Impaired voluntary drive to breathe: a possible link between depression and unexplained ventilatory failure in asthmatic patients.

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Abstract
Although psychological distress predicts mortality in asthma, an underlying physiological link has not been shown. This study examined relations between impaired voluntary drive to breathe and measures of mood states. The level of maximal voluntary activation of the diaphragm and elbow flexors was measured in a previous study using a sensitive modification of the twitch interpolation technique in 11 asthmatic and 10 control subjects. In this study psychological distress was assessed using the Profile of Mood States questionnaire and measures of distress were compared with the muscle voluntary activation results. For the asthmatic subjects, depressed mood increased the risk of impaired maximal voluntary activation of the diaphragm by 3.5 times (95% CI 1.09 to 11.3). No such association was observed in control subjects. These results suggest that depressed mood may predispose an asthmatic patient to impaired voluntary activation of the diaphragm. Such individuals would be at increased risk of rapidly developing ventilatory failure if faced with severe airway narrowing.