moments when stress feels overwhelming, consider practicing a grounding exercise, drawn from the tradition of mindfulness meditation. This can help you redirect your focus from negative or runaway thoughts. Some examples:

• Take off your shoes and focus your attention on the feeling of your feet touching carpeting or soft grass.
• Look at something beautiful like a tree or cloud for two minutes. If other thoughts enter your mind, gently return your attention to the object.
• Pick a color. Then notice all the things around you that are that color.
• Try abdominal or belly breathing for five to 10 minutes at a time. Start by lying on a flat surface. Rest one hand on your chest and the other on your stomach. Breathe in slowly through your nose, allowing air to fill your belly, noticing how the hand on your stomach moves with the breath, while the hand on your chest stays mostly still. As you breathe in, imagine light and positive energy filling you up. As you breathe out through your mouth, imagine releasing the thoughts that trouble you.

How to access help when you need it

If stress affects your daily life in profound ways—or you suspect you may have a condition like anxiety or depression—there are people and resources that can help. A mental health professional can listen and support you as you work through challenges. They can help you find coping techniques and determine if medication may benefit you.

If you are having thoughts of self-harm, reach out to the 988 Suicide and Crisis Lifeline by calling, texting, or chatting 988. The Lifeline isn’t only for people experiencing thoughts of suicide. It’s for anyone having a mental health crisis who needs help fast.

Editors’ note: “Asthma attack” and “asthma trigger” have become common terms to describe aspects of having asthma. Some people have called for the retirement of these terms in the interest of avoiding language with violent connotations. We have used “trigger” and “attack” in this article because they are the most widely known terms, but will review and update our language as the conversation evolves.

This article has been written in collaboration with the Center for Children’s Health Assessment, Research Translation, and Combating Environmental Racism (CHARTER) at Emory University. CHARTER works to develop strategies to translate research findings on children’s environmental health for stakeholders in the community, academia, and health care with the goal of improving children’s health.

Read more from this series on asthma in children, including ways to protect your children from asthma at school, and best practices for keeping your home free of allergens and asthma triggers.