The asthma-anxiety connection: friends or foes?

OBJECTIVE

To analyze the relationship between anxiety and asthma.

METHODS

We carried an English scientific literature search using electronic search engines (PubMed). We included articles published in peer-review journals from 2020 to December 2024. In order to perform the search for the most suitable and representative articles, keywords were selected (-asthma‖, and -anxiety‖). The evidence level was assessed according to the criteria of the Oxford Center For Evidence-Based Medicine.

RESULTS

Across multiple studies, the prevalence of anxiety among patients with asthma ranged from 13.7% to 54.3%, consistently higher than in the general population. Anxiety was associated with poorer asthma control (lower ACQ/ACT scores), reduced quality of life (AQLQ) and, in some cases, impaired lung function and higher inflammatory markers (hs-CRP, NLR). Depression emerged as the strongest risk factor for anxiety (OR 26.00), while well-controlled asthma (ACT ≥ 20) and allergic asthma were associated with approximately 70% lower risk. Being female and asthma onset occurring between ages 40 and 59 were also linked to higher anxiety prevalence. Screening tools such as the mini-AQLQ, HADS, EQ-5D and PHQ-4 demonstrated potential utility in identifying anxiety in asthmatic populations. In specific subgroups, asthma-related anxiety was associated with increased symptom reporting and exacerbations, even without a deterioration in objective measurements for airway obstruction.

CONCLUSIONS

Anxiety is a common comorbidity among patients with asthma and it is associated with poorer disease control and a reduced quality of life.