Breathing is life – from that very first cry at birth to the final exhalation at the end of our life. Breathing has a close link with mood modulation through hormonal pathways. We have a nasal cycle that shifts every 60-80 minutes, and alters and influences our state of emotions. Breathing over 20,000 times in one day and with 60-80,000 thoughts, the truth really is that there is some deeper link between breath and states of mind.

Today, 15 million people across the UK are living with everything from respiratory conditions – asthma and chronic obstructive pulmonary disease (COPD) – to mental health disorders. We know that one in five people suffers from chronic respiratory diseases, and one in four has some form of mental health issue. The overlap of the diseases is critical and needs particular consideration in susceptible groups like the homeless. Anxious and depressed moods nearly always accompany symptoms of breathing difficulties and chronic coughing, which further deteriorate the mental health outcomes when combined with a factor such as social isolation. Yet, the psychological support for chronic respiratory patients is practically non-existent; thus, they are largely left to their own means to cope with both physical and mental challenges. 

The mind-lung connection 

Generally, Chronic Respiratory Disease (CRD) are characterised by poor self-efficacy and self-esteem. Anxiety and depression worsen symptoms impeding effective management. Unfortunately, most mental health conditions go unnoticed in general practitioner visits, as the health systems tend to lay more emphasis on physical treatments such as inhalers and steroids. This, therefore, forms a vicious cycle where the quality of life of CRD patients continues to deteriorate since their anxiety and depression remain untreated. Whereas smoking may be used as a coping mechanism for anxiety and depression, it is known to exacerbate respiratory complications and carries social stigma, further contributing to isolation.  

The need for integrated care 

Despite the decades of initiatives on integrated care, gaps persist in CRD management, particularly in the support for mental health. Lack of training regarding the psychological aspects of CRDs represents a major barrier to the delivery of holistic care. I hereby, wholeheartedly, as a longstanding member of the European Respiratory Society, support the Lung Mind Alliance for complete integration of psychological support for respiratory care. Psychotherapists with experience in CRD are invited to become collaborators in new models of care to effect real change.  

Best practice for integrated care 

In light of this, holistic assessment, collaboration, and training on psychological impacts would, therefore, help the caregivers strike a balance in the gaps in physical and mental health care in CRDs. Every GP practice should have a psychotherapist trained in attending chronic disease management focused on respiratory disease. Wellbeing could be further enhanced with patient education and the incorporation of psychotherapy into care plans. Psychotherapists are therefore called upon to join efforts in bringing forth an integrated model for care that will support physical and psychological wellbeing. 

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