Dissociating breathlessness symptoms from mood in asthma
Asthma is one of many chronic diseases in which discordance between objectively measured pathophysiology and symptom burden is well recognised. Understanding the influences on symptom burden beyond pathophysiology could improve our ability to treat symptoms. While co-morbidities such as anxiety and depression may play a role, the impact of this relationship with symptoms on our ability to perceive bodily sensations (termed interoception), or even our general and symptom-specific attention is not yet understood. Here we studied 63 individuals with asthma and 30 healthy controls. Alongside physiological tests including spirometry, bronchodilator responsiveness, expired nitric oxide and blood eosinophils, we collected self-reported questionnaires covering affective factors such as anxiety and depression, as well as asthma symptoms and asthma-related quality of life (individuals with asthma only). Participants additionally completed a breathing-related interoception task and two attention tasks designed to measure responsiveness to general temporal/spatial cues and specific asthma-related threatening words. We conducted an exploratory factor analysis across the questionnaires which gave rise to key components of Mood and Symptoms, and compared these to physiological, interoceptive and attention measures. While no relationships were found between symptoms and physiological measures in asthma alone, negative mood was related to both decreased interoceptive metacognitive sensitivity ( insight into interoceptive performance) and metacognitive bias (confidence in interoceptive decisions), as well as increased effects of spatial orienting cues in both asthma and controls. Furthermore, the relationship between the extent of symptoms and negative mood revealed potential sub-groups within asthma, with those who displayed the most severe symptoms without concurrent negative mood also demonstrating altered physiological, interoceptive and attention measures. Our findings are a step towards understanding how both symptoms and mood are related to our ability to interpret bodily symptoms, and to explore how the balance between mood and symptoms may help us understand the heterogeneity in conditions such as asthma.