Early pulmonary response to allergen is attenuated during acute emotional stress in females with asthma

Abstract

Some asthma patients and physicians who treat asthma have reported that stress worsens their disease. It has also recently been shown that chronic stressful life events increase airway inflammation 6-24 h after inhalation of antigen in patients with allergic asthma. However, there is no data regarding the effect of an acute stressor on the airway constriction that occurs within minutes of antigen inhalation (early pulmonary response) in this same population. The aim of this study was to examine this effect in eight females with allergic asthma.Each subject was challenged with increasing concentrations of inhaled allergen on a control visit (no stress) and on a stress visit, when they were asked to verbally recount an emotionally stressful situation between each concentration. Systolic (SP) and diastolic (DP) blood pressure, cardiac frequency ( fC) and forced expiratory volume in one second (FEV1) were measured on both visits.SP, DP and fC were statistically increased on the stress visit as compared to control. Per cent decrease in FEV1 at the same last dose of allergen was significantly less on the stress visit (11.2¡7.0%) compared to control (15.0¡8.7%).These findings suggest that the early pulmonary response to inhaled allergen is attenuated while verbally re-experiencing an acute emotional stressor in females with allergic asthma. Eur Respir J 2003; 22: 613-618.

Evaluating the effects of stress on asthma: a paradoxical challenge

“…Importantly, the results were consistent with one side of the paradox that has puzzled investigators from the beginning. It is well known (and is also documented in the study by LAUBE et al [5]) that emotional arousal is accompanied by sympathetic activation, which is physiologically associated with bronchodilation. This contrasts with clinical observations and lore that have focused on emotions as precipitants of asthma attacks, which by their nature involve bronchoconstriction.…”

“…The most important aspect of the results reported by LAUBE et al [5] was the failure of the data to support the hypothesis; in fact, the results were the opposite of what was expected. The authors hypothesised that the pulmonary response to allergen exposure in individuals with allergic asthma would be potentiated by emotional arousal elicited by a stress interview.…”

“…The paper by LAUBE et al [5] in the current issue of the European Respiratory Journal, which describes careful testing of a hypothesis generated by a theoretical model, represents another step forward in this tortuous process of investigation. Although the authors9 hypothesis was not supported, the specifics of the unexpected results of the study provide another piece of the puzzle, and so contribute to a revision and refinement of the working model for investigating the interaction of stress and asthma.The most important aspect of the results reported by LAUBE et al [5] was the failure of the data to support the hypothesis; in fact, the results were the opposite of what was expected. The authors hypothesised that the pulmonary response to allergen exposure in individuals with allergic asthma would be potentiated by emotional arousal elicited by a stress interview.…”

“…From the beginning, this area of research has been plagued by the paradox wherein the typical physiological reaction to emotional arousal was the opposite of physiological events associated with bronchoconstriction. The paper by LAUBE et al [5] in the current issue of the European Respiratory Journal, which describes careful testing of a hypothesis generated by a theoretical model, represents another step forward in this tortuous process of investigation. Although the authors9 hypothesis was not supported, the specifics of the unexpected results of the study provide another piece of the puzzle, and so contribute to a revision and refinement of the working model for investigating the interaction of stress and asthma.…”

“…There is a close relationship between the two, but they are not equivalent. The complexity of studying stress effects is illustrated in the LAUBE et al [5] paper, where the subjects were asked by questionnaire about recent stressful events and were then were interviewed during the stress condition visit about the most severe of their reported stressful events. Although the study design relied on personally meaningful and disturbing recent events, the study manipulation involved the elicitation of emotional arousal.…”