The role of acute and chronic stress in asthma attacks in children

Sandberg, Seija; Paton, James Y.; Ahola, Sara; McCann, Donna C.; McGuinness, David; Hillary, Clive R.; Oja, Hannu

doi:10.1016/s0140-6736(00)02715-x

Cited by 393 publications

(282 citation statements)

References 26 publications

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“…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.…”

Section: Introductionmentioning

confidence: 99%

“…[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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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Asthma disproportionately affects non-whites in urban areas and those of low socioeconomic status, yet asthma's social patterning is not well-explained by known risk factors. We hypothesized that disadvantaged urban populations experience acute and chronic housing stressors which produce psychological stress and impact health through biological and behavioral pathways. We examined eight outcomes: six child respiratory outcomes as well as parent and child general health, using data from 682 low-income, Chicago parents of diagnosed and undiagnosed asthmatic children. We created a continuous exposure, representing material, social and emotional dimensions of housing stressors, weighted by their parent-reported difficulty. We compared the 75th to the 25th quartile of exposure in adjusted binomial and negative binomial regression models. Higher risks and rates of poor health were associated with higher housing stressors for six of eight outcomes. The risk difference (RD) for poor/fair general health was larger for children [RD=6.28 (95% CI 1.22, 11.35)] than for parents [RD=3.88 (95% CI −1.87, 9.63)]. The incidence rate difference (IRD) for exercise intolerance was nearly one extra day per 2 weeks for the higher exposure group [IRD= 0.88 (95% CI 0.41, 1.35)]; nearly one-third extra day per 2 weeks for waking at night [IRD=0.32 (95% CI 0.01, 0.63)]; and nearly one-third extra day per 6 months for unplanned medical visits [IRD=0.30 (95% CI 0.059, 0.54)]. Results contribute to the conceptualization of urban stress as a "social pollutant" and to the hypothesized role of stress in health disparities. Interventions to improve asthma outcomes must address individuals' reactions to stress while we seek structural solutions to residential stressors and health inequities.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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“…Although psychosocial variables were found to play important roles in the development and persistence of asthma 12 and obesity, 13 these variables have not been considered as shared risk factors in studies on the asthmaobesity comorbidity. Specifically, depression during childhood has been associated with an increased risk of onset and recurrence of both asthma 12 and obesity.…”

Section: Introductionmentioning

confidence: 99%

“…Specifically, depression during childhood has been associated with an increased risk of onset and recurrence of both asthma 12 and obesity. 13,14 Additionally, pathophysiological mechanisms that may underlie asthma-obesity associations, including dysfunctions of the catecholaminergic system, dysfunctions of the hypothalamic-pituitary-adrenocortical (HPA) system and systemic inflammation, 1 are also critically involved in the pathophysiology of clinical depression.…”

Section: Introductionmentioning

confidence: 99%

Asthma and body weight change: a 20-year prospective community study of young adults

Hasler

Gergen

Ajdacic³

et al. 2006

Int J Obes

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Objective: There is increasing evidence for an association between asthma and body weight change. The objectives of these analyses were to examine the temporal relationships of this association and to explore the role of childhood depression as an explanatory factor. Methods: Data were derived from six subsequent semistructured interviews on health habits and health conditions from a single-age community study of 591 young adults followed up between ages 20 and 40 years. Results: Cross-sectionally (over the whole study period), asthma was significantly associated with obesity (odds ratio ¼ 3.9 [95% confidence interval 1.2, 12.2]). Multivariate longitudinal analyses revealed that asthma was associated with increased later weight gain and later obesity among women after controlling for potentially confounding variables, whereas weight gain and obesity were not associated with later asthma. A secondary analysis showed that depressive symptoms during childhood were associated with adult obesity and asthma, partially explaining the asthma-obesity comorbidity. Conclusion: This study encourages further research on mechanisms underlying the asthma-obesity comorbidity, particularly on shared psychosocial factors operating during critical periods in childhood and adolescence that may influence the development and persistence of both obesity and asthma during adulthood.

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“…Results of animal and in vitro studies suggest that the physiological stress response, characterized by inflammation and other changes in the immune system functions, may have an aetiological role in asthma 24. There is some evidence that stressful life events increase the risk of asthma exacerbations in children 25 and adults 26. Stress is also associated with asthma triggers, such as respiratory infections 11 and smoking 12.…”

Section: Discussionmentioning

confidence: 99%

Job strain and the risk of severe asthma exacerbations: a meta‐analysis of individual‐participant data from 100 000 European men and women

Heikkilä

Madsen

Nyberg

et al. 2014

Allergy

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BackgroundMany patients and healthcare professionals believe that work‐related psychosocial stress, such as job strain, can make asthma worse, but this is not corroborated by empirical evidence. We investigated the associations between job strain and the incidence of severe asthma exacerbations in working‐age European men and women.MethodsWe analysed individual‐level data, collected between 1985 and 2010, from 102 175 working‐age men and women in 11 prospective European studies. Job strain (a combination of high demands and low control at work) was self‐reported at baseline. Incident severe asthma exacerbations were ascertained from national hospitalization and death registries. Associations between job strain and asthma exacerbations were modelled using Cox regression and the study‐specific findings combined using random‐effects meta‐analyses.ResultsDuring a median follow‐up of 10 years, 1 109 individuals experienced a severe asthma exacerbation (430 with asthma as the primary diagnostic code). In the age‐ and sex‐adjusted analyses, job strain was associated with an increased risk of severe asthma exacerbations defined using the primary diagnostic code (hazard ratio, HR: 1.27, 95% confidence interval, CI: 1.00, 1.61). This association attenuated towards the null after adjustment for potential confounders (HR: 1.22, 95% CI: 0.96, 1.55). No association was observed in the analyses with asthma defined using any diagnostic code (HR: 1.01, 95% CI: 0.86, 1.19).ConclusionsOur findings suggest that job strain is probably not an important risk factor for severe asthma exacerbations leading to hospitalization or death.

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The role of acute and chronic stress in asthma attacks in children

Abstract: Severely negative life events increase the risk of children's asthma attacks over the coming few weeks. This risk is magnified and brought forward in time if the child's life situation is also characterised by multiple chronic stressors.

Cited by 393 publications

References 26 publications

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

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

Asthma and body weight change: a 20-year prospective community study of young adults

Job strain and the risk of severe asthma exacerbations: a meta‐analysis of individual‐participant data from 100 000 European men and women

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