Violence-related distress and lung function in two longitudinal studies of youth

Abstract

Increasing violence-related distress over time was associated with worse lung function and worse asthma-related quality of life in youth with asthma despite treatment with low-dose inhaled corticosteroids.Exposure to violence has been associated with lower lung function in cross-sectional studies. We examined whether increasing violence-related distress over time is associated with worse lung function and worse asthma control or quality of life in a secondary analysis of a 48-week randomized clinical trial in 98 youth with asthma (ages 9–16 years) treated with low-dose inhaled corticosteroids (the Vitamin D Kids Asthma Study [VDKA]). We then replicated our findings for lung function in a prospective study of 232 Puerto Rican youth followed for an average of 5·4 years. Violence-related distress was assessed using the Checklist of Children's Distress Symptoms (CCDS) scale. Our outcomes of interest were percent predicted (%pred) lung function measures and (in VDKA only) asthma control (assessed using the Asthma Control Test) and asthma-related quality of life (assessed using the Pediatric Asthma Quality of Life questionnaire). In a multivariable analysis in VDKA, each 1-point increment in the CCDS score was associated with decrements of 3.27% in %predFEV1 (95% confidence interval [CI]=−6.44% to −0.22%, p=0.04) and a 2.65% decrement in percent predicted FVC (95% CI=−4.86% to −0.45%, p=0.02), and 0.30 points in the overall PAQLQ score (95% CI=−0.50 to −0.10, p<0.01). Similar findings for FEV1 and FVC were obtained in the prospective study of Puerto Rican youth. Our findings suggest that violence-related distress may worsen lung function and quality of life in youth with asthma (even those treated with low-dose inhaled corticosteroids) and further support policies to reduce exposure to violence among children in the U.S. and Puerto Rico.

Child maltreatment and asthma

“…In that report, increased violence-related distress was also significantly associated with reduced FEV 1 and FVC in an ~5-year prospective study of 232 Puerto Rican youth aged 6-14 years. 40 Taken together, those results suggest that increased violence-related distress between childhood and adolescence leads to reduced FEV 1 and FVC in subjects with asthma, and that this may be partly explained by reduced sensitivity to inhaled steroids. 40 In contrast to findings for violence-related distress in youth with asthma, there has been no or inconsistent association between child maltreatment and reduced lung function in studies of children 32 and adults 41,42 in the general population.…”

“…40 Taken together, those results suggest that increased violence-related distress between childhood and adolescence leads to reduced FEV 1 and FVC in subjects with asthma, and that this may be partly explained by reduced sensitivity to inhaled steroids. 40 In contrast to findings for violence-related distress in youth with asthma, there has been no or inconsistent association between child maltreatment and reduced lung function in studies of children 32 and adults 41,42 in the general population. In an Australian prospective cohort study of children followed from birth until age 21 years, child maltreatment was not associated with decrements in FVC, FEV 1 , or forced expiratory flow mid expiratory phase (FEF 25-75 ).…”

“…In that report, increased violence‐related distress was also significantly associated with reduced FEV 1 and FVC in an ~5‐year prospective study of 232 Puerto Rican youth aged 6–14 years 40 . Taken together, those results suggest that increased violence‐related distress between childhood and adolescence leads to reduced FEV 1 and FVC in subjects with asthma, and that this may be partly explained by reduced sensitivity to inhaled steroids 40 …”

“…To date, there is insufficient and weak evidence of an association between child maltreatment and lung function in children or adults, though a recently reported association between violence-related distress and childhood lung function, 40 together with findings for asthma attacks and asthma hospitalizations 41,43 support a possible link between child maltreatment and greater asthma severity.…”

“…In a recent 48‐week longitudinal study of data from 98 diverse youth aged 6–16 years who were treated with low‐dose inhaled corticosteroids for mild persistent asthma, 40 increased distress related to exposure to violence (including but not limited to child abuse) was associated with significant decrements in percent predicted (%pred) forced expiratory volume in the first second (FEV 1 ) (−3.27% for each 1‐point increment in a validated scale, with 95% CI = −6.44% to −0.22%) and %pred forced vital capacity (FVC) and reduced asthma‐related quality of life. In that report, increased violence‐related distress was also significantly associated with reduced FEV 1 and FVC in an ~5‐year prospective study of 232 Puerto Rican youth aged 6–14 years 40 . Taken together, those results suggest that increased violence‐related distress between childhood and adolescence leads to reduced FEV 1 and FVC in subjects with asthma, and that this may be partly explained by reduced sensitivity to inhaled steroids 40 …”