Anxiety sensitivity and panic attacks in an asthmatic population

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Abstract

The purpose of this study was to examine the relationship among anxiety sensitivity, the experience of frequent, spontaneous panic attacks, and pulmonary function in individuals with asthma. Ninety-three asthmatics participated by completing a battery of questionnaires and a spirometric assessment. Twenty-three percent of the asthmatics reported a history of spontaneous panic attacks with 9.7% reporting attacks that were severe and frequent enough to meet the DSM-IIIR criteria for panic disorder (PD). Anxiety sensitivity (ASI) scores, but not pulmonary function, was significantly related to PD. In addition, we compared the asthmatics (with and without PD) to 10 clinically diagnosed PD Ss without asthma and to 32 nonanxious, nonasthmatic controls on the ASI, the Body Sensations Questionnaire, and the Agoraphobic Cognitions Questionnaire. Whereas Ss with PD (asthmatic and nonasthmatic) displayed significant elevations on these measures compared to those without PD, the presence of asthma alone had no effect. The present study concurs with that of Porzelius et al. [Behaviour Research and Therapy, 30, 75–77 (1992)] in extending the validity of the cognitive model of PD to individuals with pulmonary disease.

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      Citation Excerpt :

      Two potential pathways have been proposed to explain the PD-worse asthma outcomes association: one postulates a direct physiological pathway where panic leads to physiological changes (e.g., increased cardiorespiratory reactivity such as heart rate, carbon dioxide partial pressure, and respiratory rate) [17,18] via increased autonomic nervous activation that may be causally linked to asthma [5–7]. The other proposes that PD patients' tendency to catastrophize bodily sensations is associated with increased symptom reporting, resulting in greater treatment-seeking, independent of worse asthma [16,19–23]. Previous evidence supports both hypotheses, but has suffered from methodological weaknesses: a failure to objectively diagnose asthma [22,24], often relying upon self-reported diagnoses which are subject to bias [25]; a failure to use a validated psychiatric interview to diagnose PD [22,26], over-relying on questionnaire measures of panic-like anxiety which are insufficient to confirm PD diagnoses; and the use of resting spirometry as the sole objective measures of asthma [23,27], which may appear normal when asthma is well controlled [28].

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