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.