The relationship between negative emotions and acute subjective and objective symptoms of childhood asthma
Background. Children with asthma are vulnerable to negative emotions, but clinical observations and research suggest that negative emotions can also be precipitants of asthma attacks. Empirical data provided mixed results. The hypothesis was tested that negative emotions influence subjective rather than objective symptoms of asthma, breathlessness and airways obstruction, respectively.
Methods. Forty asthmatic children (aged 7 to 18 years) were randomly assigned to one of four experimental conditions: 1, viewing an emotional film of 10 min; 2, performing standardized physical exercise of modest intensity up to a heartbeat of 170 b/min; 3, combination of conditions, order conditions, 1+2; and 4, combination of conditions, order conditions 2+1. Lung function, breathlessness and state anxiety were measured pre-test and post-test. Respiration sounds were recorded continuously for assessment of emotional breathing patterns.
Results. The data and responses to exit questions, confirmed a successful induction of anxiety via increased state anxiety and respiratory rate. Viewing the emotional film did not by itself enhance airways obstruction or breathlessness. Airways obstruction and breathlessness increased significantly after exercise only. Significantly more breathlessness was reported when negative emotions preceded exercise. Breathlessness was statistically independent of lung function, severity of asthma, symptoms in the past 4 weeks, anxiety or age.
Conclusion. Negative emotions affect subjective, rather than objective symptoms of childhood asthma. It was suggested that children in a negative emotional state, uncertain about the condition of their airways, are inclined to interpret exercise-related general sensations (fatigue, heart pounding, sighing) in line with expectations as symptoms of airways obstruction. Consequently, they may report relatively high breathlessness, irrespective of actual objective symptoms of asthma.
c1 Address for correspondence: Dr S. Rietveld, Department of Clinical Psychology, Roetersstraat 15, 1018 WB Amsterdam, The Netherlands.