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Akcan N, Bahceciler NN. Headliner in Physiology and Management of Childhood Asthma: Hypothalamic-Pituitary-Adrenal Axis. Curr Pediatr Rev 2020; 16:43-52. [PMID: 31738144 DOI: 10.2174/1573396315666191026100643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/23/2019] [Accepted: 10/23/2019] [Indexed: 02/06/2023]
Abstract
Asthma is the most common chronic inflammatory disease of children. Inhaled corticosteroids (ICS) are the cornerstone of asthma therapy which are the most effective, commonly used treatment of persistent asthma. Mostly, studies on the relationship between asthma and cortisol have focused on side effects of treatment. Recently, asthmatic patients not treated with ICS have been reported to have an attenuated activity and/or responsiveness of their Hypothalamic-Pituitary- Adrenal (HPA) axis. Moreover, it has been proposed that asthma worsening with stress may be due to a dysfunctional HPA axis, or cortisol insensitivity due to chronic psychological stress through impaired glucocorticoid receptor expression or function. Although long-term ICS treatment might produce adrenal suppression or iatrogenic Cushing syndrome, improvement of adrenal function has also been detected in some of asthmatic cases. Thus, the response scheme of HPA axis still contains undiscovered features in asthma. The management of asthma can be improved by increasing knowledge on the role of HPA axis in asthma pathophysiology. The risk for side effects of ICS can be minimized through increased awareness, early recognition of at-risk patients and regular patient follow-up. This review was written to draw attention to the role of HPA axis in both asthma and its treatment and to illustrate a follow up algorithm of HPA axis in the management of asthma.
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Affiliation(s)
- Nese Akcan
- Department of Pediatric Endocrinology, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | - Nerin N Bahceciler
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Near East University, Nicosia, Cyprus
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Tamman AJF, Sippel LM, Han S, Neria Y, Krystal JH, Southwick SM, Gelernter J, Pietrzak RH. Attachment style moderates effects of FKBP5 polymorphisms and childhood abuse on post-traumatic stress symptoms: Results from the National Health and Resilience in Veterans Study. World J Biol Psychiatry 2019; 20:289-300. [PMID: 28891785 DOI: 10.1080/15622975.2017.1376114] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objectives: To determine the main and interactive effects of four FKBP5 polymorphisms (rs9296158, rs3800373, rs1360780 and rs9470080), childhood abuse and attachment style in predicting severity of PTSD symptoms in two independent, nationally representative samples of US military veterans. Methods: Data were analysed from two independent samples of European-American US military veterans who participated in the National Health and Resilience in Veterans Study (N = 1,585 and 577 respectively). Results: Results revealed that carriage of two FKBP5 minor alleles, childhood abuse and insecure attachment style were associated with greater severity of PTSD symptoms. Gene × environment interactions were also observed, with the interaction of FKBP5 homozygous minor allele carriage and history of childhood abuse associated with greater severity of PTSD symptoms; however, these effects were fully counteracted by secure attachment style. Conclusions: Results of this study build on prior work demonstrating a gene × environment interaction between FKBP5 polymorphisms and childhood abuse in predicting risk for PTSD by suggesting that attachment style may moderate this effect. This study has implications for prevention and treatment efforts designed to promote a secure attachment style in veterans with high-risk FKBP5 genotypes and childhood abuse histories.
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Affiliation(s)
- Amanda J F Tamman
- a Division of Psychology and Language Sciences , University College London , London , UK.,b The PTSD Research and Treatment Program , Columbia University , New York , NY , USA.,c Anxiety Disorders Clinic , New York State Psychiatric Institute , New York , NY , USA.,d Department of Psychiatry , Yale University School of Medicine , New Haven , CT , USA
| | - Lauren M Sippel
- d Department of Psychiatry , Yale University School of Medicine , New Haven , CT , USA.,e Clinical Neurosciences Division , U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System , West Haven , CT , USA
| | - Shizhong Han
- f Department of Psychiatry , University of Iowa Carver College of Medicine , Iowa City , IA , USA
| | - Yuval Neria
- b The PTSD Research and Treatment Program , Columbia University , New York , NY , USA.,c Anxiety Disorders Clinic , New York State Psychiatric Institute , New York , NY , USA
| | - John H Krystal
- d Department of Psychiatry , Yale University School of Medicine , New Haven , CT , USA.,e Clinical Neurosciences Division , U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System , West Haven , CT , USA
| | - Steven M Southwick
- d Department of Psychiatry , Yale University School of Medicine , New Haven , CT , USA.,e Clinical Neurosciences Division , U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System , West Haven , CT , USA
| | - Joel Gelernter
- d Department of Psychiatry , Yale University School of Medicine , New Haven , CT , USA.,e Clinical Neurosciences Division , U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System , West Haven , CT , USA
| | - Robert H Pietrzak
- d Department of Psychiatry , Yale University School of Medicine , New Haven , CT , USA.,e Clinical Neurosciences Division , U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System , West Haven , CT , USA
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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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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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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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Nabors LA, Meerianos AL, Vidourek RA, King KA, Rosen BL, Zhang J, Swoboda C. Predictors of flourishing for adolescents with asthma. J Asthma 2015; 53:146-54. [PMID: 26312650 DOI: 10.3109/02770903.2015.1072722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to examine well-being or flourishing of adolescents with asthma as well as factors influencing flourishing for these adolescents. METHODS A secondary analysis of data collected for the 2011-2012 National Survey of Children's Health was conducted. Flourishing of adolescents with and without asthma was compared. Parent coping and anger, child sex and age and child flourishing were examined for adolescents with asthma. RESULTS Youth with asthma had lower flourishing than those without this disease. Positive parent coping was related to flourishing, while parent anger negatively influenced flourishing of adolescents with asthma. Interaction terms were significant, indicating that the aforementioned variables interacted with adolescent age and sex. CONCLUSIONS Study results point to a complex relationship between parent- and adolescent-level factors and adolescent well-being. Further research is needed to examine relations among flourishing and health outcomes in youth with asthma.
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Affiliation(s)
| | | | | | | | | | - Jiaqi Zhang
- b Quantitative and Mixed Methods Research Methodologies, University of Cincinnati , Cincinnati , OH , USA
| | - Christopher Swoboda
- b Quantitative and Mixed Methods Research Methodologies, University of Cincinnati , Cincinnati , OH , USA
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Abstract
People who are more securely attached to close partners show health benefits, but the mechanisms underlying this link are not well specified. We focus on physiological pathways that are potential mediators of the connection between attachment in childhood and adulthood and health and disease outcomes. Growing evidence indicates that attachment insecurity (vs. security) is associated with distinctive physiological responses to stress, including responses involving the HPA, SAM and immune systems, but these responses vary with type of stressor (e.g., social/nonsocial) and contextual factors (e.g., partner's attachment style). Taking this more nuanced perspective will be important for understanding the conditions under which attachment shapes health-related physiological processes as well as downstream health and disease consequences.
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Andrews J, Ali N, Pruessner JC. Reflections on the interaction of psychogenic stress systems in humans: the stress coherence/compensation model. Psychoneuroendocrinology 2013; 38:947-61. [PMID: 23522990 DOI: 10.1016/j.psyneuen.2013.02.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 02/05/2013] [Accepted: 02/13/2013] [Indexed: 11/15/2022]
Abstract
Although stress simultaneously affects and causes changes in central nervous system systems together with the sympathetic nervous system and the hypothalamus-pituitary-adrenal axis, this interaction and its behavioral consequences are rarely assessed. The current paper first describes the different systems involved in the perception and processing of stressful stimuli on an anatomical and functional level, and the available measures to assess changes in these systems. It then explores, based on theoretical and empirical grounds, the interaction of the systems. This is followed by a review of previous stress models, and how these attempted to integrate the interaction of these systems. Then, it complements previous models by suggesting a complementary regulation of the stress systems, and discusses potential behavioral consequences. Finally, based on the three-system approach to assess stress it is argued that psychological measures, together with physiological and endocrine measures are indispensable. However, the lack of consensus on how to best assess the central and sympathetic nervous system components of stress make it more difficult to include measures of all systems routinely in future stress studies. Thus, the paper closes by giving some recommendations on how to include a minimum of feasible stress measures for all systems involved in stress processing and regulation.
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Affiliation(s)
- Julie Andrews
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
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