Asthma exacerbations in children immediately following stressful life events: a Cox's hierarchical regression

Abstract

Background: A recent prospective study of children with asthma employing a within subject, over time analysis using dynamic logistic regression showed that severely negative life events significantly increased the risk of an acute exacerbation during the subsequent 6 week period. The timing of the maximum risk depended on the degree of chronic psychosocial stress also present. A hierarchical Cox regression analysis was undertaken to examine whether there were any immediate effects of negative life events in children without a background of high chronic stress. Methods: Sixty children with verified chronic asthma were followed prospectively for 18 months with continuous monitoring of asthma by daily symptom diaries and peak flow measurements, accompanied by repeated interview assessments of life events. The key outcome measures were asthma exacerbations and severely negative life events. Results: An immediate effect evident within the first 2 days following a severely negative life event increased the risk of a new asthma attack by a factor of 4.69 (p = 0.00). In the period 3-10 days after a severe event there was no increased risk of an asthma attack (p = 0.5). In addition to the immediate effect, an increased risk of 1.81 was found 5-7 weeks after a severe event (p = 0.002). This is consistent with earlier findings. There was a statistically significant variation due to unobserved factors in the incidence of asthma attacks between the children. Conclusion: The use of statistical methods capable of investigating short time lags showed that stressful life events significantly increase the risk of a new asthma attack immediately after the event; a more delayed increase in risk was also evident 5-7 weeks later.

Health Psychology: Developing Biologically Plausible Models Linking the Social World and Physical Health

“…Psychological stress has been linked to poorer clinical asthma outcomes, such as an increased risk of asthma exacerbations (Sandberg et al 2000(Sandberg et al , 2004. Asthma is an inflammatory disease, wherein activation of eosinophils, production of immunoglobulin E, and degranulation of mast cells form key events leading to the release of allergic mediators such as histamines and leukotrienes.…”

Childhood asthma and infection: virus-induced exacerbations as determinants and modifiers

“…The risk of hospitalisation due to asthma exacerbation is synergistically increased in the presence of viral infection, allergen sensitisation and exposure to respiratory allergens [33]. Moreover, studies using sophisticated statistical methods have emphasised the importance of psychological events in asthma control, showing that stressful life events have immediate and delayed effects in significantly increasing the risk of an asthma exacerbation [34]. Nevertheless, no studies have been able to assess all candidate-precipitating factors simultaneously in order to evaluate their relative importance and interactions.…”

Stress and the City: Housing Stressors are Associated with Respiratory Health among Low Socioeconomic Status Chicago Children

“…13 Studies link stress to asthma onset, exacerbation and phenotypes through hypothesized "dysregulated immunity" mechanisms. 10,12,[14][15][16][17][18][19][20][21][22] Stress experienced by children or their parents may also have indirect effects on asthma by causing health-compromising behaviors and comorbidities that adversely affect disease management. [23][24][25][26][27][28][29][30][31][32][33][34] Caregiver stress, negative life events, problematic family relationships, parenting difficulties, critical attitudes of one's mother and violence exposure have been related to wheeze, asthma onset, and/or adverse asthma outcomes among infants and youths.…”

“…[23][24][25][26][27][28][29][30][31][32][33][34] Caregiver stress, negative life events, problematic family relationships, parenting difficulties, critical attitudes of one's mother and violence exposure have been related to wheeze, asthma onset, and/or adverse asthma outcomes among infants and youths. 14,15,[20][21][22][29][30][31][32][35][36][37][38][39][40][41] The housing and health relationship has long been acknowledged, not surprising given that water, warmth, air, shelter, and safety are fundamental human needs. 42 US children spend as much as 80-90% of their time indoors.…”