Bronchial asthma with psychogenic trigger.

The authors present several personal studies in accordance with other published data which contest the existence of purely psychogenic bronchial asthma, as it was considered 30-50 years ago. Although psychological stimuli could trigger the occurrence of attacks of bronchial asthma, they are not an exclusive etiological factor (Iamandescu, 1980, 1985). In the context of large groups of asthma with allergic or other etiology, forms of asthma that are triggered by an additional psychogenic factor could be identified. These are noted in 62.5% of hospitalized patients, most cases with a prolonged and more severe evolution of the disease, but in only 30% of light and moderately severe cases that are followed up in outpatient (Iamandescu, 1980, 1984). The percent of psychological trigger is maximum (86%) in corticodependent asthma patients (Iamandescu, 1996). Somatic and psychological background of asthma with psychogenic triggering is represented by the following: (1) an obvious relationship between psychological stimuli and the onset of asthma attacks, and a psychological terrain "endowed" with an increased vulnerability to stress. These patients present a diminished rate of cortisol response to stress compared with asthma patients without psychogenic triggering; (2) reversibility to broncho-dilator agents, in contrast with resistance to systemic corticoid therapy; (3) sensitivity to aspirin; (4) endocrine dysfunctions (high estrogen and thyroid hormones secretion); (5) multi-factorial triggering of the attacks (especially non-specific respiratory irritants, including physical-chemical factors and meteorological changes) (1985); (6) variable response to psychotherapy and psychotropic drugs, suggesting--in case of therapeutic failure--the predominance of the chronic inflammation determined by other etiologic agents, different from psychological stress.