SAN DIEGO, May 25-Laughter isn't the best medicine for asthmatics, researchers reported here.
More than half of all asthmatics suffer from laughter-induced attacks, a team from New York University reported at the American Thoracic Society meeting here. And it doesn't take a belly laugh to trigger an attack, said Stuart Garay, M.D. Even a mild chuckle can be enough to trigger coughing and chest tightness.
Action Points
- Inform patients that even mild laughter can trigger attacks in approximately half of asthma patients, particularly those with exercise-induced asthma.
- Be aware that good asthma control appears to mitigate the effect of laughter and that excessive laughter-induced asthma may be a marker for less-than-complete control in patients in whom laughter acts as a trigger.
- This study was published as an abstract and presented at a conference poster presentation. These data and conclusions should be considered to be preliminary as they have not yet been reviewed and published in a peer-reviewed publication.
The NYU investigators presented an analysis of the asthma triggers of 235 patients who were part of a 494-patient prospective disease management program in Dr. Garay's practice.
Of the 235 patients, who were chosen for the completeness of their records, 56% reported having an asthma attack brought on by laughing, Dr. Garay said.
"We asked them three questions, in addition to the usual demographic data," Dr. Garay said. "Does laughter ever make you cough, or cause chest tightness, wheezing or shortness of breath? If so, how soon does it happen? And does it vary with how well controlled your asthma is?"
The 132 patients with laughter-induced asthma were compared with the remaining 103, Dr. Garay said. With one exception, there was no significant difference in demographics, duration of asthma, severity of disease, and triggers.
The exception, Dr. Garay said, was that patients with laughter-induced asthma were also twice as likely to have exercise-induced asthma -- 61% per cent versus 35%. The difference was statistically significant at the p = 0.001 confidence level, he said.
What is not clear, he added, is exactly why the two should be correlated; exercise-induced asthma is thought to be related to forced exhalations, which usually take six or more minutes to have an effect.
But 77% of the laughter-induced asthma patients said their attacks occurred within two minutes of laughing, and most of those said the attack started within 30 seconds. As well, since even a giggle was enough to trigger an attack, there were likely no forced exhalations involved, he said.
The symptoms of laughter-induced asthma were mainly coughing (68%) and chest tightness (17%) with wheezing and shortness of breath each seen in 7.5%, Dr. Garay said.
Patients with and without laughter-induced asthma had the same severity of disease, rate of ER visits, hospitalization, use of anti-inflammatory drugs, or degree of asthma control, as measured by the standard Asthma Treatment Assessment Questionnaire.
On the other hand, for patients with laughter-induced asthma, the degree of asthma control was related to how much laughter it took to trigger an attack or whether an attack occurred at all, Dr. Garay said.
Of the 132 patients 62 said they didn't have laughter-induced asthma when their disease was well controlled -- defined as using rescue medication less than twice a week and being wakened at night because of asthma fewer than two times a month.
The rest continued to have laughter-induced asthma despite good control, but said it took more laughter to trigger an attack when the disease was controlled, Dr. Garay reported.
"The take-home message may be that laughter-induced asthma may be a marker for asthma control," Dr. Garay said.
Laughter-induced asthma has been reported before, he said. Australian researchers reported findings similar to Dr. Garay's in the Journal of Asthma in 2004. In the 1970s, in letters to The Lancet, there was a discussion of the phenomenon under the title "Should Asthmatic Patients Laugh?"
"I think asthmatic patients should laugh," Dr. Garay commented.
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