Asthma nervosa: old concept, new insights: Table 1–

Stress has long been recognised to be associated with asthma. Hippocrates stated that to prevent an asthma attack “the asthmatic should guard himself against his own anger” 1. Maimonides in his treatise of asthma suggested that “mental anguish, fear, mourning or distress” may cause asthma whereas “gaiety and joy” which “gladden the heart and stimulate the blood and mental activity” may have the opposite effect 2. In his treatise, H.H. Salter wrote that “asthma is essentially, and with perhaps the exception of a single class of cases, exclusively a nervous disease; the nervous system is the seat of the essential pathological condition” 3, and W. Osler referred to asthma as “a neurotic affection” 4. Thus, until the second half of the 20th century, asthma was predominantly viewed as a psychosomatic disorder in which emotional stress and imbalances in the nervous system were key factors in its aetiology. As a result, relief of anxiety was considered the main therapeutic intervention for “asthma nervosa”; as it has been referred to historically. Although the increased awareness in the second half of the 20th century of other triggers of asthma (allergens and air pollution) has shifted the focus away from psychosocial factors, these old concepts are going through a renaissance, with an increasing number of publications reporting consistent positive associations between psychosocial stress and asthma. Associations with asthma have been shown for a wide range of stressors including: post-traumatic stress disorder (PTSD) 5, 6; psychiatric disorders 7, 8; community violence 9; stressful life events 10; partner violence and housing quality 11; war-related stress 12; neuroticism and relational problems 13; perceived safety 14; social depravity and high crime rates 15; anxiety and attention disorders 16; psychological distress 17; …