Severe Asthma Linked to Stronger Defenses Despite Worse Perceived Health

A recent study reported that patients with severe allergic asthma have greater defensive functioning despite lower perceived physical health.¹

“Our first hypothesis, that defensive functioning in our sample was positively related to physical and mental health and, conversely, negatively related to psychological symptoms of depression, anxiety, and alexithymia, was fully confirmed,” wrote investigators, led by Gabriella Martino, MD, PhD, from the department of clinical and experimental medicine at the University of Messina in Italy.

Chronic immune-mediated diseases, such as severe allergic asthma, have a large impact on quality of life. For instance, those with severe asthma may struggle with sleep disturbances, tiredness, and poor concentration.² Symptoms that are too severe may require a hospital visit.

People’s defense mechanisms influence their ability to manage chronic diseases. Studies have shown that personality traits and implicit emotion regulation are linked to the development, progression, recurrence, and severity of chronic illness.³ Poorer defense mechanisms can result in a hindered quality of life.

Chronic immune-mediated diseases, such as severe allergic asthma and hymenoptera venom anaphylaxis, significantly impact quality of life. Individuals with severe allergic asthma may struggle to complete everyday tasks, need to use their inhaler more than once a day, and always be thinking about their asthma and believing no medicines will help.⁴

Severe asthma can also impact physical health, personal relationships, and emotional health. The My Life with Asthma online survey reported that 55% of respondents with severe uncontrolled asthma experienced symptoms more than once a day, with 15% experiencing symptoms once a day, 22% experiencing symptoms ≥ 2 times per week but not daily, and 8% experiencing symptoms ≤ 2 times a week.⁴

Another chronic immune-mediated disease, hymenoptera venom anaphylaxis, can also largely impact quality of life. A study published in February 2024 reported that anxiety and outdoor activities had the largest impact on quality of life in these patients, with larger effects on women.⁵ A history of acute anaphylactic shock due to hymenoptera venom also affected quality of life.

In this recent cross-sectional study, investigators sought to assess the relationship between defensive functioning, psychological symptoms, and the perceived physical and mental health among patients with severe allergic asthma and hymenoptera venom anaphylaxis.¹ In total, 34 patients with severe allergic asthma and 32 with hymenoptera venom anaphylaxis were assessed with the Short-Form Health Survey, the Beck Depression Inventory, the Hamilton Anxiety Rating Scale, the Toronto Alexithymia Scale, and the Defense Mechanisms Rating Scales Self Report-30.

The analysis found that defensive functioning was positively linked to mental health but negatively linked to depressive symptoms, anxiety, and alexithymia. Males reported significantly greater physical and psychological health than females.

Greater scores on the Overall Defensive Functioning scale, indicating greater defensive maturity, corresponded to participants’ ability to manage emotional distress. These scores were linked to better mental health and lower depression and anxiety.

“As expected, higher use of immature defenses was found in participants that reported greater psychological symptoms of depression, anxiety, and alexithymia, indicating that poor implicit emotional regulation hindered the management of life difficulties, including the experience of being chronically ill,” investigators wrote.

Patients with severe allergic asthma demonstrated significantly greater defensive functioning but lower self-reported physical health than patients with hymenoptera venom anaphylaxis. Patients with severe allergic asthma and hymenoptera venom anaphylaxis had no mental health differences.

“These findings suggest interesting reflections about how chronic diseases could lead to a decline in defensive functioning,” investigators added.

A mediation analysis found defensive functioning correlated with disease type and physical health, explaining 39% of the variance. Defensive functioning independently predicted mental health.

“The systematic investigation of defense mechanisms in the clinical follow-up of patients with chronic diseases could allow us to obtain essential information on the impact of implicit emotional regulation on psychological functioning,” investigators concluded. “Research advances on the under-investigated role of defensive functioning as a mediator of psychological symptoms…in chronic patients can offer clues to the scientific debate on the importance of observing and assessing implicit aspects of psychological functioning on the onset, course, and treatment of chronic disease.”

References

1. Martino G, Di Giuseppe M, Silvestro O, et al. Defense mechanisms in immune-mediated diseases: a cross-sectional study focusing on Severe Allergic Asthma and Hymenoptera Venom Anaphylaxis patients. Front Psychol. 2025;16:1608335. Published 2025 Jun 18. doi:10.3389/fpsyg.2025.1608335

2. Asthma. World Health Organization. May 6, 2024. https://www.who.int/news-room/fact-sheets/detail/asthma. Accessed July 25, 2025.

3. Conversano C, Di Giuseppe M. Psychological Factors as Determinants of Chronic Conditions: Clinical and Psychodynamic Advances. Front Psychol. 2021;12:635708. Published 2021 Jan 28. doi:10.3389/fpsyg.2021.635708

4. My Life with Asthma. Asthma and Allergy Foundation of America. https://aafa.org/asthma-allergy-research/our-research/my-life-with-asthma-report/. Accessed July 25, 2025.

5. Bemaniyan MH, Heidari M, Tavakol M, et al. A Quality-of-life Study in Patients with Anaphylaxis to Hymenoptera Venom in Iran. Iran J Allergy Asthma Immunol. 2024;23(1):59-68. Published 2024 Feb 11. doi:10.18502/ijaai.v23i1.14954