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Ritz T, Kroll JL, Patel SV, Chen JR, Yezhuvath US, Aslan S, Khan DA, Pinkham AE, Rosenfield D, Brown ES. Central nervous system signatures of affect in asthma: associations with emotion-induced bronchoconstriction, airway inflammation, and asthma control. J Appl Physiol (1985) 2019; 126:1725-1736. [PMID: 30920889 DOI: 10.1152/japplphysiol.01018.2018] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The effects of asthma on affect have been noted for some time, but little is known about associated brain processes. We therefore examined whether emotion-induced bronchoconstriction, airway inflammation, and asthma control are related to specific patterns of brain activity during processing negative affective stimuli. Fifteen adults with asthma viewed alternating blocks of distressing film clips (negative condition), affectively neutral film clips (neutral condition), and a crosshair image (baseline condition) while undergoing blood oxygenation level-dependent (BOLD) functional MRI (fMRI). Block-design fMRI analysis evaluated the BOLD response to "negative-baseline" and "neutral-baseline" contrasts. Airway response to these film clips was also assessed with impulse oscillometry in a separate session. Measures of airway inflammation [fractional exhaled nitric oxide (FENO)] and asthma control [Asthma Control Questionnaire (ACQ)] were additionally obtained. A whole brain voxel-based regression analysis of contrast maps was performed against respiratory resistance increase during negative and neutral films, FENO, and ACQ. Peak airway obstruction to negative affective stimulation was associated with stronger activation of the anterior and middle cingulate gyrus, including the dorsal anterior cingulate cortex (dACC). Stronger airway inflammation and lower asthma control were associated with reduced activation to negative stimuli in the superior frontal gyrus, middle cingulate gyrus, and supplementary motor area. Activation of the dACC in negative-affect-induced airway obstruction could be part of an integrated defensive response to critical environmental change. In addition, reduced frontal and limbic activation during processing of negative affect may reflect consequences of pathophysiological processes for CNS functioning. NEW & NOTEWORTHY This functional magnetic resonance imaging study shows, for the first time, that the degree of airway constriction due to negative affective stimuli in asthma is associated with stronger response to these stimuli in the dorsal anterior and middle cingulate cortex. Asthma patients with stronger airway inflammation and reduced asthma control also show reduced activation in a number of cortical and subcortical areas relevant for affective processing and breathing control.
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Affiliation(s)
- Thomas Ritz
- Southern Methodist University , Dallas, Texas
| | | | - Sheenal V Patel
- The University of Texas Southwestern Medical Center , Dallas, Texas
| | - Justin R Chen
- The University of Texas Southwestern Medical Center , Dallas, Texas
| | | | - Sina Aslan
- The University of Texas Southwestern Medical Center , Dallas, Texas.,Advance MRI, LLC, Frisco, Texas.,The University of Texas at Dallas , Richardson, Texas
| | - David A Khan
- The University of Texas Southwestern Medical Center , Dallas, Texas
| | - Amy E Pinkham
- The University of Texas at Dallas , Richardson, Texas
| | | | - E Sherwood Brown
- The University of Texas Southwestern Medical Center , Dallas, Texas
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Marsland AL, Gentile D, Hinze-Crout A, von Stauffenberg C, Rosen RK, Tavares A, Votruba-Drzal E, Cohen S, McQuaid EL, Ewing LJ. A randomized pilot trial of a school-based psychoeducational intervention for children with asthma. Clin Exp Allergy 2019; 49:591-602. [PMID: 30657230 DOI: 10.1111/cea.13337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/30/2018] [Accepted: 12/29/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Asthma is a common childhood illness with high morbidity and mortality among minority and socio-economically disadvantaged children. Disparities are not fully accounted for by differences in asthma prevalence, highlighting a need for interventions targeting factors associated with poorer asthma control. One such factor is psychological stress. OBJECTIVE Here, we examine the feasibility and acceptability of "I Can Cope (ICC)," a school-based stress management and coping intervention for children with asthma. METHODS A parallel randomized pilot trial was conducted. One hundred and four low-income children (mean age 10 years; 54% male; 70% African American) with persistent asthma were recruited from 12 urban schools and randomized to the following: (a) ICC or one of two control conditions: (b) "Open Airways for Schools (OAS)"-an asthma education intervention or (c) no treatment. RESULTS Seventy one percentage of eligible children participated in the study, with a dropout rate of 12%. ICC was rated as highly acceptable by participating children and parents. Preliminary efficacy data suggest that when compared with no treatment, ICC resulted in decreased symptoms of depression, perceived stress and child-reported symptoms of asthma, and improvements in sleep quality and child-reported asthma control. There were no intervention-related changes in objective measures of asthma morbidity. The magnitude of intervention effects on psychological function did not differ between the ICC and OAS groups. CONCLUSIONS Results support the feasibility and acceptability of utilizing school-based interventions to access hard to reach children with asthma. Preliminary findings offer support for future, large-scale efficacy studies of school-based interventions designed to target multiple factors that contribute to asthma disparities.
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Affiliation(s)
| | | | | | | | | | - Amy Tavares
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Sheldon Cohen
- Carnegie Mellon University, Pittsburgh, Pennsylvania
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53
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Abstract
After over 70 years of research on the association between stressful life events and health, it is generally accepted that we have a good understanding of the role of stressors in disease risk. In this review, we highlight that knowledge but also emphasize misunderstandings and weaknesses in this literature with the hope of triggering further theoretical and empirical development. We organize this review in a somewhat provocative manner, with each section focusing on an important issue in the literature where we feel that there has been some misunderstanding of the evidence and its implications. Issues that we address include the definition of a stressful event, characteristics of diseases that are impacted by events, differences in the effects of chronic and acute events, the cumulative effects of events, differences in events across the life course, differences in events for men and women, resilience to events, and methodological challenges in the literature.
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Affiliation(s)
- Sheldon Cohen
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA; ,
| | - Michael L M Murphy
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA; ,
| | - Aric A Prather
- Department of Psychiatry, University of California, San Francisco, California 94118, USA;
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54
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Fleming L, Heaney L. Severe Asthma-Perspectives From Adult and Pediatric Pulmonology. Front Pediatr 2019; 7:389. [PMID: 31649906 PMCID: PMC6794347 DOI: 10.3389/fped.2019.00389] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022] Open
Abstract
Both adults and children with severe asthma represent a small proportion of the asthma population; however, they consume disproportionate resources. For both groups it is important to confirm the diagnosis of severe asthma and ensure that modifiable factors such as adherence have, as far as possible, been addressed. Most children can be controlled on inhaled corticosteroids and long term oral corticosteroid use is rare, in contrast to adults where steroid related morbidity accounts for a large proportion of the costs of severe asthma. Atopic sensitization is very common in children with severe asthma as are other atopic conditions such as allergic rhinitis and hay fever which can impact on asthma control. In adults, the role of allergic driven disease, even in those with co-existent evidence of sensitization, is unclear. There is currently an exciting pipeline of novel biologicals, particularly directed at Type 2 inflammation, which afford the possibility of improved asthma control and reduced treatment side effects for people with asthma. However, not all drugs will work for all patients and accurate phenotyping is essential. In adults the terms T2 high and T2 low asthma have been coined to describe groups of patients based on the presence/absence of eosinophilic inflammation and T-helper 2 (TH2) cytokines. Bronchoscopic studies in children with severe asthma have demonstrated that these children are predominantly eosinophilic but the cytokine patterns do not fit the T2 high paradigm suggesting other steroid resistant pathways are driving the eosinophilic inflammation. It remains to be seen whether treatments developed for adult severe asthma will be effective in children and which biomarkers will predict response.
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Affiliation(s)
- Louise Fleming
- National Heart and Lung Institute, Imperial College, London and Royal Brompton Hospital, London, United Kingdom
| | - Liam Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Institute for Health Sciences, Queens University Belfast, Belfast, United Kingdom
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55
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Ribeiro-Silva RC, Malta DC, Rodrigues LC, Ramos DO, Fiaccone RL, Machado DB, Barreto ML. Social, Environmental and Behavioral Determinants of Asthma Symptoms in Brazilian Middle School Students-A National School Health Survey (Pense 2012). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122904. [PMID: 30572563 PMCID: PMC6313389 DOI: 10.3390/ijerph15122904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 11/30/2022]
Abstract
Biological and psychosocial factors are recognized contributors to the worldwide burden of asthma. However, the relationship between psychosocial factors and asthma symptoms among students in low- and middle-income countries remains underexplored. We aimed to identify socioeconomic, environmental, psychosocial, family-related and lifestyle factors associated with the self-reporting of asthma symptoms in Brazilian adolescents. This is a cross-sectional study using data from the 2012 PeNSE survey (n = 109,104). We analyzed the following variables: socioeconomic conditions, demographic characteristics, lifestyle, family context and dynamics, psychosocial indicators, smoking, and exposure to violence. Our outcome variable was the self-report of asthma symptoms in the past 12 months. The prevalence of wheezing was 22.7% (21.5–23.9). After adjusting for sex, age and the variables from higher hierarchical levels, exposure to violence (feeling unsafe at school, being frequently bullied, being exposed to fights with firearms) and physical aggression by an adult in the family were the environmental factors that showed the strongest associations with self-reporting of asthma symptoms. For psychosocial indicators of mental health and social integration, feelings of loneliness and sleeping problems were the strongest factors, and among individual behavioral factors, the largest associations were found for tobacco consumption. Our findings were consistent with previous studies, showing an association between self-reported asthma symptoms and socio-economic status, family context and dynamics, psychosocial indicators of mental health, exposure to violence and social integration, as well as a sedentary lifestyle and tobacco use.
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Affiliation(s)
| | - Deborah C Malta
- School of Nursery, Federal University of Minas Gerais, Belo Horizonte 30.130-100, Brazil.
| | - Laura C Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Dandara O Ramos
- Center for Data and Knowledge Integration for Health (CIDACS), Institute Gonçalo Moniz (IGM), Oswaldo Cruz Foundation (FIOCRUZ), Salvador 41.745-715, Brazil.
| | - Rosemeire L Fiaccone
- Institute of Mathematics and Statistics, Federal University of Bahia, Salvador 40.170-110, Brazil.
| | - Daiane B Machado
- Center for Data and Knowledge Integration for Health (CIDACS), Institute Gonçalo Moniz (IGM), Oswaldo Cruz Foundation (FIOCRUZ), Salvador 41.745-715, Brazil.
| | - Maurício L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Institute Gonçalo Moniz (IGM), Oswaldo Cruz Foundation (FIOCRUZ), Salvador 41.745-715, Brazil.
- Institute of Collective Health (ISC), Federal University of Bahia, Salvador 40110-040, Brazil.
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56
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Finnell JE, Wood SK. Putative Inflammatory Sensitive Mechanisms Underlying Risk or Resilience to Social Stress. Front Behav Neurosci 2018; 12:240. [PMID: 30416436 PMCID: PMC6212591 DOI: 10.3389/fnbeh.2018.00240] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/25/2018] [Indexed: 12/30/2022] Open
Abstract
It has been well recognized that exposure to stress can lead to the onset of psychosocial disorders such as depression. While there are a number of antidepressant therapies currently available and despite producing immediate neurochemical alterations, they require weeks of continuous use in order to exhibit antidepressant efficacy. Moreover, up to 30% of patients do not respond to typical antidepressants, suggesting that our understanding of the pathophysiology underlying stress-induced depression is still limited. In recent years inflammation has become a major focus in the study of depression as several clinical and preclinical studies have demonstrated that peripheral and central inflammatory mediators, including interleukin (IL)-1β, are elevated in depressed patients. Moreover, it has been suggested that inflammation and particularly neuroinflammation may be a direct and immediate link in the emergence of stress-induced depression due to the broad neural and glial effects that are elicited by proinflammatory cytokines. Importantly, individual differences in inflammatory reactivity may further explain why certain individuals exhibit differing susceptibility to the consequences of stress. In this review article, we discuss sources of individual differences such as age, sex and coping mechanisms that are likely sources of distinct changes in stress-induced neuroimmune factors and highlight putative sources of exaggerated neuroinflammation in susceptible individuals. Furthermore, we review the current literature of specific neural and glial mechanisms that are regulated by stress and inflammation including mitochondrial function, oxidative stress and mechanisms of glutamate excitotoxicity. Taken together, the impetus for this review is to move towards a better understanding of mechanisms regulated by inflammatory cytokines and chemokines that are capable of contributing to the emergence of depressive-like behaviors in susceptible individuals.
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Affiliation(s)
- Julie E Finnell
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Susan K Wood
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States.,WJB Dorn Veterans Administration Medical Center, Columbia, SC, United States
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57
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Iio M, Hamaguchi M, Nagata M, Yoshida K. Stressors of School-age Children With Allergic Diseases: A Qualitative Study. J Pediatr Nurs 2018; 42:e73-e78. [PMID: 29752045 DOI: 10.1016/j.pedn.2018.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Most studies of stress in children with chronic diseases have been geared toward parents and caregivers have not considered allergic diseases together. This study aimed to identify the stressors associated with allergic diseases in Japanese school-age children. DESIGN AND METHODS Stressors associated with allergic diseases of 11 school-age children (seven boys and four girls; age range: 9-12 years) were investigated using semi-structured interviews. RESULTS In the qualitative thematic analysis of stressors about allergic diseases, two themes: allergic disease-specific stressors and common stressors in chronic diseases, and 12 categories were identified. A thematic map was applied to four domains of stressor: physiological factors, psychological factors, social factors, and environmental factors. CONCLUSIONS The results showed that school-age children with allergic diseases have a variety of stressors. Future studies should aim to develop an allergic disease-specific stress management program with school-age children. PRACTICE IMPLICATIONS In children with allergic diseases, not only is stress management in daily life important, but also stress management for disease-specific matters to control the symptoms and maintain mental health. Stress management should be supported for school-age children with allergic diseases.
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Affiliation(s)
- Misa Iio
- College of Nursing, Kanto-Gakuin University, Yokohama, Kanagawa, Japan.
| | | | - Mayumi Nagata
- College of Nursing, Kanto-Gakuin University, Yokohama, Kanagawa, Japan
| | - Koichi Yoshida
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
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58
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Maitra A. Severe Asthma: Challenges and Pitfalls in Management. Indian J Pediatr 2018; 85:763-772. [PMID: 29736695 DOI: 10.1007/s12098-018-2686-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 01/03/2023]
Abstract
A small but significant subset of asthmatic children show a lack of response to standard management, resulting in further intensification of therapy to optimise symptom control and may remain symptomatic despite maximal therapy. Severe asthma results in increased risk of adverse outcomes whilst contributing significantly to the economic burden on the nation's health resources. The ERS / ATS guidelines were published in 2014 and form the basis of identifying, evaluating and managing severe asthmatic children. However, much of this evidence is extrapolated from adult studies and may be inappropriate in children as unlike adults, children have a more atopic phenotype. Severe asthma is an umbrella term and may represent several overlapping heterogeneous wheezing entities. This chapter aims at discussing the strategies employed in managing severe asthmatic children with particular focus on diagnostic challenges and management pitfalls. Particular emphasis is put into the logical and systematic approach to a child with severe asthma and describes the multidisciplinary approach to manage these children. Finally, this chapter describes the novel therapies available in children and in adults in managing this challenging condition.
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Affiliation(s)
- Anirban Maitra
- Pediatric Respiratory Medicine, Royal Manchester Children's Hospital, Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK.
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59
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Deng Q, Deng L, Lu C, Li Y, Norbäck D. Parental stress and air pollution increase childhood asthma in China. ENVIRONMENTAL RESEARCH 2018; 165:23-31. [PMID: 29655040 DOI: 10.1016/j.envres.2018.04.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/28/2018] [Accepted: 04/04/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Although air pollution and social stress may independently increase childhood asthma, little is known on their synergistic effect on asthma, particularly in China with high levels of stress and air pollution. OBJECTIVES To examine associations between exposure to a combination of parental stress and air pollution and asthma prevalence in children. METHODS We conducted a cohort study of 2406 preschool children in Changsha (2011-2012). A questionnaire was used to collect children's lifetime prevalence of asthma and their parental stress. Parental socioeconomic and psychosocial stresses were respectively defined in terms of housing size and difficulty concentrating. Children's exposure to ambient air pollutants was estimated using concentrations measured at monitoring stations. Associations between exposure to parental stress and air pollution and childhood asthma were estimated by multiple logistic regression models using odds ratio (OR) and 95% confidence interval (CI). RESULTS Life time prevalence of asthma in preschool children (6.7%) was significantly associated with parental socioeconomic and psychosocial stresses with OR (95% CI) respectively 1.48 (1.02-2.16) and 1.64 (1.00-2.71). Asthma was also associated with exposure to air pollutants, with adjusted OR (95% CI) during prenatal and postnatal periods respectively 1.43 (1.10-1.86) and 1.35 (1.02-1.79) for SO2 and 1.61 (1.19-2.18) and 1.76 (1.19-2.61) for NO2. The association with air pollution was significant only in children exposed to high parental stress, the association with parental stress was significant only in children exposed to high air pollution, and the association was the strongest in children exposed to a combination of parental stress and air pollution. Sensitivity analysis showed that the synergistic effects of parental stress and air pollution on childhood asthma were stronger in boys. CONCLUSIONS Parental stress and air pollution were synergistically associated with increased childhood asthma, indicating a common biological effect of parental stress and air pollution during both prenatal and postnatal periods.
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Affiliation(s)
- Qihong Deng
- School of Energy Science and Engineering, Central South University, Changsha, Hunan, China; XiangYa School of Public Health, Central South University, Changsha, Hunan, China.
| | - Linjing Deng
- School of Energy Science and Engineering, Central South University, Changsha, Hunan, China
| | - Chan Lu
- School of Energy Science and Engineering, Central South University, Changsha, Hunan, China
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Dan Norbäck
- School of Energy Science and Engineering, Central South University, Changsha, Hunan, China; Department of Medical Sciences/Occupational & Environmental Medicine, Uppsala University, Uppsala, Sweden
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60
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Reinhard E, Layte R, McCrory C, Panico L, Avendano M. The Great Recession and the Health of Young Children: A Fixed-Effects Analysis in Ireland. Am J Epidemiol 2018; 187:1438-1448. [PMID: 29370331 DOI: 10.1093/aje/kwy001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 01/03/2018] [Indexed: 12/19/2022] Open
Abstract
Economic recessions have been linked to adult health, but few studies have examined how recessions influence the health of young children. This study examined the impact of life transitions linked to the recent financial crisis on the health of young children in Ireland. Data came from the Growing Up in Ireland Infant Cohort Study (n = 11,134), which assessed children before (2008), during (2011), and after (2013) the Great Recession that followed the financial crisis of 2008 and incorporated questions on the impacts of the financial crisis on families. Using fixed-effects models to control for confounding, we found that a reduction in welfare benefits during the recession was associated with a significant increase in the risks of asthma (β = 0.014, 95% confidence interval (95% CI): 0.004, 0.023) and atopy (β = 0.014, 95% CI: 0.001, 0.027). While parental job loss was not associated with child health, a reduction in working hours was associated with increased reports of child health problems (β = 0.024, 95% CI: 0.004, 0.043), as were difficulties affording basic necessities (β = 0.019, 95% CI: 0.001, 0.038). Results suggest that failing to protect vulnerable families and children during economic recessions may have long-lasting implications for child health.
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Affiliation(s)
- Erica Reinhard
- Department of Global Health and Social Medicine, King’s College London, London, United Kingdom
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Richard Layte
- Department of Sociology, Trinity College Dublin, Dublin, Ireland
- Economic and Social Research Institute, Dublin, Ireland
| | - Cathal McCrory
- Economic and Social Research Institute, Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Lidia Panico
- National Institute of Demographic Studies, Paris, France
| | - Mauricio Avendano
- Department of Global Health and Social Medicine, King’s College London, London, United Kingdom
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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61
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Amemiya A, Fujiwara T. Association of Low Family Income With Lung Function Among Children and Adolescents: Results of the J-SHINE Study. J Epidemiol 2018; 29:50-56. [PMID: 29962491 PMCID: PMC6336726 DOI: 10.2188/jea.je20170220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background The respiratory tract of children in low-income families is more likely to be exposed to toxins, which may lead to poor lung function. The purpose of this study was to elucidate the impact of low household income on lung function among children and adolescents in Japan. Methods We analyzed a population-based sample of 1,224 children aged 5 to 17 years old from the Japanese Study on Stratification, Health, Income, and Neighborhood (J-SHINE). Forced expiratory volume in 1 s (FEV1) and in 6 s (FEV6) was measured. Annual household income and other potential covariates were assessed through a questionnaire. Low household income was defined as less than 3 million yen (approximately 27,000 United States dollars [USD]) per year. Multivariate regression analysis was used to adjust for potential covariates. Results We observed statistically significantly lower FEV1:FEV6 ratio with children in lowest-income families compared with those in highest-income families, after adjusting for child’s age and sex (coefficient = −0.082; 95% confidence interval [CI], −0.131 to −0.034). After adjusting for other covariates, including parental smoking status and parental diagnosis of asthma, a similar trend remained (coefficient = −0.054; 95% CI, −0.109 to 0.001). Conclusions Children in low-income families showed significantly lower lung function than those in high-income families. Prevention and early intervention are necessary to help the development of lung function among children living in low-income families.
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Affiliation(s)
- Airi Amemiya
- Department of Social Medicine, National Research Institute for Child Health and Development
| | - Takeo Fujiwara
- Department of Social Medicine, National Research Institute for Child Health and Development.,Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU)
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62
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Miyasaka T, Dobashi-Okuyama K, Takahashi T, Takayanagi M, Ohno I. The interplay between neuroendocrine activity and psychological stress-induced exacerbation of allergic asthma. Allergol Int 2018; 67:32-42. [PMID: 28539203 DOI: 10.1016/j.alit.2017.04.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/04/2017] [Accepted: 04/16/2017] [Indexed: 12/27/2022] Open
Abstract
Psychological stress is recognized as a key factor in the exacerbation of allergic asthma, whereby brain responses to stress act as immunomodulators for asthma. In particular, stress-induced enhanced type 2 T-helper (Th2)-type lung inflammation is strongly associated with asthma pathogenesis. Psychological stress leads to eosinophilic airway inflammation through activation of the hypothalamic-pituitary-adrenal pathway and autonomic nervous system. This is followed by the secretion of stress hormones into the blood, including glucocorticoids, epinephrine, and norepinephrine, which enhance Th2 and type 17 T-helper (Th17)-type asthma profiles in humans and rodents. Recent evidence has shown that a defect of the μ-opioid receptor in the brain along with a defect of the peripheral glucocorticoid receptor signaling completely disrupted stress-induced airway inflammation in mice. This suggests that the stress response facilitates events in the central nervous and endocrine systems, thus exacerbating asthma. In this review, we outline the recent findings on the interplay between stress and neuroendocrine activities followed by stress-induced enhanced Th2 and Th17 immune responses and attenuated regulatory T (Treg) cell responses that are closely linked with asthma exacerbation. We will place a special focus on our own data that has emphasized the continuity from central sensing of psychological stress to enhanced eosinophilic airway inflammation. The mechanism that modulates psychological stress-induced exacerbation of allergic asthma through neuroendocrine activities is thought to involve a series of consecutive pathological events from the brain to the lung, which implies there to be a "neuropsychiatry phenotype" in asthma.
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Affiliation(s)
- Tomomitsu Miyasaka
- Division of Pathophysiology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kaori Dobashi-Okuyama
- Division of Pathophysiology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tomoko Takahashi
- Division of Pathophysiology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Motoaki Takayanagi
- Division of Pathophysiology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Isao Ohno
- Center for Medical Education, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
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63
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Booster GD, Oland AA, Bender BG. Psychosocial Factors in Severe Pediatric Asthma. Immunol Allergy Clin North Am 2017; 36:449-60. [PMID: 27401618 DOI: 10.1016/j.iac.2016.03.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Asthma is the most common chronic illness among children in the United States and can impact nearly all aspects of functioning. Most research suggests that children with severe asthma display more emotional and behavioral problems than their healthy peers. These psychological difficulties are associated with increased risk for functional impairments and problematic disease course. Multidisciplinary teams that assess and treat these psychosocial factors using psychoeducational and behavioral interventions are important for children whose asthma is poorly controlled. Future research should examine the ways in which stress, emotions, and immune functions interact, so as to develop more preventative interventions.
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Affiliation(s)
- Genery D Booster
- Pediatric Behavioral Health, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
| | - Alyssa A Oland
- Pediatric Behavioral Health, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Bruce G Bender
- Pediatric Behavioral Health, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
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64
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Oudin A, Bråbäck L, Oudin Åström D, Forsberg B. Air Pollution and Dispensed Medications for Asthma, and Possible Effect Modifiers Related to Mental Health and Socio-Economy: A Longitudinal Cohort Study of Swedish Children and Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111392. [PMID: 29144419 PMCID: PMC5708031 DOI: 10.3390/ijerph14111392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 12/30/2022]
Abstract
It has been suggested that children that are exposed to a stressful environment at home have an increased susceptibility for air pollution-related asthma. The aim here was to investigate the association between air pollution exposure and asthma, and effect modification by mental health and by socio-economic status (as markers of a stressful environment). All individuals under 18 years of age in four Swedish counties during 2007 to 2010 (1.2 million people) were included. The outcome was defined as dispensing at least two asthma medications during follow up. We linked data on NO2 from an empirical land use regression to data from national registers on outcome and potential confounders. Data was analyzed with logistic regression. There was an odds ratio (OR) of 1.02 (95% Confidence Interval (CI: 1.01–1.03) for asthma associated with a 10 µg·m−3 increase in NO2. The association only seemed to be present in areas where NO2 was higher than 15 µg·m−3 with an OR of 1.09 (95% CI: 1.07–1.12), and the association seemed stronger in children with parents with a high education, OR = 1.05 (95% CI: 1.02–1.09) and OR = 1.04 (95% CI: 1.01–1.07) in children to mothers and father with a high education, respectively. The association did not seem to depend on medication history of psychiatric disorders. There was weak evidence for the association between air pollution and asthma to be stronger in neighborhoods with higher education levels. In conclusion, air pollution was associated with dispensed asthma medications, especially in areas with comparatively higher levels of air pollution, and in children to parents with high education. We did not observe support for our hypothesis that stressors linked to socio-economy or mental health problems would increase susceptibility to the effects of air pollution on the development of asthma.
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Affiliation(s)
- Anna Oudin
- Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden.
| | - Lennart Bråbäck
- Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden.
| | - Daniel Oudin Åström
- Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden.
| | - Bertil Forsberg
- Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden.
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Neuropsychiatry phenotype in asthma: Psychological stress-induced alterations of the neuroendocrine-immune system in allergic airway inflammation. Allergol Int 2017; 66S:S2-S8. [PMID: 28669635 DOI: 10.1016/j.alit.2017.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 05/11/2017] [Accepted: 05/14/2017] [Indexed: 01/11/2023] Open
Abstract
Since the recognition of asthma as a syndrome with complex pathophysiological signs and symptoms, recent research has sought to classify asthma phenotypes based on its clinical and molecular pathological features. Psychological stress was first recognized as a potential immune system modulator of asthma at the end of the 19th century. The activation of the central nervous system (CNS) upon exposure to psychological stress is integral for the initiation of signal transduction processes. The stress hormones, including glucocorticoids, epinephrine, and norepinephrine, which are secreted following CNS activation, are involved in the immunological alterations involved in psychological stress-induced asthma exacerbation. The mechanisms underlying this process may involve a pathological series of events from the brain to the lungs, which is attracting attention as a conceptually advanced phenotype in asthma pathogenesis. This review presents insights into the critical role of psychological stress in the development and exacerbation of allergic asthma, with a special focus on our own data that emphasizes on the continuity from the central sensing of psychological stress to enhanced eosinophilic airway inflammation.
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66
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Cillessen L, van de Ven MO, Karremans JC. The role of trait mindfulness in quality of life and asthma control among adolescents with asthma. J Psychosom Res 2017; 99:143-148. [PMID: 28712420 DOI: 10.1016/j.jpsychores.2017.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The current study focused on the role of trait mindfulness in asthma-related quality of life (QoL) and asthma control in adolescent asthma patients. Furthermore, potential underlying mechanisms (general and asthma-specific stress) of this relationship were investigated. METHODS In this cross-sectional study, questionnaire data of 94 adolescents with asthma that were prescribed daily asthma medication were included. Two Structural Equation Models (SEMs), a direct model and an indirect model, were tested. RESULTS We found that trait mindfulness was directly related to asthma-related QoL, but not to asthma control. The relationship between trait mindfulness and asthma-related QoL was explained by asthma-specific, but not by general stress. Furthermore, an indirect relation from mindfulness to asthma control via asthma-specific stress was found. CONCLUSIONS Cross-sectional evidence for a relation between mindfulness and asthma-related QoL is found. These findings may point to the possibility that an intervention aimed at increasing mindfulness could be a promising tool to improve asthma-related QoL in adolescents via a decrease in asthma-specific stress.
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Affiliation(s)
- Linda Cillessen
- Behavioral Science Institute, Radboud University Nijmegen, the Netherlands.
| | | | - Johan C Karremans
- Behavioral Science Institute, Radboud University Nijmegen, the Netherlands
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67
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Shepherd CCJ, Li J, Cooper MN, Hopkins KD, Farrant BM. The impact of racial discrimination on the health of Australian Indigenous children aged 5-10 years: analysis of national longitudinal data. Int J Equity Health 2017; 16:116. [PMID: 28673295 PMCID: PMC5496226 DOI: 10.1186/s12939-017-0612-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/21/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND A growing body of literature highlights that racial discrimination has negative impacts on child health, although most studies have been limited to an examination of direct forms of racism using cross-sectional data. We aim to provide further insights on the impact of early exposure to racism on child health using longitudinal data among Indigenous children in Australia and multiple indicators of racial discrimination. METHODS We used data on 1239 Indigenous children aged 5-10 years from Waves 1-6 (2008-2013) of Footprints in Time, a longitudinal study of Indigenous children across Australia. We examined associations between three dimensions of carer-reported racial discrimination (measuring the direct experiences of children and vicarious exposure by their primary carer and family) and a range of physical and mental health outcomes. Analysis was conducted using multivariate logistic regression within a multilevel framework. RESULTS Two-fifths (40%) of primary carers, 45% of families and 14% of Indigenous children aged 5-10 years were reported to have experienced racial discrimination at some point in time, with 28-40% of these experiencing it persistently (reported at multiple time points). Primary carer and child experiences of racial discrimination were each associated with poor child mental health status (high risk of clinically significant emotional or behavioural difficulties), sleep difficulties, obesity and asthma, but not with child general health or injury. Children exposed to persistent vicarious racial discrimination were more likely to have sleep difficulties and asthma in multivariate models than those with a time-limited exposure. CONCLUSIONS The findings indicate that direct and persistent vicarious racial discrimination are detrimental to the physical and mental health of Indigenous children in Australia, and suggest that prolonged and more frequent exposure to racial discrimination that starts in the early lifecourse can impact on multiple domains of health in later life. Tackling and reducing racism should be an integral part of policy and intervention aimed at improving the health of Australian Indigenous children and thereby reducing health disparities between Indigenous and non-Indigenous children.
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Affiliation(s)
- Carrington C J Shepherd
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, WA, 6872, Australia.
| | - Jianghong Li
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, WA, 6872, Australia.,WZB Berlin Social Science Center, Reichpietschufer 50, 10785, Berlin, Germany.,Centre for Population Health Research, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - Matthew N Cooper
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, WA, 6872, Australia
| | - Katrina D Hopkins
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, WA, 6872, Australia
| | - Brad M Farrant
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, WA, 6872, Australia
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68
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Kong L, Zhang H, Cao Y, Le J, Wu J, Liu B, Chen M, Du Y, Wang J, Wang G, Yi T, Zhou X, Wang G, Miao Q, Li S, Zhao N, Dong J. The Anti-Inflammatory Effects of Invigorating Kidney and Supplementing Qi Chinese Herbal Formulae in Asthma Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2017; 2017:3754145. [PMID: 28740537 PMCID: PMC5504930 DOI: 10.1155/2017/3754145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 03/27/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The theories of Shen-reinforcement and Qi-supplementation are important in asthma treatment based on traditional Chinese medicine theories. Early studies suggested that Invigorating Kidney and Supplementing Qi herbal formulae, Bu Shen Fang Chuan (BSFC) and Bu Shen Yi Qi (BSYQ), conveyed promising results in asthma treatment. However, the efficacy and safety of the formulae need to be further investigated by a randomized double-blind clinical trial. METHODS 328 eligible patients were randomly sent to BSFC, BSYQ, and placebo group. The two formulae were received as add-on therapy. The primary endpoints were rate of asthma exacerbation and Hamilton Rating Scale for Depression (HAM-D) score. The secondary endpoints included HPA axis function and inflammatory cytokine production profile. All indexes were measured before and after treatment. RESULTS The primary endpoints were not improved in both groups; however, the depression levels of subgroup patients with HAM-D score > 5 were improved in BSFC group. HPA axis functions and inflammatory cytokines level were also improved by two formulae. The incidences of adverse events were similar among groups. CONCLUSIONS The two formulae had multiple advantage effects on neuroendocrine-immune system. They are worth used as a replacement therapy in asthma. TRIAL REGISTRATION This trial is registered with clinical trial number ChiCTR-PRC-09000529.
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Affiliation(s)
- Lingwen Kong
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Hongying Zhang
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Yuxue Cao
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Jingjing Le
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Jinfeng Wu
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Baojun Liu
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Meixia Chen
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Yijie Du
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Jia Wang
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Genfa Wang
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Tao Yi
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Xianmei Zhou
- Pneumology Department, Jiangsu Provincial Hospital of TCM, Nanjing 210029, China
| | - Gang Wang
- Pneumology Department, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qing Miao
- Pneumology Department, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Suyun Li
- Pneumology Department, The First Affiliated Hospital of Henan University of TCM, Zhengzhou City, Henan Province 450008, China
| | - Naiqing Zhao
- Department of Statistics, Fudan University, Shanghai 200032, China
| | - Jingcheng Dong
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
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Bush A, Fleming L, Saglani S. Severe asthma in children. Respirology 2017; 22:886-897. [PMID: 28543931 DOI: 10.1111/resp.13085] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/21/2017] [Accepted: 04/21/2017] [Indexed: 12/16/2022]
Abstract
Most children with asthma have their disease easily controlled if low-dose inhaled corticosteroids (ICSs) are regularly and correctly administered. If a child presents with asthma which is apparently resistant to therapy with high-dose ICS and other controllers, then they have problematic severe asthma. However, in light of the UK National Review of Asthma Deaths, definitions of severe asthma based solely on the levels of prescribed treatment are too narrow. A detailed assessment of all such children should be performed. First, the diagnosis of asthma should be confirmed, then co-morbidities assessed. Next, a nurse-led assessment further characterizes the problem, conventionally categorizing the child as either having difficult asthma or severe therapy-resistant asthma. Here, we reassess in particular the interactions between, and management of, these two categories, highlighting that this dichotomous classification may need reconsideration. We use bronchoscopy and an intramuscular steroid injection to determine if the child has steroid-resistant asthma, using a novel, multidomain approach because the adult definition does not apply to around half the children we see. Finally, we highlight some mechanistic data which have emerged from this protocol such as the absence of T-helper 2 (TH2) cytokines even in eosinophilic severe asthma and the potential role of the innate epithelial cytokine IL-33, novel data on lineage negative innate lymphoid cells, which we can measure in induced sputum, and demonstrating that intraepithelial neutrophils are associated with better, not worse asthma outcomes. Severe paediatric asthma is very different from severe asthma in adults, and approaches must not be uncritically extrapolated from adult disease to children.
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Affiliation(s)
- Andrew Bush
- Paediatric Respiratory Medicine, National Heart and Lung Institute, Imperial College and Royal Brompton Harefield NHS Foundation Trust, London, UK
| | - Louise Fleming
- Paediatric Respiratory Medicine, National Heart and Lung Institute, Imperial College and Royal Brompton Harefield NHS Foundation Trust, London, UK
| | - Sejal Saglani
- Paediatric Respiratory Medicine, National Heart and Lung Institute, Imperial College and Royal Brompton Harefield NHS Foundation Trust, London, UK
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Edwards MR, Saglani S, Schwarze J, Skevaki C, Smith JA, Ainsworth B, Almond M, Andreakos E, Belvisi MG, Chung KF, Cookson W, Cullinan P, Hawrylowicz C, Lommatzsch M, Jackson D, Lutter R, Marsland B, Moffatt M, Thomas M, Virchow JC, Xanthou G, Edwards J, Walker S, Johnston SL. Addressing unmet needs in understanding asthma mechanisms: From the European Asthma Research and Innovation Partnership (EARIP) Work Package (WP)2 collaborators. Eur Respir J 2017; 49:49/5/1602448. [PMID: 28461300 DOI: 10.1183/13993003.02448-2016] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/13/2017] [Indexed: 12/27/2022]
Abstract
Asthma is a heterogeneous, complex disease with clinical phenotypes that incorporate persistent symptoms and acute exacerbations. It affects many millions of Europeans throughout their education and working lives and puts a heavy cost on European productivity. There is a wide spectrum of disease severity and control. Therapeutic advances have been slow despite greater understanding of basic mechanisms and the lack of satisfactory preventative and disease modifying management for asthma constitutes a significant unmet clinical need. Preventing, treating and ultimately curing asthma requires co-ordinated research and innovation across Europe. The European Asthma Research and Innovation Partnership (EARIP) is an FP7-funded programme which has taken a co-ordinated and integrated approach to analysing the future of asthma research and development. This report aims to identify the mechanistic areas in which investment is required to bring about significant improvements in asthma outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rene Lutter
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Benjamin Marsland
- University of Lausanne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | | | - Georgina Xanthou
- Biomedical Research Foundation, Academy of Athens, Athens, Greece
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Plourde A, Lavoie KL, Raddatz C, Bacon SL. Effects of acute psychological stress induced in laboratory on physiological responses in asthma populations: A systematic review. Respir Med 2017; 127:21-32. [PMID: 28502415 DOI: 10.1016/j.rmed.2017.03.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/21/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Psychological stress has long been suspected to have a deleterious effect on asthma, with acute psychological stress being associated with physiological responses in asthma patients. OBJECTIVES The purpose of this systematic review was to provide a narrative synthesis of the impact of acute laboratory psychological stress on physiological responses among asthma patients. METHODS An extensive search was conducted by two independent authors using Pubmed, PsycINFO, PsyArticles and the Cochrane Library electronic databases (up to September 2016). English and French articles which assessed physiological responses during or post-stress and compare them to baseline or pre-stress values were included. RESULTS Thirty-two studies met the inclusion criteria. Studies indicated that exposure to active stressors (e.g., arithmetic tasks) was associated with an increase in sympathetic nervous system (SNS) responses, cortisol, and inflammatory responses, but had little effect on the caliber of the bronchi. Exposure to passive stressors (e.g., watching stressful movies or pictures) was also associated with an increase in SNS responses and with mild bronchoconstriction. However, a paucity of data for passive stressors limited conclusions on other measures. CONCLUSIONS In patients with asthma, both active and passive stressors seem to be associated with an increased activation of the SNS. Passive stressors seem to have a more immediate, deleterious impact on the airways than active stressors, but the latter may be associated with delayed inflammatory driven an asthma exacerbation. Further studies are needed to understand the impact of acute stressors on the physiological mechanisms associated with asthma, particularly HPA and immune markers. Systematic review registration number: CRD42015026431.
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Affiliation(s)
- Annik Plourde
- Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Canada; Research Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Canada; Department of Psychology, Université du Québec à Montréal (UQAM), Canada
| | - Kim L Lavoie
- Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Canada; Research Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Canada; Department of Psychology, Université du Québec à Montréal (UQAM), Canada
| | - Candace Raddatz
- Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Canada; Research Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Canada; Department of Exercise Science, Concordia University, Montreal, Canada
| | - Simon L Bacon
- Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Canada; Research Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Canada; Department of Exercise Science, Concordia University, Montreal, Canada.
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72
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Oren E, Gerald L, Stern DA, Martinez FD, Wright AL. Self-Reported Stressful Life Events During Adolescence and Subsequent Asthma: A Longitudinal Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2017; 5:427-434.e2. [PMID: 27815066 PMCID: PMC5591640 DOI: 10.1016/j.jaip.2016.09.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/17/2016] [Accepted: 09/08/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although exposure to stressful life events in adolescence has been associated with poor health as measured by number of physicians' visits and symptom scores, little is known regarding stress in adolescence and either concurrent or subsequent asthma. OBJECTIVE The objective of this study was to explore whether life events in adolescence are associated with either concurrent or new active asthma. METHODS The Tucson Children's Respiratory Study, a prospective population-based birth cohort, surveyed participants at 10 ages between 6 and 29 years regarding respiratory health. Asthma was defined as a physician-diagnosis of asthma with symptoms during the previous year. At age 16, participants (n = 318) were queried regarding stressful life events using the 67-item Life Events Questionnaire for Adolescents (LEQA). LEQA scores were examined in relation to both concurrent and new active asthma. Estimates were obtained with logistic regression and mixed models. RESULTS There was no relation between asthma prevalence at age 16 and LEQA scores in the overall sample, although males with high LEQA scores had higher prevalence of asthma compared with males with low scores (relative risk [RR]: 3.03; 95% confidence interval [CI]: 1.37, 6.69; P = .006). Among adolescents with no asthma through age 16, risk of new asthma was greater for those with high LEQA scores (adjRR: 4.07; 95% CI: 1.33, 12.43; P = .014), after adjustment for potential confounders including smoking. Emotional support from family and friends slightly diminished the relation of stress to new asthma. CONCLUSIONS Stressful life events during adolescence are associated with subsequent new asthma. Additional biological and psychological measures of stress would complement these findings.
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Affiliation(s)
- Eyal Oren
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona Health Sciences Center, Tucson, Ariz; Asthma and Airway Disease Research Center, College of Medicine, University of Arizona Health Sciences Center, Tucson, Ariz.
| | - Lynn Gerald
- Asthma and Airway Disease Research Center, College of Medicine, University of Arizona Health Sciences Center, Tucson, Ariz; Health Promotion Sciences, College of Public Health, University of Arizona Health Sciences Center, Tucson, Ariz
| | - Debra A Stern
- Asthma and Airway Disease Research Center, College of Medicine, University of Arizona Health Sciences Center, Tucson, Ariz
| | - Fernando D Martinez
- Asthma and Airway Disease Research Center, College of Medicine, University of Arizona Health Sciences Center, Tucson, Ariz; Department of Pediatrics, College of Medicine, University of Arizona Health Sciences Center, Tucson, Ariz
| | - Anne L Wright
- Asthma and Airway Disease Research Center, College of Medicine, University of Arizona Health Sciences Center, Tucson, Ariz; Department of Pediatrics, College of Medicine, University of Arizona Health Sciences Center, Tucson, Ariz
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Low-Grade Inflammation and Ambulatory Cortisol in Adolescents: Interaction Between Interviewer-Rated Versus Self-Rated Acute Stress and Chronic Stress. Psychosom Med 2017; 79:133-142. [PMID: 27490853 PMCID: PMC5285458 DOI: 10.1097/psy.0000000000000377] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine whether the association between self-rated or interviewer-rated recent acute stress exposures and low-grade inflammation and daily cortisol production in adolescents is moderated by chronic stress ratings. METHODS Acute and chronic stress exposures were assessed in 261 adolescents aged 13 to 16 years using a semistructured life stress interview. The negative impact of acute stressors was independently rated by both adolescents (self-rated) and interviewers (interviewer-rated). Markers of inflammation (interleukin (IL)-6, IL-1ra, C-reactive protein) were measured from peripheral blood samples obtained via antecubital venipuncture. Participants collected 4 saliva samples at home on each of 6 consecutive days for the analysis of diurnal salivary cortisol profiles. RESULTS There were no main effects of acute stressors (self- and interviewer-rated) and chronic family or peer stress on adolescent inflammation markers and cortisol (p values > .10). However, the interaction between interviewer-rated acute stress and chronic family stress was significantly associated with adolescent inflammation markers (IL-6, IL-1ra). Specifically, as chronic family stress increased, the association between acute stressor impact (interviewer-rated) and inflammation markers became more positive (IL-6 (B = .054, SE = .023, p = .022); IL-1ra (B = .030, SE = .014, p = .034)). Interactions between self-rated acute stress and chronic family stress were not associated with any biological measures (p values > .10). Interactions between acute stressor impact (both self- and interviewer-rated) and chronic peer stress were also not significantly associated with any biological measures (p values > .05). CONCLUSIONS Among adolescents, interviewer-based ratings of acute stressor impact may allow for better prediction of health-relevant inflammation markers than adolescents' own ratings.
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Murray LA, Grainge C, Wark PA, Knight DA. Use of biologics to treat acute exacerbations and manage disease in asthma, COPD and IPF. Pharmacol Ther 2016; 169:1-12. [PMID: 27889330 DOI: 10.1016/j.pharmthera.2016.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A common feature of chronic respiratory disease is the progressive decline in lung function. The decline can be indolent, or it can be accelerated by acute exacerbations, whereby the patient experiences a pronounced worsening of disease symptoms. Moreover, acute exacerbations may also be a marker of insufficient disease management. The underlying cause of an acute exacerbation can be due to insults such as pathogens or environmental pollutants, or the cause can be unknown. For each acute exacerbation, the patient may require medical intervention such as rescue medication, or in more severe cases, hospitalization and ventilation and have an increased risk of death. Biologics, such as monoclonal antibodies, are being developed for chronic respiratory diseases including asthma, COPD and IPF. This therapeutic approach is particularly well suited for chronic use based on the route and frequency of delivery and importantly, the potential for disease modification. In recent clinical trials, the frequency of acute exacerbation has often been included as an endpoint, to help determine whether the investigational agent is impacting disease. Therefore the significance of acute exacerbations in driving disease, and their potential as a marker of disease activity and progression, has recently received much attention. There is also now a need to standardize the definition of an acute exacerbation in specific disease settings, particularly as this endpoint is increasingly used in clinical trials to also assess therapeutic efficacy. Moreover, specifically targeting exacerbations may offer a new therapeutic approach for several chronic respiratory diseases.
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Affiliation(s)
| | - Chris Grainge
- Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, Australia
| | - Peter A Wark
- Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, Australia
| | - Darryl A Knight
- Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, Australia; School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
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Zoratti EM, Krouse RZ, Babineau DC, Pongracic JA, O'Connor GT, Wood RA, Khurana Hershey GK, Kercsmar CM, Gruchalla RS, Kattan M, Teach SJ, Sigelman SM, Gergen PJ, Togias A, Visness CM, Busse WW, Liu AH. Asthma phenotypes in inner-city children. J Allergy Clin Immunol 2016; 138:1016-1029. [PMID: 27720016 PMCID: PMC5104222 DOI: 10.1016/j.jaci.2016.06.061] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/24/2016] [Accepted: 06/03/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Children with asthma in low-income urban areas have high morbidity. Phenotypic analysis in these children is lacking, but may identify characteristics to inform successful tailored management approaches. OBJECTIVE We sought to identify distinct asthma phenotypes among inner-city children receiving guidelines-based management. METHODS Nine inner-city asthma consortium centers enrolled 717 children aged 6 to 17 years. Data were collected at baseline and prospectively every 2 months for 1 year. Participants' asthma and rhinitis were optimally managed by study physicians on the basis of guidelines. Cluster analysis using 50 baseline and 12 longitudinal variables was performed in 616 participants completing 4 or more follow-up visits. RESULTS Five clusters (designated A through E) were distinguished by indicators of asthma and rhinitis severity, pulmonary physiology, allergy (sensitization and total serum IgE), and allergic inflammation. In comparison to other clusters, cluster A was distinguished by lower allergy/inflammation, minimally symptomatic asthma and rhinitis, and normal pulmonary physiology. Cluster B had highly symptomatic asthma despite high step-level treatment, lower allergy and inflammation, and mildly altered pulmonary physiology. Cluster C had minimally symptomatic asthma and rhinitis, intermediate allergy and inflammation, and mildly impaired pulmonary physiology. Clusters D and E exhibited progressively higher asthma and rhinitis symptoms and allergy/inflammation. Cluster E had the most symptomatic asthma while receiving high step-level treatment and had the highest total serum IgE level (median, 733 kU/L), blood eosinophil count (median, 400 cells/mm3), and allergen sensitizations (15 of 22 tested). CONCLUSIONS Allergy distinguishes asthma phenotypes in urban children. Severe asthma often coclusters with highly allergic children. However, a symptomatic phenotype with little allergy or allergic inflammation was identified.
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Affiliation(s)
- Edward M Zoratti
- Henry Ford Health System and Wayne State University School of Medicine, Detroit, Mich.
| | | | | | | | | | - Robert A Wood
- Johns Hopkins University School of Medicine, Baltimore, Md
| | | | | | | | - Meyer Kattan
- College of Physicians and Surgeons, Columbia University, New York, NY
| | - Stephen J Teach
- Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Steven M Sigelman
- National Institutes of Allergy and Infectious Diseases, Bethesda, Md
| | - Peter J Gergen
- National Institutes of Allergy and Infectious Diseases, Bethesda, Md
| | - Alkis Togias
- National Institutes of Allergy and Infectious Diseases, Bethesda, Md
| | | | - William W Busse
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Andrew H Liu
- National Jewish Health, Denver, Colo; Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
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76
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Liu AH, Babineau DC, Krouse RZ, Zoratti EM, Pongracic JA, O'Connor GT, Wood RA, Khurana Hershey GK, Kercsmar CM, Gruchalla RS, Kattan M, Teach SJ, Makhija M, Pillai D, Lamm CI, Gern JE, Sigelman SM, Gergen PJ, Togias A, Visness CM, Busse WW. Pathways through which asthma risk factors contribute to asthma severity in inner-city children. J Allergy Clin Immunol 2016; 138:1042-1050. [PMID: 27720018 PMCID: PMC5381517 DOI: 10.1016/j.jaci.2016.06.060] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/24/2016] [Accepted: 06/03/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Pathway analyses can be used to determine how host and environmental factors contribute to asthma severity. OBJECTIVE To investigate pathways explaining asthma severity in inner-city children. METHODS On the basis of medical evidence in the published literature, we developed a conceptual model to describe how 8 risk-factor domains (allergen sensitization, allergic inflammation, pulmonary physiology, stress, obesity, vitamin D, environmental tobacco smoke [ETS] exposure, and rhinitis severity) are linked to asthma severity. To estimate the relative magnitude and significance of hypothesized relationships among these domains and asthma severity, we applied a causal network analysis to test our model in an Inner-City Asthma Consortium study. Participants comprised 6- to 17-year-old children (n = 561) with asthma and rhinitis from 9 US inner cities who were evaluated every 2 months for 1 year. Asthma severity was measured by a longitudinal composite assessment of day and night symptoms, exacerbations, and controller usage. RESULTS Our conceptual model explained 53.4% of the variance in asthma severity. An allergy pathway (linking allergen sensitization, allergic inflammation, pulmonary physiology, and rhinitis severity domains to asthma severity) and the ETS exposure pathway (linking ETS exposure and pulmonary physiology domains to asthma severity) exerted significant effects on asthma severity. Among the domains, pulmonary physiology and rhinitis severity had the largest significant standardized total effects on asthma severity (-0.51 and 0.48, respectively), followed by ETS exposure (0.30) and allergic inflammation (0.22). Although vitamin D had modest but significant indirect effects on asthma severity, its total effect was insignificant (0.01). CONCLUSIONS The standardized effect sizes generated by a causal network analysis quantify the relative contributions of different domains and can be used to prioritize interventions to address asthma severity.
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Affiliation(s)
- Andrew H Liu
- National Jewish Health, Denver, Colo; Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
| | | | | | | | | | | | - Robert A Wood
- Johns Hopkins University School of Medicine, Baltimore, Md
| | | | | | | | - Meyer Kattan
- College of Physicians and Surgeons, Columbia University, New York, NY
| | - Stephen J Teach
- Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Melanie Makhija
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Dinesh Pillai
- Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Carin I Lamm
- College of Physicians and Surgeons, Columbia University, New York, NY
| | - James E Gern
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | | | - Peter J Gergen
- National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | | | - William W Busse
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
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Validation of the English Version of the Scale for Psychosocial Factors in Food Allergy and the Relationship with Mental Health, Quality of Life, and Self-Efficacy. J Allergy (Cairo) 2016; 2016:4850940. [PMID: 27688785 PMCID: PMC5027308 DOI: 10.1155/2016/4850940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/07/2016] [Indexed: 11/18/2022] Open
Abstract
Background. The Scale for Psychosocial Factors in Food Allergy (SPS-FA) is based on the biopsychosocial model of health and was developed and validated in Chile to measure the interaction between psychological variables and allergy symptoms in the child. We sought to validate this scale in an English speaking population and explore its relationship with parental quality of life, self-efficacy, and mental health. Methods. Parents (n = 434) from the general population in the UK, who had a child with a clinical diagnosis of food allergy, completed the SPS-FA and validated scales on food allergy specific parental quality of life (QoL), parental self-efficacy, and general mental health. Findings. The SPS-FA had good internal consistency (alphas = .61–.86). Higher scores on the SPS-FA significantly correlated with poorer parental QoL, self-efficacy, and mental health. All predictors explained 57% of the variance in SPS-FA scores with QoL as the biggest predictor (β = .52). Discussion. The SPS-FA is a valid scale for use in the UK and provides a holistic view of the impact of food allergy on the family. In conjunction with health-related QoL measures, it can be used by health care practitioners to target care for patients and evaluate psychological interventions for improvement of food allergy management.
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Miyasaka T, Okuyama-Dobashi K, Masuda C, Iwami S, Sato M, Mizoguchi H, Kawano T, Ohkawara Y, Sakurada S, Takayanagi M, Ohno I. The involvement of central nervous system histamine receptors in psychological stress-induced exacerbation of allergic airway inflammation in mice. Allergol Int 2016; 65 Suppl:S38-44. [PMID: 27523601 DOI: 10.1016/j.alit.2016.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/17/2016] [Accepted: 05/25/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Psychological stress is one of the major risk factors for asthma exacerbation. Although histamine in the brain acts as an excitatory and inhibitory neurotransmitter associated with psychological stress, the contribution of brain histamine to psychological stress-induced exacerbation of asthma remains unclear. The objective of this study was to investigate the role of histamine receptors in the CNS on stress induced asthma aggravation. METHODS We monitored the numbers of inflammatory cells and interleukin (IL)-13 levels in bronchoalveolar lavage fluid, airway responsiveness to inhaled methacholine, mucus secretion in airway epithelial cells, and antigen-specific IgE contents in sera in a murine model of stress-induced asthma treated with epinastine (an H1R antagonist), thioperamide (an H3/4R antagonist), or solvent. RESULTS All indicators of stress-induced asthma exacerbation were significantly reduced in stressed mice treated with epinastine compared with those treated with solvent, whereas treatment with thioperamide did not reduce the numbers of inflammatory cells in the stressed mice. CONCLUSIONS These results suggest that H1R, but not H3/4R, may be involved in stress-induced asthma exacerbations in the central nervous system.
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Affiliation(s)
- Tomomitsu Miyasaka
- Department of Pathophysiology, Tohoku Pharmaceutical University, Sendai, Japan.
| | | | - Chiaki Masuda
- Department of Pathophysiology, Tohoku Pharmaceutical University, Sendai, Japan
| | - Shunya Iwami
- Department of Pathophysiology, Tohoku Pharmaceutical University, Sendai, Japan
| | - Miki Sato
- Department of Pathophysiology, Tohoku Pharmaceutical University, Sendai, Japan
| | - Hirokazu Mizoguchi
- Department of Physiology and Anatomy, Tohoku Pharmaceutical University, Sendai, Japan
| | - Tasuku Kawano
- Department of Pathophysiology, Tohoku Pharmaceutical University, Sendai, Japan
| | - Yuichi Ohkawara
- Department of Pathophysiology, Tohoku Pharmaceutical University, Sendai, Japan
| | - Shinobu Sakurada
- Department of Physiology and Anatomy, Tohoku Pharmaceutical University, Sendai, Japan
| | - Motoaki Takayanagi
- Department of Pathophysiology, Tohoku Pharmaceutical University, Sendai, Japan
| | - Isao Ohno
- Department of Pathophysiology, Tohoku Pharmaceutical University, Sendai, Japan
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Beydon N, Cochez M, Mahut B, Tarbé de Saint Hardouin AL, Gajdos V, Régnard D, Soussan-Banini V, de Pontual L, Delclaux C. Avoidable Emergency Visits for Acute Asthma in Children: Prevalence and Risk Factors. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2016; 29:130-136. [DOI: 10.1089/ped.2016.0646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Nicole Beydon
- APHP, Unité Fonctionnelle de Physiologie-Explorations Fonctionnelles Respiratoires (EFR), Hôpital d'Enfants Armand-Trousseau, Paris, France
- INSERM U938 Centre de Recherche Saint Antoine, Paris, France
| | - Mélanie Cochez
- APHP, Hôpitaux Universitaires Paris Sud, Clamart, France
- Université Paris Sud, Le Kremlin Bicêtre, France
| | | | | | - Vincent Gajdos
- APHP, Hôpitaux Universitaires Paris Sud, Clamart, France
- Université Paris Sud, Le Kremlin Bicêtre, France
- INSERM, CESP Centre for Research in Epidemiology and Population Health, U1018, Le Kremlin Bicêtre, France
| | - Delphine Régnard
- APHP, Hôpitaux Universitaires Paris Sud, Service d'Accueil des Urgences Pédiatriques, Le Kremlin Bicêtre, France
| | | | - Loïc de Pontual
- APHP, Service de Pédiatrie–Hôpital Jean Verdier, Bondy, France
- Université Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - Christophe Delclaux
- APHP, Hôpital Robert Debré, Service de Physiologie Pédiatrique, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
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80
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Parenting Stress Related to Behavioral Problems and Disease Severity in Children with Problematic Severe Asthma. J Clin Psychol Med Settings 2016; 22:179-93. [PMID: 26054697 PMCID: PMC4575360 DOI: 10.1007/s10880-015-9423-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Our study examined parenting stress and its association with behavioral problems and disease severity in children with problematic severe asthma. Research participants were 93 children (mean age 13.4 ± 2.7 years) and their parents (86 mothers, 59 fathers). As compared to reference groups analyzed in previous research, scores on the Parenting Stress Index in mothers and fathers of the children with problematic severe asthma were low. Higher parenting stress was associated with higher levels of internalizing and externalizing behavioral problems in children (Child Behavior Checklist). Higher parenting stress in mothers was also associated with higher airway inflammation (FeNO). Thus, although parenting stress was suggested to be low in this group, higher parenting stress, especially in the mother, is associated with more airway inflammation and greater child behavioral problems. This indicates the importance of focusing care in this group on all possible sources of problems, i.e., disease exacerbations and behavioral problems in the child as well as parenting stress.
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81
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Feitosa CA, Santos DN, Barreto ML, Rodrigues LC. The effect of internalization and other psychologic factors on the remission and severity of wheeze in children. Pediatr Allergy Immunol 2016; 27:398-403. [PMID: 26843104 DOI: 10.1111/pai.12545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Asthma prevalence in Latin America is high and continues to increase. There is evidence that the psychologic characteristics of the child are associated with greater asthma morbidity. This study aimed to investigate the independent effect of internalizing/externalizing problems on two asthma/wheeze outcomes: (i) remission and (ii) progression to severity on Latin American children with mild asthma symptoms at baseline. METHODS This was a prospective study in a cohort of 371 asthmatic children living in a poor urban area in Salvador, Brazil. The psychologic characteristics of the child were assessed using the Child Behavior Checklist (CBCL), and wheezing was defined using the ISAAC questionnaire at the start and end of follow-up. A multiple logistic regression model with random effects was used to examine the association between the psychologic components and both outcomes. RESULTS Remission of symptoms of wheeze was observed among 229 (61.73%) children. Remission was 56% lower among children with internalizing problems (OR = 0.54, 95% CI 0.33-0.87, p = 0.01). In addition, we found that 19 (8.76%) of the children acquired severe symptoms during follow-up and there was strong evidence of the effect of internalizing problems in increasing the risk of progression to severe wheeze symptoms (OR = 4.03, 95% CI 1.39-11.70, p = 0.01). CONCLUSIONS Children with internalizing problems but not externalizing had less remission of wheezing, and a higher risk of acquiring severe symptoms. These results highlight the importance of psychologic care for children with asthma, to improve the prognosis of this condition.
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Affiliation(s)
- Caroline A Feitosa
- Institute of Collective Health, Federal University of Bahia - ISC/UFBA, Salvador, Brazil
| | - Darci N Santos
- Institute of Collective Health, Federal University of Bahia - ISC/UFBA, Salvador, Brazil
| | - Maurício L Barreto
- Institute of Collective Health, Federal University of Bahia - ISC/UFBA, Salvador, Brazil
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82
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Lu Y, Ho RCM. An association between neuropeptide Y levels and leukocyte subsets in stress-exacerbated asthmatic mice. Neuropeptides 2016; 57:53-8. [PMID: 26673939 DOI: 10.1016/j.npep.2015.11.091] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/22/2015] [Accepted: 11/22/2015] [Indexed: 02/07/2023]
Abstract
Neuropeptide Y (NPY) was recently proposed to be associated with stress and airway inflammation; however, this has rarely been studied in animal models of asthma. Twenty-four C57BL/6 mice were randomly divided into 3 groups of 8 each: naive control group, asthma group (with an established asthma model), and stressed asthma group (with established asthma and stress models). Bronchoalveolar lavage (BAL) fluid was collected for total cell counts using a hemocytometer and for cytological examinations by Wright stain. Differential inflammatory cell counts were performed to identify eosinophils, macrophages, neutrophils, and lymphocytes. NPY and corticosterone serum levels were determined with enzyme immunoassay kits. Stress was associated with increased airway inflammatory response, which was manifested by the accumulation of total leukocytes and eosinophils in the BAL fluid in comparison with the asthma and the control groups. The levels of NPY (p<0.05) and corticosterone (p<0.01) were elevated in the stressed asthma group in comparison with the control and asthma groups. The concentration of NPY and corticosterone positively correlated with the total leukocyte count (r=0.892, p<0.05 and r=0.937, p<0.01 respectively) and eosinophil numbers (r=0.806, p=0.053 and r=0.885, p<0.01 respectively). Stress may be associated with elevated peripheral NPY level, which was observed to be associated with exacerbated airway inflammation in asthmatic mice.
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Affiliation(s)
- Yanxia Lu
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Roger Chun-Man Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore.
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83
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Horner CC, Dula C, Bacharier LB, Garbutt JM, Gonzalez C, Deych E, Shannon WD, Strunk RC. Daily global stress is associated with nocturnal asthma awakenings in school-age children. J Allergy Clin Immunol 2016; 138:1196-1199.e3. [PMID: 27246525 DOI: 10.1016/j.jaci.2016.01.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 01/14/2016] [Accepted: 01/29/2016] [Indexed: 01/26/2023]
Affiliation(s)
- Caroline C Horner
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo.
| | - Courtney Dula
- Department of Neurology, Washington University School of Medicine, St Louis, Mo
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Jane M Garbutt
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo; Department of Medicine, Washington University School of Medicine, St Louis, Mo
| | - Carlos Gonzalez
- Department of Medicine, Washington University School of Medicine, St Louis, Mo
| | - Elena Deych
- Department of Medicine, Washington University School of Medicine, St Louis, Mo
| | - William D Shannon
- Department of Medicine, Washington University School of Medicine, St Louis, Mo
| | - Robert C Strunk
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
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84
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Trueba AF, Ritz T, Trueba G. The Role of the Microbiome in the Relationship of Asthma and Affective Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 874:263-88. [PMID: 26589224 DOI: 10.1007/978-3-319-20215-0_13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The effect of stress, anxiety and other affective states on inflammatory conditions such as asthma is well documented. Although several immune pathway mechanisms have been proposed and studied, they cannot fully explain the relationship. In this chapter we present a new perspective on asthma development and exacerbation that integrates findings on the role of psychological factors in asthma with the microbiome and the hygiene hypothesis in asthma development.
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Affiliation(s)
- Ana F Trueba
- Universidad San Francisco de Quito, Quito, Ecuador.
| | - Thomas Ritz
- Southern Methodist University, Dallas, TX, USA.
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85
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Tsuji M, Koriyama C, Yamamoto M, Anan A, Shibata E, Kawamoto T. The association between maternal psychological stress and inflammatory cytokines in allergic young children. PeerJ 2016; 4:e1585. [PMID: 26819847 PMCID: PMC4727978 DOI: 10.7717/peerj.1585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/18/2015] [Indexed: 11/30/2022] Open
Abstract
Background. Previous studies have shown that psychological stress is linked to asthma prevalence. Parental psychological stress may potentially influence inflammatory responses in their allergic children. The purpose of this study is to clarify the association between maternal psychological status and inflammatory response of allergic young children. Methods. The study subjects were 152 young allergic children (median age: 13 months) who had not shown any allergic symptoms in the past one month. mRNA expression levels of the inflammatory response genes IL-6, IL-8, IL-10 and IL-22 were quantified by qRT-PCR. Maternal psychological status was assessed by standardized questionnaires: the Centre for Epidemiological Studies Depression Scale (CES-D) for depression and the Japanese Perceived Stress Scale (JPSS) for perceived stress. Results. A significant positive association was observed between maternal CES-D scores and IL-6 mRNA expression in the children with asthma. The JPSS scores were also positively associated with IL-8 mRNA expression in asthmatic children and IL-6 mRNA expression in children with allergic rhinitis. Similar trends were observed among children positive for house dust mite-specific IgE, but these associations were not significant. Conclusion. This study supports the hypothesis that maternal psychological stress affects the inflammatory response in their allergic children.
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Affiliation(s)
- Mayumi Tsuji
- Department of Environmental Health, University of Occupational and Environmental Health, Kitakyusyu, Japan; Department of Environmental Toxicology, University of California, Davis, United States
| | - Chihaya Koriyama
- Department of Epidemiology and Preventive Medicine, Kagoshima University , Kagoshima , Japan
| | - Megumi Yamamoto
- Integrated Physiology Section, Department of Basic Medical Science, National Institute for Minamata Disease , Minamata , Japan
| | - Ayumi Anan
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health , Kitakyusyu , Japan
| | - Eiji Shibata
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health , Kitakyusyu , Japan
| | - Toshihiro Kawamoto
- Department of Environmental Health, University of Occupational and Environmental Health , Kitakyusyu , Japan
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87
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Ronaldson A, Gazali AM, Zalli A, Kaiser F, Thompson SJ, Henderson B, Steptoe A, Carvalho L. Increased percentages of regulatory T cells are associated with inflammatory and neuroendocrine responses to acute psychological stress and poorer health status in older men and women. Psychopharmacology (Berl) 2016; 233:1661-8. [PMID: 25678193 PMCID: PMC4828497 DOI: 10.1007/s00213-015-3876-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/21/2015] [Indexed: 01/05/2023]
Abstract
RATIONALE The percentage of regulatory T cells (TRegs)-a subtype of T lymphocyte that suppresses the immune response-appears to be reduced in a number of stress-related diseases. The role of the TReg in stress-disease pathways has not yet been investigated. OBJECTIVES The aim of the study was to investigate the association between biological responsivity to acute psychosocial stress and the percentage of TRegs in healthy older adults. The secondary purpose was to measure the associations between TReg percentage and psychological and physical well-being in the participants. METHODS Salivary cortisol and plasma interleukin (IL)-6 samples were obtained from 121 healthy older men and women from the Whitehall II cohort following acute psychophysiological stress testing. Three years later at a follow-up visit, we measured TReg percentages and psychological and physical well-being were recorded using the Short Form 36 Health Survey and the Center for Epidemiologic Studies Depression Scale. RESULTS Blunted cortisol responses (p = 0.004) and elevated IL-6 responses (p = 0.027) to acute psychophysiological stress were associated with greater TReg percentage independently of age, sex, BMI, smoking status, employment grade, time of testing, and baseline measures of cortisol and IL-6, respectively. Percentage of TRegs was associated cross-sectionally with lower physical (p = 0.043) and mental health status (p = 0.008), and higher levels of depressive symptoms (p = 0.002), independently of covariates. CONCLUSIONS Increased levels of TRegs may act as a defence against increased inflammation and may be a pre-indication for chronically stressed individuals on the cusp of clinical illness.
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Affiliation(s)
- Amy Ronaldson
- Department of Epidemiology and Public Health, University College London, 1-19, Torrington Place, London, WC1E 6BT, UK.
| | - Ahmad M. Gazali
- Department of Academic Rheumatology, Division of Immunology, Infection and Inflammatory Disease, School of Medicine, Kings College London, Guy’s Campus, London, SE1 1UL UK
| | - Argita Zalli
- Department of Epidemiology and Public Health, University College London, 1-19, Torrington Place, London, WC1E 6BT UK
| | - Frank Kaiser
- Department of Microbial Diseases, UCL-Eastman Dental Institute, London, WC1X 8LD UK
| | - Stephen J. Thompson
- Department of Academic Rheumatology, Division of Immunology, Infection and Inflammatory Disease, School of Medicine, Kings College London, Guy’s Campus, London, SE1 1UL UK
| | - Brian Henderson
- Department of Microbial Diseases, UCL-Eastman Dental Institute, London, WC1X 8LD UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, 1-19, Torrington Place, London, WC1E 6BT UK
| | - Livia Carvalho
- Department of Epidemiology and Public Health, University College London, 1-19, Torrington Place, London, WC1E 6BT UK
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Bonfim CB, dos Santos DN, Barreto ML. The association of intrafamilial violence against children with symptoms of atopic and non-atopic asthma: A cross-sectional study in Salvador, Brazil. CHILD ABUSE & NEGLECT 2015; 50:244-253. [PMID: 26149733 PMCID: PMC4685965 DOI: 10.1016/j.chiabu.2015.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/17/2015] [Accepted: 05/27/2015] [Indexed: 06/04/2023]
Abstract
This study aims to describe the types of intrafamilial violence perpetrated against children according to living conditions, family factors, and child characteristics, and to identify the association between types of intrafamilial violence and asthma symptoms in atopic and non-atopic children. A cross-sectional study was carried out with 1,370 caregivers as part of the Social Changes, Asthma and Allergy in Latin America (SCAALA) study, conducted in 2006 in Brazil. The study population was selected by random sampling. The main outcome measures were atopic and non-atopic asthma. We investigate the association between intrafamilial violence and asthma symptoms in atopic and non-atopic children. A backward multivariate logistic polytomous regression was performed to verify the main association. Nonviolent discipline (NVD) and maltreatment nonviolent discipline (MNVD) were positively associated with non-atopic asthma symptoms (NVD: odds ratio (OR)=1.95/95% confidence interval (CI)=1.17-3.25; MNVD: OR=1.95/95% CI=1.19-3.20). However, for the most severe intrafamilial violence, this association was not found after control of potential confounders. This study demonstrates the effect of types of intrafamilial violence on non-atopic asthma. Intrafamilial violence against children represents one more component in the determination of non-atopic asthma in Latin America.
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Bair-Merritt MH, Voegtline K, Ghazarian SR, Granger DA, Blair C, Johnson SB. Maternal intimate partner violence exposure, child cortisol reactivity and child asthma. CHILD ABUSE & NEGLECT 2015; 48:50-7. [PMID: 25435104 PMCID: PMC4446253 DOI: 10.1016/j.chiabu.2014.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 10/31/2014] [Accepted: 11/04/2014] [Indexed: 05/11/2023]
Abstract
Psychosocial stressors like intimate partner violence (IPV) exposure are associated with increased risk of childhood asthma. Longitudinal studies have not investigated the role of hypothalamic-pituitary-adrenal (HPA) axis reactivity (and associated alterations in cortisol release) in the child IPV exposure-asthma association. We sought to investigate this association, and to assess whether this relationship differs by child HPA reactivity. This secondary analysis used longitudinal cohort data from the Family Life Project. Participants included 1,292 low-income children and mothers; maternal interview and child biomarker data, including maternal report of IPV and child asthma, and child salivary cortisol obtained with validated stress reactivity paradigms, were collected when the child was 7, 15, 24, 35, and 48 months. Using structural equation modeling, maternal IPV when the child was 7 months of age predicted subsequent reports of childhood asthma (B=0.18, p=.002). This association differed according to the child's HPA reactivity status, with IPV exposed children who were HPA reactors at 7 and 15 months of age--defined as a ≥10% increase in cortisol level twenty minutes post peak arousal during the challenge tasks and a raw increase of at least .02μg/dl--being significantly at risk for asthma (7 months: B=0.17, p=.02; 15 months: B=0.17, p=.02). Our findings provide support that children who are physiologically reactive are the most vulnerable to adverse health outcomes when faced with environmental stressors.
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Affiliation(s)
- Megan H Bair-Merritt
- Division of General Pediatrics, Boston Medical Center, 88 East Newton Street, Vose 305, Boston, MA 02118, USA
| | - Kristin Voegtline
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Sharon R Ghazarian
- Johns Hopkins School of Medicine, 200 North Wolfe Street, Division of General Pediatrics, Baltimore, MD 21287, USA
| | - Douglas A Granger
- Institute for Interdisciplinary Salivary Bioscience Research, Arizona State University, 550 East Orange Street, Tempe, AZ 85287, USA; School of Nursing, Johns Hopkins, 525 North Wolfe Street, Baltimore, MD 21205, USA; Department of Applied Psychology, New York University, 246 Greene Street, New York, NY 10003, USA
| | - Clancy Blair
- Division of General Pediatrics, Boston Medical Center, 88 East Newton Street, Vose 305, Boston, MA 02118, USA; Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA; Johns Hopkins School of Medicine, 200 North Wolfe Street, Division of General Pediatrics, Baltimore, MD 21287, USA; Institute for Interdisciplinary Salivary Bioscience Research, Arizona State University, 550 East Orange Street, Tempe, AZ 85287, USA; School of Nursing, Johns Hopkins, 525 North Wolfe Street, Baltimore, MD 21205, USA; Department of Applied Psychology, New York University, 246 Greene Street, New York, NY 10003, USA
| | - Sara B Johnson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA; Johns Hopkins School of Medicine, 200 North Wolfe Street, Division of General Pediatrics, Baltimore, MD 21287, USA
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90
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Liao Z, Xiao HT, Zhang Y, Tong RS, Zhang LJ, Bian Y, He X. IL-1β: a key modulator in asthmatic airway smooth muscle hyper-reactivity. Expert Rev Respir Med 2015; 9:429-36. [PMID: 26134749 DOI: 10.1586/17476348.2015.1063422] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Asthma is a chronic inflammatory disorder of the airway. It is characterized by airway hyper-reactivity, which can be attributed to the chronically inflamed airway. However, the molecular mechanism is still under investigation. In this article, we have shown that IL-1β is a key molecule that can orchestrate both Toll-like receptor and muscarinic receptor pathways, and that antagonizing the function of IL-1β has a promising future as a potential drug target for asthma treatment. IL-1β can activate NF-κB pathways via Toll-like receptors, and NF-κB will eventually transactivate the genes of cytokines, chemokines, proteins of the complement system, adhesion molecules and immune receptors involved in inflammation. IL-1β can activate eosinophils, which can release major basic protein (MBP) to antagonize the M2 receptors leading to excessive acetylcholine release. Acetylcholine has an effect on M3 receptors, which are related to airway smooth muscle contraction and mucus production. IL-1β is reported to activate COX-2 resulting in heterologous desensitization of adenylate cyclase and impairs relaxation of the ASM. IL-1β is involved in mediation of neutrophilic inflammation. Identification of the prominent role of IL-1β in asthma could lead to successful use of anti-IL1β agents.
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Affiliation(s)
- Zhi Liao
- Department of Gynecology and Obstetrics, Hospital of the University of Electronic Science and Technology of China and Sichuan Provincial People's Hospital, Chengdu, China
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91
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Blakey JD, Zaidi S, Shaw DE. Defining and managing risk in asthma. Clin Exp Allergy 2015; 44:1023-32. [PMID: 24773229 DOI: 10.1111/cea.12334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Asthma attacks are a major global source of morbidity and cost. The incidence and impact of asthma attacks have not improved despite widespread adoption of effective universal treatment guidelines. Consequently, there is increasing interest in managing asthma based on specific assessments of both current symptoms and future risk. In this review, we consider 'risk' in asthma, and how it might be assessed from the patient's history and objective measurements. We also discuss the potential for encouraging shared decision-making and improving medical consensus through explicit communication of risk and highlight the potential opportunities and challenges in risk assessment to improve asthma management through individualised treatment strategies.
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Affiliation(s)
- J D Blakey
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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92
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Samaha HMS, Elsaid AR, Sabri Y. Depression, anxiety, distress and somatization in asthmatic patients. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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93
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Wing R, Gjelsvik A, Nocera M, McQuaid EL. Association between adverse childhood experiences in the home and pediatric asthma. Ann Allergy Asthma Immunol 2015; 114:379-84. [PMID: 25843164 DOI: 10.1016/j.anai.2015.02.019] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/15/2015] [Accepted: 02/25/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Numerous studies suggest that psychosocial factors could contribute to pediatric asthma. OBJECTIVE To examine the relation between single and cumulative adverse childhood experiences (ACEs), a measurement of household dysfunction, on parent report of lifetime asthma in children. METHODS This cross-sectional study used data from the 2011 to 2012 National Survey of Children's Health, a nationally representative sample of children 0 to 17 years old (n = 92,472). The main exposure was parent or guardian report of 6 ACE exposures (eg, witnessing domestic violence). The relation between ACE exposures and parent-reported diagnosis of childhood asthma was examined using multivariable logistic regression after controlling for demographic, socioeconomic, and behavioral covariates. RESULTS Overall asthma prevalence was 14.6%. Exposure prevalence to any ACE was 29.2%. Increased number of ACE exposures was associated with increased odds of asthma. In the adjusted model, the odds of reporting asthma were 1.28 (95% confidence interval [CI] 1.14-1.43) for those reporting 1 ACE, 1.73 (95% CI 1.27-2.36) for those with 4 ACEs, and 1.61 (95% CI 1.15-2.26) for those with 5 or 6 ACEs compared with those with no ACE exposures. Effects were moderated by Hispanic ethnicity. Hispanic children exposed to 4 ACEs had a 4.46 times increase in lifetime asthma (95% CI 2.46-8.08); white children had a 1.19 times increase (95% CI 0.80-1.79) compared with those exposed to 0 ACE. CONCLUSION This study supports the growing evidence for the biopsychosocial model of asthma onset. Future studies should examine the association between ACEs and specific asthma-related health outcomes.
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Affiliation(s)
- Robyn Wing
- Departments of Emergency Medicine and Pediatrics, Section of Pediatric Emergency Medicine, Brown University/Hasbro Children's Hospital, Providence, Rhode Island; Warren Alpert Medical School of Brown University/Hasbro Children's Hospital, Providence, Rhode Island; School of Public Health, Brown University, Providence, Rhode Island.
| | - Annie Gjelsvik
- School of Public Health, Brown University, Providence, Rhode Island
| | - Mariann Nocera
- Departments of Emergency Medicine and Pediatrics, Section of Pediatric Emergency Medicine, Brown University/Hasbro Children's Hospital, Providence, Rhode Island; Warren Alpert Medical School of Brown University/Hasbro Children's Hospital, Providence, Rhode Island
| | - Elizabeth L McQuaid
- Warren Alpert Medical School of Brown University/Hasbro Children's Hospital, Providence, Rhode Island; Bradley/Hasbro Children's Research Center and Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
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94
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Yoshihara K. Psychosomatic treatment for allergic diseases. Biopsychosoc Med 2015; 9:8. [PMID: 25844089 PMCID: PMC4384507 DOI: 10.1186/s13030-015-0036-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 02/26/2015] [Indexed: 11/10/2022] Open
Abstract
Many reports have been published concerning how psychosocial stress influences the occurrence and progression of allergic diseases such as bronchial asthma and atopic dermatitis. As for asthma, a typical allergic disease often accompanied by psychosomatic related problems, the Global Initiative for Asthma (GINA), international medical guidelines for asthma, describes psychosocial problems as causative factors of poor asthma control and as risk factors for asthma exacerbation, even if symptoms are well controlled. However, because there is little high quality evidence for effective treatments for asthma patients with psychosocial problems, concrete assessments and treatments for such problems is scarcely described in GINA. Therefore, psychosomatic intervention for asthma patients is not effectively conducted on a worldwide scale. In contrast, the “Japanese Guidelines for the Diagnosis and Treatment of Psychosomatic Diseases” describe the assessment and treatment of psychosomatic disorders in detail. In the guidelines, psychosocial factors are classified into five categories; 1) Relation between stress and asthma occurrence or progression, 2) Relation between emotion and asthma symptoms, 3) Problems related to a patient’s character and behaviors, 4) Problems of daily life and Quality of Life (QOL), and 5) Problems related to family relationships and life history. The employment of a self-administered questionnaire, the “Psychosomatic Questionnaire related to Asthmatic Occurrence and Progression”, is useful for clarifying psychosocial factors and for setting up treatment strategies according to the problems identified. The Japanese guidelines have been proven to be useful, but empirical evidence for their effectiveness is still relatively limited. It will be necessary in the future to accumulate high-quality evidence and to revise the psychosomatic approaches in the guidelines that are universally valid.
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Affiliation(s)
- Kazufumi Yoshihara
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582 Japan
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95
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Amato JN, Tuon RA, Castelo PM, Gavião MBD, Barbosa TDS. Assessment of sleep bruxism, orthodontic treatment need, orofacial dysfunctions and salivary biomarkers in asthmatic children. Arch Oral Biol 2015; 60:698-705. [PMID: 25757147 DOI: 10.1016/j.archoralbio.2015.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 11/25/2014] [Accepted: 02/13/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the sleep bruxism, malocclusions, orofacial dysfunctions and salivary levels of cortisol and alpha-amylase in asthmatic children. DESIGN 108 7-9-yr-old children were selected from Policlinic Santa Teresinha Doutor Antonio Haddad Dib (asthmatics, n=53) and from public schools (controls, n=55), Piracicaba, SP, Brazil. Sleep bruxism diagnosis was confirmed by parental report of grinding sounds and the presence of shiny and polish facets on incisors and/or first permanent molars. The index of orthodontic treatment need was used for occlusion evaluation. Orofacial dysfunctions were evaluated using the nordic orofacial test-screening (NOT-S). Salivary cortisol and alpha-amylase were expressed as "awakening response" (AR), calculated as the difference between levels immediately after awakening and 30 min after waking, and "diurnal decline" (DD), calculated as the difference between levels at 30 min after waking and at bedtime. Data were analyzed using Shapiro-Wilk/Kolmogorov-Smirnov, Chi-square, unpaired t test/Mann-Whitney and paired t/Wilcoxon tests. RESULTS Sleep bruxism was more prevalent in children with asthma than controls (47.2% vs. 27.3%, p<0.05). Asthmatics had higher scores of NOT-S total and interview (p<0.05). Dysfunctions on sensory function and chewing and swallowing were more frequent in asthmatics (p<0.05). Salivary cortisol AR on weekend was significantly higher for asthmatics (p<0.05). Salivary cortisol DD was significantly higher on weekday than weekend for controls (p<0.05). There were no significant differences in alpha-amylase values in and between groups. CONCLUSIONS The presence of asthma in children was associated with sleep bruxism, negative perception of sensory, chewing and swallowing functions, and higher concentrations of salivary cortisol on weekend.
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Affiliation(s)
| | - Rogério Antônio Tuon
- Piracicaba Dental School - State University of Campinas, São Paulo, Brazil; Municipal Government of Piracicaba, São Paulo, Brazil
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96
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Senra MS, Wollenberg A. Psychodermatological aspects of atopic dermatitis. Br J Dermatol 2015; 170 Suppl 1:38-43. [PMID: 24930567 DOI: 10.1111/bjd.13084] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2014] [Indexed: 11/30/2022]
Abstract
Psychodermatology is an evolving area of science that focuses on the interaction between the mind, skin and body. It is known that various neuroendocrine mediators - including adrenocorticotropin, β-endorphin, catecholamines and cortisol - are produced in response to stress. The resulting increase in endogenous glucocorticoids can disrupt the skin's barrier function, leaving it vulnerable to inflammatory disorders like atopic dermatitis (AD). In turn, AD is associated with high levels of stigmatization, social withdrawal, anxiety and depression among patients and their carers. It is well known that the stress caused by AD can make the symptoms of the disease worse. Therefore, the goal of psychodermatological treatment is not only to improve the condition of the skin, but also to teach patients/carers how to cope with the disease. This requires a multifaceted approach, and time and patience, to ascertain the needs of individual patients. A multidisciplinary team that includes a dermatologist, psychiatrist and psychologist will be necessary to deliver high-quality, tailored care to patients.
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Affiliation(s)
- M S Senra
- Department of Dermatology, Ipanema Hospital, Rio de Janeiro, Brazil
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97
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Wilson C, Rapp KI, Jack L, Hayes S, Post R, Malveaux F. Asthma Risk Profiles of Children Participating in an Asthma Education and Management Program. AMERICAN JOURNAL OF HEALTH EDUCATION 2015. [DOI: 10.1080/19325037.2014.977412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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98
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Kopel LS, Gaffin JM, Ozonoff A, Rao DR, Sheehan WJ, Friedlander JL, Permaul P, Baxi SN, Fu C, Subramanian SV, Gold DR, Phipatanakul W. Perceived neighborhood safety and asthma morbidity in the school inner-city asthma study. Pediatr Pulmonol 2015; 50:17-24. [PMID: 24421055 PMCID: PMC4096619 DOI: 10.1002/ppul.22986] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 12/11/2013] [Indexed: 11/09/2022]
Abstract
AIM The aim of this study was to investigate whether neighborhood safety as perceived by primary caregivers is associated with asthma morbidity outcomes among inner-city school children with asthma. METHODS School children with asthma were recruited from 25 inner-city schools between 2009 and 2012 for the School Inner-City Asthma Study (N = 219). Primary caregivers completed a baseline questionnaire detailing their perception of neighborhood safety and their children's asthma symptoms, and the children performed baseline pulmonary function tests. In this cross-sectional analysis, asthma control was compared between children whose caregivers perceived their neighborhood to be unsafe versus safe. RESULTS After adjusting for potential confounders, those children whose primary caregivers perceived the neighborhood to be unsafe had twice the odds of having poorly controlled asthma (odds ratio [OR] adjusted = 2.2, 95% confidence interval [CI] = 1.2-3.9, P = 0.009), four times the odds of dyspnea and rescue medication use (OR adjusted = 4.7; 95% CI = 1.7-13.0, P = 0.003, OR adjusted = 4.0; 95% CI = 1.8-8.8, P < 0.001, respectively), three times as much limitation in activity (OR adjusted = 3.2; 95% CI = 1.4-7.7, P = 0.008), and more than twice the odds of night-time symptoms (OR adjusted = 2.2; 95% CI = 1.3-4.0, P = 0.007) compared to participants living in safe neighborhoods. There was no difference in pulmonary function test results between the two groups. CONCLUSIONS Primary caregivers' perception of neighborhood safety is associated with childhood asthma morbidity among inner-city school children with asthma. Further study is needed to elucidate mechanisms behind this association, and future intervention studies to address social disadvantage may be important.
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Affiliation(s)
- Lianne S Kopel
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts
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99
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Abstract
Objective: To evaluate the olfactory and psychophysical performances in a 13-year-old boy with intellectual disability and severe hypoplasia of the corpus callosum and of the olfactory bulbs, compared to controls.Methods: The Sniffin’ Sticks Identification Test was administered to the patient and to a patient control child with cognitive delay, with the same mental (5 years) and chronological age, but normal brain magnetic resonance image. Two typically developing control participants, aged 13 and 5, were also evaluated. Psychophysical tests were performed during the olfactory assessment by smart portable sensors.Results: A significant decrease in olfactory function and a different psychophysical response to stimuli were observed in the patient compared to control participants, suggesting absence of ‘odorous stress’. A higher olfactory score but a similar psychophysical trend was found in the patient control with cognitive delay, while the two other control participants showed a selective increase of the anxiety state depending on the odour presented.Conclusions: Olfactory dysfunction is reported in children with neurodevelopmental disabilities. Low-cost, portable devices to assess olfactory function are proposed for use with children with intellectual disability. Stress monitoring by unobtrusive platforms provides discriminant information in this subset, as compared to controls.
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100
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Lu Y, Ho R, Lim TK, Kuan WS, Goh DYT, Mahadevan M, Sim TB, Van Bever HPS, Larbi A, Ng TP. Neuropeptide Y may mediate psychological stress and enhance TH2 inflammatory response in asthma. J Allergy Clin Immunol 2014; 135:1061-1063.e4. [PMID: 25498790 DOI: 10.1016/j.jaci.2014.10.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/22/2014] [Accepted: 10/29/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Yanxia Lu
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tow Keang Lim
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University of Singapore, Singapore
| | - Win Sen Kuan
- Emergency Medicine Department, National University of Singapore, Singapore
| | - Daniel Yam Thiam Goh
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Malcolm Mahadevan
- Emergency Medicine Department, National University of Singapore, Singapore
| | - Tiong Beng Sim
- Emergency Medicine Department, National University of Singapore, Singapore
| | - Hugo P S Van Bever
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anis Larbi
- Singapore Immunology Network (SIgN), Immunos Building at Biopolis, Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Tze Pin Ng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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