Psychobiological Aspects of Asthma and the Consequent Research Implications
Despite considerable debate, the most accepted definition of asthma is that it is a disorder of the respiratory tract, characterized by a hyperreactive bronchial tree, producing episodes of reversible airway obstruction. Gross, in a discussion on the problems of defining asthma, quoted Permutt as stating “asthma is like love, we all know what it is but who would trust anybody else’s definition.” However asthma is defined, though, it remains a common, chronic, recurrent, disabling, and potentially fatal illness, with a multifactorial pathogenesis. Among the most commonly accepted trigger factors are allergens, infections, physical irritants, chemical irritants, reflex reactions (eg, to cold temperatures), exercise, and psychogenic factors, including hyperventilation.
Asthma has been recognized since the time of Hippocrates. Gabbay has recently written a fascinating account of the history of asthma giving a social perspective to the disorder. He emphasized the importance of the subjective cultural views that dominated at any point in history and the effect that these have had on medical knowledge. He argued that there are still strong grounds “for scepticism about today s clinical and ontological views of asthma.” He concluded that far from medical knowledge about asthma having consisted of proven, timeless, objective facts, it has appeared under scrutiny to be composed of limited interpretations of the complex phenomena of illness. The nature of these interpretations is formed by the world, a social world, in which the physician and patient happen to live; it also contributes to the formation of that world. He also noted how the anatomical, physiological, social, psychological, dietary, meteorological, astrological and countless other phenomena associated with each asthma attack form a vast substrate for interpretation by the physician. It is with these issues in mind that we have attempted to draw together the formulation presented in this article to explain why patients with asthma present more commonly than might be expected with anxiety disorders that are of clinical relevance.