Current perspectives on the psychological stress-immune axis in asthma: Pathophysiology, interventions, and significance for patient care

Psychological stress and psychiatric comorbidities are highly prevalent in patients with asthma, with evidence supporting bidirectional links. Excessive psychological stress is associated with immune dysregulation, hypothalamic-pituitary-adrenal (HPA) axis dysfunction, and neuroimmune crosstalk that increases Type 2 inflammation associated with poorly controlled asthma. Anxiety and depression worsen asthma control and quality of life through complex and bidirectional mechanisms. Both cognitive-behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) can help reduce distress and increase quality of life for people with asthma. However, their effects on lung function and exacerbation rates remain inconsistent. Integrating interventions that address stress and mental health factors into asthma care is essential for optimal care. Distinguishing formal psychiatric illness from stress-related emotional distress allows for specific interventions to be utilized. Embedding validated screening tools and behavioral health into routine clinical practice can address the value of managing psychosocial burden while complementing pharmacologic therapy.