A case history; Asthma: emotions out of control.

I received a call from the Emergency Room staff that a patient of mine had arrived by Aid Car. She was described as being in a state of extreme status asthmaticus. Occurring occasionally in persons with bronchial asthma, this condition manifests typical asthmatic bronchospasm so unrelenting and extreme that the air exchange is so marginal that it becomes life threatening. The usual bronchodilating drugs are ineffective, and often the condition mandates insertion of a breathing tube into the trachea.

By the time I arrived at the hospital, an endotracheal tube had been inserted, and the patient was being managed by a pulmonologist, a specialist in respiratory disease. I had little to add to the acute treatment, but obtained a detailed history from her husband who was dressed in paint-splattered overalls.

G. had come to the office intermittently for over a decade, always for minor conditions. Occasionally, we had the opportunity to talk about her asthma, but she managed her disease rather well by herself, utilizing only inhaled bronchodilators as needed. She was a diminutive wisp of a woman, probably weighing less than one hundred pounds, and her husband was over six feet with a large frame. I had occasionally seen her and her husband and, in my mind, recalled some tension in their interactions in my examination rooms.

During the early evening before her ambulance ride to the hospital (which was only about one-half mile away), she and her husband had been repainting their living room. She was painting the lower portion of a wall, and he was painting near the ceiling while standing high on a stepladder. As might typically happen in that situation, she suddenly noticed that he had dripped a blob of pain on the natural-finished base shoe, also spilling onto the rug.

She immediately flared into anger, screaming and raging at him for doing such sloppy work, as well as for not noticing it and stepping down from the ladder to clean it up. Within five minutes, she was markedly wheezing, her asthma triggered into full expression. A few minutes later, as her air exchange became alarmingly limited, her husband called for the ambulance. He was so alarmed by her condition that he thought she might die before help arrived. I asked if he had previously observed anger trigger such a severe asthmatic episode. He recalled similar episodes of serious loss of air exchange with severe wheezing, but nothing approaching the extreme nature of this episode.

The story ended with her full recovery from the episode after five days in the hospital. Following up in the office, I judiciously approached the issue of the role anger had played in the episode. She was in mild denial about the anger, but did admit, "I did let my anger get out of control." She was not, however, about to deal with the issues underlying her predisposition to express anger so violently.

It was quite apparent to me that the unbridled and extreme expression of her anger triggered the asthma "attack." Some years later, I read a newspaper account of a woman who had made arrangements for the graveside memorial service of her deceased father. Arriving at the cemetery and discovering that the grave for the casket had not even been dug, she became extremely angry with the mortician who had failed to follow through on the preparations. After screaming at him in a rage for about two minutes, she had collapsed and died, in spite of the best resuscitation efforts of a 911-response team that happened to be nearby.

All powerful emotions, including grief, sadness, anxiety, fear, and anger can be normal, and failure to express them in some acceptable way is also detrimental to health. Acting out these powerful emotions in extreme form can also be life threatening. G. taught me much about these mind-body relationships.