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Recent research from psychological, psychiatric and social viewpoints has emphasized the importance to the whole community of the aged population, and has stressed in particular that the changing proportion of aged to working populations is bringing with it problems of great urgency.

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Asthmatic children do not constitute a homogeneous group. They show wide variations in severity of physiological involvement, in parental attitudes to the disorder and in the attitude of the child himself to his disability. Each of these factors has been shown to affect the therapeutic outcome. This paper seeks to demonstrate that in addition, adversity of life circumstances may equally influence the pattern of clinical response. Two groups of juvenile asthmatics were studied; 161 referred to a children’s hospital, and 55 accomodated within a residental open-air school. Both groups showed the characteristic alternation between relative improvement under hospital supervision or in boarding school and the tendency to relapse if discharged prematurely. Both groups were similarly comparable in their constituent physiological grades. By contrast, a much higher incidence of sociopathic stress was found to operate within the residential open-air school group than within the hospital based group, this difference being highly significant statistically. Among a number of general implications, which emerge from this study, the conclusion of most immediate import is that sociopathology, where it exists, should never be dismissed as trivial or irrelevant to the clinical course of the individual asthmatic case. On the contrary, adverse life circumstances can be shown on occasion to be as important in the genesis of clinical intractability as the more familiar variants of psychopathology based upon interpersonal or intrapsychic considerations. In effect, we have to consider the whole patient within his family and social environment rather than just his efficiency in ventilatory function if we are to achieve the optimum therapeutic response in childhood asthma.

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