This conceptual review examines how psychological stress influences asthma through neuroendocrine (HPA axis), autonomic, and immune pathways, and evaluates evidence for behavioral interventions—including CBT and MBSR—on asthma outcomes across all age groups.
CBT and MBSR consistently improve perceived distress and asthma-related quality of life, but their effects on objective outcomes (lung function, exacerbation rates, inflammatory biomarkers) remain inconsistent across trials. Stress-driven mechanisms include HPA axis dysfunction, alarmin release (IL-33, IL-25, TSLP), mast cell activation, and Type 2 inflammatory polarization, all of which can worsen asthma control.
- Most underlying studies are observational with self-reported stress measures, limiting causal inference. - Psychosocial stressors co-occur with environmental triggers (allergens, pollution) and social determinants, making it hard to isolate stress-specific effects. - Intervention trials are small, heterogeneous in design and duration, and use variable outcome measures, restricting comparability.
Screen asthma patients routinely for depression (PHQ-9), anxiety (GAD-7), and stress exposure (ACEs questionnaire), especially after exacerbations or treatment step-changes. Refer patients with moderate-to-severe scores to behavioral health; use CBT or MBSR as first-line adjuncts to—not replacements for—standard inhaled corticosteroids and biologics.
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