Stress and asthma: novel insights on genetic, epigenetic, and immunologic mechanisms

Chemical respiratory sensitization-Current status of mechanistic understanding, knowledge gaps and possible identification methods of sensitizers

Respiratory sensitization is a complex immunological process eventually leading to hypersensitivity following re-exposure to the chemical. A frequent consequence is occupational asthma, which may occur after long latency periods. Although chemical-induced respiratory hypersensitivity has been known for decades, there are currently no comprehensive and validated approaches available for the prospective identification of chemicals that induce respiratory sensitization, while the expectations of new approach methodologies (NAMs) are high. A great hope is that due to a better understanding of the molecular key events, new methods can be developed now. However, this is a big challenge due to the different chemical classes to which respiratory sensitizers belong, as well as because of the complexity of the response and the late manifestation of symptoms. In this review article, the current information on respiratory sensitization related processes is summarized by introducing it in the available adverse outcome pathway (AOP) concept. Potentially useful models for prediction are discussed. Knowledge gaps and gaps of regulatory concern are identified.

Impact of socioeconomic factors on allergic diseases

Allergic and immunologic conditions, including asthma, food allergy, atopic dermatitis, and allergic rhinitis, are among the most common chronic conditions in children and adolescents that often last into adulthood. Although rare, inborn errors of immunity are life-altering and potentially fatal if unrecognized or untreated. Thus, allergic and immunologic conditions are both medical and public health issues that are profoundly affected by socioeconomic factors. Recently, studies have highlighted societal issues to evaluate factors at multiple levels that contribute to health inequities and the potential steps toward closing those gaps. Socioeconomic disparities can influence all aspects of care, including health care access and quality, diagnosis, management, education, and disease prevalence and outcomes. Ongoing research, engagement, and deliberate investment of resources by relevant stakeholders and advocacy approaches are needed to identify and address the impact of socioeconomics on health care disparities and outcomes among patients with allergic and immunologic diseases.

Local and systemic mechanisms that control the hair follicle stem cell niche

Hair follicles are essential appendages of the mammalian skin, as hair performs vital functions of protection, thermoregulation and sensation. Hair follicles harbour exceptional regenerative abilities as they contain multiple somatic stem cell populations such as hair follicle stem cells (HFSCs) and melanocyte stem cells. Surrounding the stem cells and their progeny, diverse groups of cells and extracellular matrix proteins are organized to form a microenvironment (called 'niche') that serves to promote and maintain the optimal functioning of these stem cell populations. Recent studies have shed light on the intricate nature of the HFSC niche and its crucial role in regulating hair follicle regeneration. In this Review, we describe how the niche serves as a signalling hub, communicating, deciphering and integrating both local signals within the skin and systemic inputs from the body and environment to modulate HFSC activity. We delve into the recent advancements in identifying the cellular and molecular nature of the niche, providing a holistic perspective on its essential functions in hair follicle morphogenesis, regeneration and ageing.

Sleep, brain systems, and persistent stress in early adolescents during COVID-19: Insights from the ABCD study

PURPOSE

The first year of the COVID-19 pandemic constituted a major life stress event for many adolescents, associated with disrupted school, behaviors, social networks, and health concerns. However, pandemic-related stress was not equivalent for everyone and could have been influenced by pre-pandemic factors including brain structure and sleep, which both undergo substantial development during adolescence. Here, we analyzed clusters of perceived stress levels across the pandemic and determined developmentally relevant pre-pandemic risk factors in brain structure and sleep of persistently high stress during the first year of the COVID-19 pandemic.

METHODS

We investigated longitudinal changes in perceived stress at six timepoints across the first year of the pandemic (May 2020-March 2021) in 5559 adolescents (50 % female; age range: 11-14 years) in the United States (U.S.) participating in the Adolescent Brain Cognitive Development (ABCD) study. In 3141 of these adolescents, we fitted machine learning models to identify the most important pre-pandemic predictors from structural MRI brain measures and self-reported sleep data that were associated with persistently high stress across the first year of the pandemic.

RESULTS

Patterns of perceived stress levels varied across the pandemic, with 5 % reporting persistently high stress. Our classifiers accurately detected persistently high stress (AUC > 0.7). Pre-pandemic brain structure, specifically cortical volume in temporal regions, and cortical thickness in multiple parietal and occipital regions, predicted persistent stress. Pre-pandemic sleep difficulties and short sleep duration were also strong predictors of persistent stress, along with more advanced pubertal stage.

CONCLUSIONS

Adolescents showed variable stress responses during the first year of the COVID-19 pandemic, and some reported persistently high stress across the whole first year. Vulnerability to persistent stress was evident in several brain structural and self-reported sleep measures, collected before the pandemic, suggesting the relevance of other pre-existing individual factors beyond pandemic-related factors, for persistently high stress responses.

Ayurvedic clinical decision-making methods to predict, prevent and manage childhood allergic disorders

Allergy is a conundrum lacking satisfactory answers despite its global prevalence. Traditional systems of medicine may contain sustainable and effective solutions for the same. For mainstreaming them, an evaluation based on the system's own methods is inevitable rather than symptom-based correlations. Atopy is a novel entity in Ayurveda, but the methods of tripartite delineation (disease pattern, disease targets and influencing factors) of novel diseases and multifactorial approach to diagnosis and management in Ayurveda can bring about comprehensiveness in collection and categorization of data regarding the entity. This in turn can make the prediction, prevention and management of the same more precise, effective and sustainable. The article provides a template for the application of Ayurvedic biological framework in the diagnosis and management of novel diseases, with special reference to childhood allergic disorders.

Adverse Events during Adulthood, Child Maltreatment, and Asthma among British Adults in the UK Biobank

Rationale: Intimate partner violence and child maltreatment have been separately associated with asthma in adults. No study has concurrently examined of adulthood adverse events (including, but not limited to, intimate partner violence) and child maltreatment on asthma in adults. Objectives: To concurrently examine of adulthood adverse events and child maltreatment on asthma in adults. Methods: This was a cross-sectional study of adulthood adverse events and child maltreatment on current asthma in 87,891 adults 40-69 years old who participated in the UK Biobank. Adulthood adverse events were assessed using questions adapted from a national crime survey. Child maltreatment was ascertained using the Childhood Trauma Screener questionnaire. Current asthma was defined as physician-diagnosed asthma and current wheeze and was further classified as noneosinophilic or eosinophilic according to eosinophil count (<300 vs. ⩾300 cells per microliter). Results: In a multivariable analysis, participants who reported two or more types of adulthood adverse events had 1.19-1.45 times significantly higher odds of asthma than those who did not, whereas participants who reported two or more types of child maltreatment had 1.25-1.59 significantly higher odds of asthma than those who reported no child maltreatment. After stratification by sex, similar results were obtained for child maltreatment in women and men, whereas adulthood adverse events were only significantly associated with asthma in women. Similar findings were observed in analyses that were restricted to never-smokers and former smokers with <10 pack-years of smoking and in analyses of noneosinophilic and eosinophilic asthma. Conclusions: In a cohort of British adults, child maltreatment was associated with current asthma in men and women, whereas adulthood adverse events were associated with current asthma in women only. This was independent of cigarette smoking or eosinophil count.

Child marriage as a risk factor for non-communicable diseases among women in India

BACKGROUND

Child marriage, defined as marriage under the age of 18 years, remains pervasive in India. Global evidence documents a negative association between child marriage and women's reproductive and sexual health outcomes; however, its relationship with non-communicable diseases (NCDs) remains underexplored.

METHODS

We utilize biomarkers and self-reported data from the nationally representative National Family and Health Survey 4 (2015-2016) to examine the associations between child marriage and hypertension, diabetes, heart disease, asthma and thyroid disorder among currently married women (N = 421 107). We use regression models adjusted for a range of demographic and socio-economic controls to assess the association between child marriage and NCDs among women in India. We further assess whether and to what extent these relationships are mediated by early motherhood using the Karlson, Holm and Breen method of decomposition.

RESULTS

Child marriage was associated with hypertension [adjusted odds ratio 1.20 (95% CI: 1.17-1.24)], diabetes [1.29 (1.22-1.37)], heart disease [1.27 (1.18-1.36)], asthma [1.19 (1.11-1.28)] and thyroid disorder [1.10 (1.02-1.18)]. Early motherhood also increased the risk of NCDs among women. Furthermore, it emerged as a pathway linking child marriage with hypertension, diabetes and heart disease; however, it provided a partial explanation for the disadvantage associated with child marriages.

CONCLUSIONS

Child marriage emerges as a risk factor for NCDs among women in India. Health systems need to recognize the enduring influence of child marriages on women's health and ensure early detection and effective treatment of NCDs for this vulnerable group.

Atopic Dermatitis Across Shades of Skin

Atopic dermatitis (AD) is a chronic, heterogeneous inflammatory skin disease that is associated with immense patient burden globally. There is increasing appreciation of disparities among patients identified as having skin of color (SOC), which often refers to patients of non-White race or non-European ancestry, but can broadly include individuals from a number of different racial, ethnic, ancestral, and skin pigmentation groups based on definition. In this narrative review, we discuss key terminology as it relates to AD across shades of skin, including modern definitions of 'race', 'ethnicity', and 'SOC'. We then synthesize the current literature describing disparities in AD prevalence, disease recognition, and burden alongside current data regarding genetic and immunologic findings across SOC populations. In the context of these findings, we highlight key concomitant social determinants of health, including environmental factors, socioeconomic status, and access to care, for which race often serves as a proxy for true biological and genetic differences. Finally, we discuss future efforts to shift to a more inclusive understanding of AD to encompass all shades of skin, to ensure equitable representation of diverse populations in high impact research, and intensify efforts to address the critical upstream factors driving observed disparities.

Prevalence and risk factors for self-reported asthma among sámi in Sweden: a cross-sectional study

OBJECTIVE

Literature about asthma among Indigenous communities worldwide is scarce. This study aimed to estimate the prevalence of self-reported asthma and to identify the risk factors associated with it among the Sámi population in Sweden.

METHODS

A population-based health study (SámiHET) was conducted among the Sámi population aged 18-84 years in 2021. The asthma outcome was self-reported. Potential risk factors included sociodemographic, socioeconomic, cultural, behavioral and psychosomatic factors. Frequencies and percentages of the independent variables and the outcome were calculated. Then, the magnitude of the association between the independent variables and asthma was summarized with the prevalence ratio (PR) using the 95% confidence interval (95% CI) for inferential purposes.

RESULTS

Overall, 20.6% of participants reported having asthma and 13.9% suffering from asthma with symptoms. Women (PR: 1.19; 95% CI: 1.01-1.42), those living in the Västerbotten region (PR: 1.35; 95% CI: 1.11-1.63) and those suffering financial strain (PR: 1.34; 95% CI: 1.07-1.69) had a higher risk of self-reported asthma. Among the psychosomatic factors, self-reported allergy (PR: 6.45; 95% CI: 5.11-8.17), overweight (PR: 1.46; 95% CI: 1.19-1.78) and obesity (PR: 1.75; 95% CI: 1.41-2.17) were statistically significant associated to asthma symptoms.

CONCLUSION

A higher prevalence of asthma was found among the Sámi in Sweden compared to the average Swedish population. The associated risk factors were similar to those described in the literature. To understand the reason behind the higher prevalence of asthma among Sámi, more asthma-specific research, including register data, is needed.

The Risk Factors of Chronic Pain in Victims of Violence: A Scoping Review

Violent situations are unfortunately very frequent in women and children all over the world. These experiences have long-term consequences for adult physical and psychological health. One of the most reported is chronic pain, defined in various sub-diagnoses and present in all types of violence. Unfortunately, the etiology of this condition is not clear and neither are the predisposing factors. The aim of this scoping review is to examine the literature trends about the probable risk factors of chronic pain in violence victims. Considering a bio-psycho-social model, it is possible to hypothesize the presence of all these aspects. The results will be discussed in the present article.

Exposure to violence and asthma in Puerto Rican youth with high Th2 immunity

BACKGROUND

Little is known about the determinants of asthma among youth with high T helper 2 (Th2) immunity. We hypothesized that exposure to violence (ETV) and violence-related distress are associated with asthma in children and adolescents with high Th2 immunity.

METHODS

We analyzed data from Puerto Ricans with high Th2 immunity aged 9-20 years in the Puerto Rico Genetics of Asthma and Lifestyle (PR-GOAL) and the Epigenetic Variation of Childhood Asthma in Puerto Ricans (EVA-PR) studies, and in a prospective study (PROPRA). High Th2-immunity was defined as ≥1 positive allergen-specific IgE and/or a total IgE ≥ 100 IU/mL and/or an eosinophil count ≥ 150 cells/μL. Asthma was defined as physician-diagnosed asthma and current wheeze. ETV and violence-related distress were assessed with the validated ETV Scale and Checklist of Children's Distress Symptoms (CCDS) questionnaires, respectively.

RESULTS

In multivariable analyses, each 1-point increment in ETV score was significantly associated with 1.13-1.17 times increased odds of asthma in PR-GOAL and in EVA-PR (both at p ≤ 0.01), and each 1-point increment in CCDS score was significantly associated with 1.53-1.54 increased odds of asthma in PR-GOAL and in EVA-PR (both at p ≤ 0.03). Further, a persistently high ETV score was significantly associated with asthma in PROPRA (odds ratio [OR] = 2.83, 95% confidence interval [CI] = 1.10-7.29). Similar results were obtained in a sensitivity analysis using an eosinophil count ≥ 300 cells/μL instead of ≥150 cells/μL to define high Th2 immunity.

CONCLUSIONS

ETV during childhood is associated with increased risk of persistent or new-onset asthma in youth with high Th2 immunity.

Eye and airway symptoms in hospital staff exposed to a product containing hydrogen peroxide, peracetic acid, and acetic acid

BACKGROUND

Sporicidal products containing hydrogen peroxide (HP), peracetic acid (PAA), and acetic acid (AA) are used widely in multiple industries, including healthcare. Despite widespread use in healthcare, few studies have assessed associations between exposures to HP, PAA, and AA, and work-related symptoms in these settings.

METHODS

In 2018, we performed a health and exposure assessment at a hospital where a sporicidal product consisting of HP, PAA, and AA, was used as the primary cleaner on hospital surfaces. We collected 56 personal and mobile air samples for HP, PAA, and AA on participants while they performed their regular cleaning duties; collected area samples for HP (n = 28), PAA (n = 28), and AA (n = 70) in multiple hospital locations where cleaning was performed; and administered a postshift survey to assess eye, skin, and upper and lower airway symptoms that occurred cross-shift or in the previous 4 weeks.

RESULTS

Full-shift exposure levels for HP (range: <3-559 ppb), PAA (range: <0.2-8 ppb), and AA (range: <5-915 ppb) were all below US occupational exposure limits. We observed positive associations (p < 0.05) between shift, departmental average, and departmental 95th percentile exposures to HP, PAA, and AA vapors, and work-related acute (cross-shift) and chronic (previous 4 weeks) eye, upper airway, and lower airway symptoms after adjusting for age, gender, smoking status, use of other cleaning products containing sensitizers and irritants, allergic status, and stress.

CONCLUSIONS

Our observations of work-related upper and lower airway symptoms among hospital workers exposed to vapors from a sporicidal product containing HP, PAA, and AA indicate a need for a combination of engineering, administrative, and PPE controls to reduce exposure. Additionally, alternative nonchemical disinfection technologies should be further investigated as a means to simultaneously reduce healthcare workers' exposure to disinfectants while also minimizing costly healthcare-acquired infections.

[Diagnosis and treatment of asthma: a guideline for respiratory specialists 2023 - published by the German Respiratory Society (DGP) e. V.]

The management of asthma has fundamentally changed during the past decades. The present guideline for the diagnosis and treatment of asthma was developed for respiratory specialists who need detailed and evidence-based information on the new diagnostic and therapeutic options in asthma. The guideline shows the new role of biomarkers, especially blood eosinophils and fractional exhaled NO (FeNO), in diagnostic algorithms of asthma. Of note, this guideline is the first worldwide to announce symptom prevention and asthma remission as the ultimate goals of asthma treatment, which can be achieved by using individually tailored, disease-modifying anti-asthmatic drugs such as inhaled steroids, allergen immunotherapy or biologics. In addition, the central role of the treatment of comorbidities is emphasized. Finally, the document addresses several challenges in asthma management, including asthma treatment during pregnancy, treatment of severe asthma or the diagnosis and treatment of work-related asthma.

Airway transcriptome networks identify susceptibility to frequent asthma exacerbations in children

BACKGROUND

Frequent asthma exacerbators, defined as those experiencing more than 1 hospitalization in a year for an asthma exacerbation, represent an important subgroup of individuals with asthma. However, this group remains poorly defined and understudied in children.

OBJECTIVE

Our aim was to determine the molecular mechanisms underlying asthma pathogenesis and exacerbation frequency.

METHODS

We performed RNA sequencing of upper airway cells from both frequent and nonfrequent exacerbators enrolled in the Ohio Pediatric Asthma Repository.

RESULTS

Through molecular network analysis, we found that nonfrequent exacerbators display an increase in modules enriched for immune system processes, including type 2 inflammation and response to infection. In contrast, frequent exacerbators showed expression of modules enriched for nervous system processes, such as synaptic formation and axonal outgrowth.

CONCLUSION

These data suggest that the upper airway of frequent exacerbators undergoes peripheral nervous system remodeling, representing a novel mechanism underlying pediatric asthma exacerbation.

Urinary 1H NMR Metabolomic Analysis of Prenatal Maternal Stress Due to a Natural Disaster Reveals Metabolic Risk Factors for Non-Communicable Diseases: The QF2011 Queensland Flood Study

Prenatal stress alters fetal programming, potentially predisposing the ensuing offspring to long-term adverse health outcomes. To gain insight into environmental influences on fetal development, this QF2011 study evaluated the urinary metabolomes of 4-year-old children (n = 89) who were exposed to the 2011 Queensland flood in utero. Proton nuclear magnetic resonance spectroscopy was used to analyze urinary metabolic fingerprints based on maternal levels of objective hardship and subjective distress resulting from the natural disaster. In both males and females, differences were observed between high and low levels of maternal objective hardship and maternal subjective distress groups. Greater prenatal stress exposure was associated with alterations in metabolites associated with protein synthesis, energy metabolism, and carbohydrate metabolism. These alterations suggest profound changes in oxidative and antioxidative pathways that may indicate a higher risk for chronic non-communicable diseases such obesity, insulin resistance, and diabetes, as well as mental illnesses, including depression and schizophrenia. Thus, prenatal stress-associated metabolic biomarkers may provide early predictors of lifetime health trajectories, and potentially serve as prognostic markers for therapeutic strategies in mitigating adverse health outcomes.

The Role of Staphylococcus aureus and Its Toxins in the Pathogenesis of Allergic Asthma

Bronchial asthma is one of the most common chronic diseases worldwide and affects more than 300 million patients. Allergic asthma affects the majority of asthmatic children as well as approximately 50% of adult asthmatics. It is characterized by a Th2-mediated immune response against aeroallergens. Many aspects of the overall pathophysiology are known, while the underlying mechanisms and predisposing factors remain largely elusive today. Over the last decade, respiratory colonization with Staphylococcus aureus (S. aureus), a Gram-positive facultative bacterial pathogen, came into focus as a risk factor for the development of atopic respiratory diseases. More than 30% of the world’s population is constantly colonized with S. aureus in their nasopharynx. This colonization is mostly asymptomatic, but in immunocompromised patients, it can lead to serious complications including pneumonia, sepsis, or even death. S. aureus is known for its ability to produce a wide range of proteins including toxins, serine-protease-like proteins, and protein A. In this review, we provide an overview of the current knowledge about the pathophysiology of allergic asthma and to what extent it can be affected by different toxins produced by S. aureus. Intensifying this knowledge might lead to new preventive strategies for atopic respiratory diseases.

Child maltreatment, anxiety and depression, and asthma among British adults in the UK Biobank

BACKGROUND

Child maltreatment is associated with asthma in adults. We examined whether lifetime major depressive disorder (MDD) or lifetime generalised anxiety disorder (GAD) mediate an association between child maltreatment and current asthma among 81 105 British adults in the UK Biobank who completed a mental health survey and had complete data on child maltreatment, GAD, MDD, asthma and relevant covariates but no diagnosis of chronic obstructive pulmonary disease.

METHODS

Child maltreatment was ascertained based on answers to the five questions in the Childhood Trauma Screener. Two mediators, lifetime MDD and GAD, were assessed based on the Composite International Diagnostic Interview Short Form. Current asthma was defined as physician-diagnosed asthma and wheeze or whistling in the chest in the previous year. Logistic regression was used for the multivariable analysis of child maltreatment and current asthma, and a mediation analysis was conducted to estimate the contributions of lifetime MDD and lifetime GAD to the child maltreatment-current asthma association.

RESULTS

In a multivariable analysis, any child maltreatment was associated with asthma (adjusted OR 1.22, 95% CI 1.15-1.28; p<0.01). In a mediation analysis adjusted for household income, educational attainment, smoking status, pack-years of smoking and other covariates, lifetime GAD and lifetime MDD explained 21.8% and 32.5%, respectively, of the child maltreatment-current asthma association. Similar results were obtained after excluding current smokers and former smokers with ≥10 pack-years of smoking from the mediation analysis.

CONCLUSION

Our findings suggest that GAD and MDD mediate an association between child maltreatment and asthma in adults, independently of smoking.

Child maltreatment and asthma

A growing body of evidence suggests a potential link between child maltreatment and asthma. Determining whether and how child maltreatment causes or worsens asthma would have major implications for disease prevention and treatment, as well as public health policy. In this article, we examine epidemiologic studies of child maltreatment and asthma and asthma-related outcomes, review the evidence for potential mechanisms underlying the child maltreatment-asthma association, and discuss future directions. To date, a child maltreatment-asthma link has been reported in most studies of children and adults, though the type of maltreatment associated with asthma has differed across studies. Such discrepant findings are likely explained by differences in study design and quality. All studies have been limited by potential under-reporting of child maltreatment and selection bias, and nonthorough assessment of asthma. Despite these limitations, the aggregate evidence from epidemiologic studies suggests a possible causal link between child maltreatment and asthma, though the relative contributions of various types of maltreatment (physical, sexual, emotional, or neglect) are unclear. To date, there is insufficient evidence of an association between child maltreatment and lung function in children or adults. Limited evidence further suggests that child maltreatment could influence the development or severity of asthma through direct effects on stress responses and anxiety- or depressive-related disorders, immunity, and airway inflammation, as well as indirect effects such as increased obesity risk. Future prospective studies should aim to adequately characterize both child maltreatment and asthma, while also assessing relevant covariates and biomarkers of stress, immune, and therapeutic responses.

Biologicals decrease psychological distress, anxiety and depression in severe asthma, despite Covid-19 pandemic

Patients with respiratory diseases suffer more from problems of severe psychiatric comorbidity than the general population. Asthma might cause psychiatric disorders and affect patients' quality of life negatively. Previous studies reported that mental disorders prevail in asthmatic patients, causing anxiety, depression, and suicidal risk. The aim of this study is to evaluate in real life the prevalence of psychological comorbidities in asthmatics with severe asthma treated by biologicals (Benralizumab, Mepolizumab, Omalizumab). This study starts with the hypothesis that psychological distress, anxiety, depression and suicidal risk in severe asthma patients decreases if treated by biologicals. This study involves a sample of 90 patients (32 males, 58 females and aged 53.92 ± 15.92) suffering from severe asthma and treated with the biological drugs of Benralizumab, Mepolizumab, Omalizumab during Covid-19 pandemic. At the beginning of the treatment (T0) and after 16 weeks (T1), there have been reported results from both clinical disease control, assessed using the ACT, and psychological disorders, assessed with the PSS, HADS and C-SSRS. In the sample of these patients treated with biologicals for severe asthma, the study reported a significant change in all observed parameters, including asthma control (ACT), stress (PSS), anxiety (HADS-A) and depressive symptoms (HADS-D, despite Covid-19 pandemic. In addition, there was a significant improvement in disease management, perceived stress, anxiety and depressive symptoms after a 16 week treatment for severe asthma, independent from the type of biologic drugs used during the pandemic.

Rates of and factors associated with atopy and allergies in posttraumatic stress disorder as compared to controls

OBJECTIVE

Several studies suggest a relationship between atopy and psychiatric disorders, but few have investigated the association between atopic conditions and posttraumatic stress disorder (PTSD). We sought to compare the rates of atopy and allergies in a South African case-control study of 220 patients with PTSD (mean age 41.7 years, SD = 11.7) and 196 trauma exposed controls (TEC, mean age 45.4 years, SD = 14.7) conducted in Cape Town, South Africa from May 2014 to June 2017.

METHODS

Self-reported atopic conditions and allergies were regressed on PTSD, as determined with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), in multivariate logistic regression models, controlling for age, gender, body mass index, physical activity, lifetime and childhood trauma, and time since index trauma.

RESULTS

Rates of lifetime atopy (p = 0.03), current asthma (p = 0.04), lifetime allergic rhinitis (p = 0.002), and current allergic rhinitis (p = 0.004) were significantly higher in patients than TEC on bivariate analysis. On multivariate analysis, rates of current atopy (Cohen's d = 0.26, p = 0.04) and current allergic rhinitis (Cohen's d = 0.34, p = 0.012) were significantly higher in patients with PTSD than in TEC. Current eczema (p = 0.24), current asthma (p = 0.26), and allergies (p = 0.59) were not associated with PTSD.

CONCLUSIONS

Rates of atopy are higher in participants with PTSD than TEC, and this effect is related to higher rates of allergic rhinitis. Further studies are needed to elucidate the pathways linking allergic rhinitis and PTSD.

Association of the 5HTR2C gene Ser23 variation with childhood allergic asthma

Objective: Allergic asthma is the most frequently observed subtype of individuals with asthma. The effects of serotonin plays in the pathophysiology of asthma has not been clearly determined. Thus, this study aimed to investigate the association between the 5HTR2C gene rs 6318 G>C polymorphism and allergic asthma in pediatric patients in Cyprus.

Methods: This study included total number of 177 individuals with 118 control and 59 pediatric patients (43 atopic and 16 non-atopic asthma patient). A skin prick test was performed for each patient to confirm asthma diagnosis and to evaluate atopic status. Genotyping for the 5HTR2C was completed by Real Time-PCR analysis.

Results: The genotype distribution frequencies were not in agreement with the Hardy-Weinberg Equilibrium in the patients’ group (p<0.00001). The frequency of the risk allele (allele C) was not significantly different between the patient and control groups (p=0.255). The genotypic distribution between atopic asthma and non-atopic asthma within the patientsts groups was not in agreement with the Hardy-Weinberg Equilibrium (p=0.006). However, risk allele presence showed a statistically significant association with atopy-related asthma (p=0.037).

Discussion & Conclusion: Overall, despite the finding of no association between the 5HTR2C rs6318 C allele and childhood asthma, the current results indicated that there is a strong association between the 5HTR2C rs6318 C variant and childhood atopic asthma.

Change in Asthma Is Associated with Change in PTSD in World Trade Center Health Registrants, 2011 to 2016

The WTC Health Registry (WTCHR) is a closed, longitudinal cohort of rescue/recovery workers and survivors exposed to the 11 September 2001 disaster. WTCHR enrollees diagnosed with asthma after 11 September 2001 continued to experience poor control despite treatment. Asthma is associated with mental problems, although their bidirectional movement has not been studied. This study tested whether a clinical change in mental problems was associated with a difference in asthma control, and whether a change in asthma control varied with a change in quality of life (QoL). Difference in the Asthma Control Test (ACT) on the WTCHR from 2011-12 to 2015-16 was compared with the change in the Post-traumatic Stress Disorder Checklist (PCL-17), the Patient Health Questionnaire depression scale, self-reported heartburn, and change of physical and mental QoL over this period. In adjusted multinomial multivariable logistic regression, improved PCL-17 was associated with a better ACT score, odds ratio (OR) = 1.42 (95% C.I. 1.01, 1.99), and a worsened PCL-17 score was associated with a worsened ACT score, OR = 1.77 (95% C.I. 1.26, 2.50). Decreased ACT was associated with poor physical QoL, OR = 1.97 (95% C.I. 1.48, 2.62). Change in mental health measures tracked with change in asthma control, which correlated with a change in QoL. Careful follow-up and treatment of all three are indicated to improve these inter-related issues.

Psychological and Sociocultural Determinants in Childhood Asthma Disease: Impact on Quality of Life

Asthma is the most common chronic disease in childhood. The presence of this pathology in children leads to the appearance of different alterations (physical, psychological, social, etc.). Due to their high influence, the aim of this study is to understand these psychological and sociocultural determinants and their impact on the quality of life of asthmatic children. In order to determine the influence of these determinants on quality of life, a narrative review of 48 articles collected in different databases was carried out. Emotions are the most powerful precursor to producing an asthmatic attack. Anxiety and depression are the pathologies that appear frequently associated with childhood asthma, together with Attention-Deficit/Hyperactivity Disorder. In addition, the personality of these children seems to be characterized by shyness and impulsivity, although exceptionally it has been associated with psychopathic behaviors, aggressiveness, and cases of psychosis. School performance is impaired and bullying occurs more frequently. Likewise, dysfunctional family relationships and lower socioeconomic status have a negative impact on the severity and management of asthma. In short, the quality of life of asthmatic children is lower due to the presence of the aforementioned psychological and sociocultural determinants.

Bullying and lifetime asthma among children and adolescents in the United States

PURPOSE

To examine the association of experiencing bullying within the past year with the prevalence of lifetime childhood asthma in US children and adolescents; and whether this associations vary with sex of the child and select socioeconomic indicators.

METHODS

We performed secondary analysis of data from the 2018 National Survey of Children's Health participants aged 6 to 17 years (n=19,766). We used log-binomial regression to examine the association between bullying and lifetime childhood asthma before and after controlling for select covariates. We also tested interactions of bullying with sex and select socioeconomic indicators.

RESULTS

Children who experience bullying have a significantly increased probability of having asthma in adjusted analyses. The probability of childhood asthma increased with the frequency of bullying with PRs starting at 1.28 (95%CI:1.06, 1.55) for children bullied 1-2 times per year to 1.59 (95%:1.22, 2.09) for those being bullied at least 4 times per month. This association did not differ with sex of the child and select socioeconomic indicators.

CONCLUSION

We found that children who experienced bullying had a greater probability of having asthma relative to those who never experienced bullying. These finding highlight the impact of psychosocial stressors on asthma as a nontraditional trigger in children with asthma.

The Role of Comorbidities in Difficult-to-Control Asthma in Adults and Children

Assessment of asthma comorbidities, conditions that adversely affect the pathobiology of asthma or impair its response to therapies, is a fundamental step in the evaluation and management of patients with difficult-to-treat asthma. Identifying and effectively treating asthma comorbidities, such as obesity, obstructive sleep apnea, and chronic sinusitis with nasal polyps, may improve asthma control and reduce exacerbations. In addition, identifying comorbid T2 inflammatory conditions may help guide optimal selection of biologic therapies. Here, we describe common comorbid conditions found in adult and pediatric difficult-to-control asthma, discuss evidence for the association with asthma morbidity and treatment benefit, and provide information on how and when to assess comorbidities.

The Omnipresence of Autonomic Modulation in Health and Disease

The Autonomic Nervous System (ANS) is a critical part of the homeostatic machinery with both central and peripheral components. However, little is known about the integration of these components and their joint role in the maintenance of health and in allostatic derailments leading to somatic and/or neuropsychiatric (co)morbidity. Based on a comprehensive literature search on the ANS neuroanatomy we dissect the complex integration of the ANS: (1) First we summarize Stress and Homeostatic Equilibrium - elucidating the responsivity of the ANS to stressors; (2) Second we describe the overall process of how the ANS is involved in Adaptation and Maladaptation to Stress; (3) In the third section the ANS is hierarchically partitioned into the peripheral/spinal, brainstem, subcortical and cortical components of the nervous system. We utilize this anatomical basis to define a model of autonomic integration. (4) Finally, we deploy the model to describe human ANS involvement in (a) Hypofunctional and (b) Hyperfunctional states providing examples in the healthy state and in clinical conditions.

Associations of asthma self-management and mental health in adolescents: A scoping review

BACKGROUND

Adolescent asthma is highly prevalent and frequently uncontrolled despite control being achievable with good self-management. Anxiety, depression, and stress are associated with worse asthma outcomes, and may impact self-management; no previous review has examined this relationship.

AIM

This scoping review assessed the nature of the current literature on mental health and asthma self-management among adolescents ages 11 to 24 and synthesized their relationships.

METHODS

Guided by the PRISMA-ScR guidelines, we systematically searched the literature using MEDLINE, Embase, CINAHL, PsycInfo, and Scopus in September 2020 and updated it in June 2021. Included studies examined associations between anxiety, depression, and/or stress and asthma self-management in adolescents ages 11-24. We did not restrict study design, location, or date.

RESULTS

Out of 1559 records identified, 14 met inclusion criteria. Types of self-management included trigger control, healthcare adherence, and overall symptom prevention and management. Anxiety symptoms were associated with poorer asthma self-management in four studies, but better in three. Depressive symptoms were associated with poorer asthma self-management in five studies, but better in two. Stress was associated with poorer self-management in one study. Mental health symptoms were nearly universally associated with poorer trigger control, but associations with healthcare adherence and overall symptom prevention and management varied.

CONCLUSION

Mental health symptoms may facilitate or hinder asthma self-management depending on the types of mental health and self-management. Further research is needed to better understand this relationship and inform future interventions. Providers might assess mental health as a potential barrier to adolescent asthma self-management.

The A118G single-nucleotide polymorphism in OPRM1 is a risk factor for asthma severity

BACKGROUND

Although population studies have implicated emotional burden in asthma severity, the underlying genetic risk factors are not completely understood. We aimed to evaluate the genetic influence of a functional single-nucleotide polymorphism (SNP) in the stress-related μ-opioid receptor gene (OPRM1; A118G SNP, rs1799971) on asthma severity.

METHODS

We initially assessed disease severity in asthmatic outpatients carrying A118G. Using an ovalbumin-induced experimental asthma rodent model harboring the functionally equivalent SNP, we investigated the mechanism by which this SNP influences the allergic immune response.

RESULTS

Among 292 outpatients, 168 underwent airway hyperresponsiveness (AHR) to methacholine testing. Compared with patients carrying the AA and AG genotypes, those carrying the GG genotype exhibited enhanced AHR. The stress levels were presumed to be moderate among patients and were comparable among genotypes. Compared with Oprm1 AA mice, GG mice demonstrated aggravated asthma-related features and increased pulmonary interleukin-4⁺CD4⁺ effector and effector memory T cells under everyday life stress conditions. Intraperitoneal naloxone methiodide injection reduced effector CD4⁺ T cell elevation associated with increased eosinophil numbers in bronchoalveolar lavage fluid of GG mice to the levels in AA mice, suggesting that elevated Th2 cell generation in the bronchial lymph node (BLN) of GG mice induces enhanced eosinophilic inflammation.

CONCLUSIONS

Without forced stress exposure, patients with asthma carrying the OPRM1 GG genotype exhibit enhanced AHR, attributable to enhanced Th2 cell differentiation in the regional lymph node. Further research is necessary to elucidate the role of the OPRM1 A118G genotype in the Th2 cell differentiation pathway in the BLN.

Structural racism and its pathways to asthma and atopic dermatitis

Black, Latinx, and Indigenous people in the United States experience a disproportionate burden of asthma and atopic dermatitis. The study of these disease disparities has focused on proximal socioenvironmental exposures and on the biomechanistic (including genetic) differences between racial and ethnic groups. Although biomedical research in allergy and immunology stands to benefit from the inclusion of diverse study populations, the narrow focus on biologic mechanisms disregards the complexity of interactions across biologic and structural factors, including the effects of structural racism. Structural racism is the totality of ways in which society fosters discrimination by creating and reinforcing inequitable systems through intentional policies and practices sanctioned by government and institutions. It is embedded across multiple levels, including the economic, educational, health care, and judicial systems, which are manifested in inequity in the physical and social environment. In this review, we present a conceptual framework and pull from the literature to demonstrate how structural racism is a root cause of atopic disease disparities by way of residential segregation, socioeconomic position, and mass incarceration, which may lead to aberrations in the innate and adaptive immune response and the augmentation of physiologic stress responses, contributing to a disproportionate disease burden for racial and ethnic populations.

Parent-child conflict and physical health trajectories among youth with asthma

OBJECTIVE

To investigate the role of caregiver- and youth-reports of parent-child conflict on trajectories of asthma-related health outcomes over 2 years.

METHODS

In a sample of 193 youth with asthma (42.7% female; M age = 12.78) and their primary caregivers, we used a multi-method and multi-informant approach to assess self-reported parent-child conflict from youth and caregivers at both the daily and global levels at baseline. Next, we annually assessed subjective (i.e., youth self-reported asthma symptoms) and clinical (i.e., peak flow) asthma health outcomes for 2 years.

RESULTS

Latent growth curve models revealed an effect of baseline youth-reported global family conflict on peak flow trajectories such that youth who reported greater parent-child conflict at baseline experienced less of an increase in peak flow over time than youth who reported less parent-child conflict at baseline (standardized β = -0.27, p = .003).

CONCLUSIONS

Youth with asthma who perceive greater overall conflict with their caregivers experience less improvement in peak flow as they age. The research and clinical implications of these findings are discussed.

Asthma and posttraumatic stress disorder (PTSD): Emerging links, potential models and mechanisms

Posttraumatic stress disorder (PTSD) is a highly prevalent, debilitating mental health condition. A better understanding of contributory neurobiological mechanisms will lead to effective treatments, improving quality of life for patients. Given that not all trauma-exposed individuals develop PTSD, identification of pre-trauma susceptibility factors that can modulate posttraumatic outcomes is important. Recent clinical evidence supports a strong link between inflammatory conditions and PTSD. A particularly strong association has been reported between asthma and PTSD prevalence and severity. Unlike many other PTSD-comorbid inflammatory conditions, asthma often develops in children, sensitizing them to subsequent posttraumatic pathology throughout their lifetime. Currently, there is a significant need to understand the neurobiology, shared mechanisms, and inflammatory mediators that may contribute to comorbid asthma and PTSD. Here, we provide a translational perspective of asthma and PTSD risk and comorbidity, focusing on clinical associations, relevant rodent paradigms and potential mechanisms that may translate asthma-associated inflammation to PTSD development.

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

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

Intimate Partner Violence and Adult Asthma Morbidity: A Population-Based Study

BACKGROUND

The etiologies for difficult-to-control asthma are complex and incompletely understood. Intimate partner violence (IPV) is a pervasive problem and may play a role in difficult-to-control asthma. IPV is associated with increased prevalence of asthma. There are no prior studies evaluating IPV's association with adult asthma exacerbations.

OBJECTIVE

This study hypothesized that IPV exposure would be associated with increased asthma exacerbations, higher symptom burden, and poorer asthma control among adults.

METHODS

Analyses are based on 2634 adults who participated in the 2005 Behavioral Risk Factor Surveillance System survey, reported active asthma, and completed the asthma and IPV questions. We used multivariate logistic regression to examine the association of IPV with asthma morbidity outcomes while controlling for the following potential confounders: sex, race, education, health care coverage, smoking status, age, and body mass index.

RESULTS

The prevalence of IPV was 32.4%. IPV was associated with increased odds of an asthma exacerbation (adjusted odds ratio [AOR] = 1.75, 95% confidence interval [CI] = 1.26-2.43), higher symptom burden (AOR = 2.33, 95% CI = 1.53-3.55), and lack of asthma control (AOR = 2.23, 95% CI = 1.22-4.09) when using composite measures for these outcomes. When using single-item measures for outcomes, IPV was also associated with increased asthma-related emergency department or urgent care visits (AOR = 2.35, 95% CI = 1.56-3.54), other urgent provider visits (AOR = 1.84, 95% CI = 1.28-2.64), perceived asthma attacks (AOR = 1.53, 95% CI = 1.12-2.09), limitations (AOR = 2.07, 95% CI = 1.49-2.89), daytime symptoms (AOR = 1.92, 95% CI = 1.35-2.72), and nocturnal awakenings (AOR = 1.88, 95% CI = 1.32-2.69).

CONCLUSIONS

IPV is prevalent in adult asthmatics and consistently and significantly associated with worsened adult asthma morbidity, even after adjusting for key confounders. Further research is needed to more fully understand the mechanisms underlying these relationships.

Adverse Childhood Experiences and Association With Pediatric Asthma Severity in the 2016-2017 National Survey of Children's Health

OBJECTIVES

Prior studies have found that adverse childhood experiences (ACEs) are associated with asthma prevalence and onset, presumably related to stress and increased inflammation. We hypothesized that ACEs may be associated with asthma severity as well. We studied the 2016-2017 US National Survey of Children's Health dataset to explore the relationship between ACEs and pediatric asthma severity.

METHODS

We analyzed children ages 0 to 17 years old who had current caregiver-reported asthma diagnosed by a healthcare provider. We reported descriptive characteristics using chi-square analysis of variance (ANOVA) and used multivariable regression analysis to assess the relationship of cumulative and individual ACEs with asthma severity. Survey sampling weights and SAS survey procedures were implemented to produce nationally representative results.

RESULTS

Our analysis included 3691 children, representing a population of 5,465,926. Unadjusted analysis demonstrated that ACEs - particularly household economic hardship, parent/guardian served time in jail, witnessed household violence, or victim/witness of neighborhood violence - were each associated with higher odds of moderate/severe caregiver-reported asthma. After controlling for confounders possibly associated with both exposure (ACEs) and outcome (asthma severity), children who witnessed parent/adult violence had higher adjusted odds of caregiver-reported moderate/severe asthma. (1.67, confidence interval 1.05-2.64, P = .03) CONCLUSIONS: Intrafamilial witnessed household violence is significantly associated with caregiver-reported moderate/severe asthma.

Socioeconomic status, financial stress, and glucocorticoid resistance among youth with asthma: Testing the moderation effects of maternal involvement and warmth

OBJECTIVES

Children who grow up in more socioeconomically disadvantaged homes experience greater levels of inflammation and worse asthma symptoms than children from more advantaged families. However, recent evidence suggests that certain family-level factors can mitigate health disparities associated with socioeconomic status (SES). In a sample of youth with asthma, we investigated the potential buffering effects of maternal involvement and warmth on SES disparities in asthma-related immune responses, assessed via glucocorticoid resistance (GR) of immune cells.

METHODS

One hundred and forty-three youth (10-16 years of age) with asthma completed measures of maternal involvement and warmth, and their primary caregivers reported their levels of education, income, and financial stress. Peripheral blood mononuclear cells from youth's blood were isolated, cultured, and assayed to determine mitogen-stimulated (PMA/INO + Etho) and mitogen/hydrocortisone-stimulated (PMA/INO + Cort) levels of two Th-2 cytokines (i.e., interleukin-5, interleukin-13) and one Th-1 cytokine (i.e., interferon-γ). GR was calculated by subtracting log-transformed cytokine concentration in the PMA/INO + Etho samples from log-transformed cytokine concentration in the PMA/INO + Cort samples.

RESULTS

Both maternal involvement and warmth moderated the indirect pathway from family SES to GR of Th-2 cytokines via financial stress. Specifically, we found that low family SES was associated with elevated GR of Th-2 cytokines via increased financial stress among youth reporting low levels of maternal involvement and warmth, but not among those reporting high levels of maternal involvement or warmth.

CONCLUSIONS

These results highlight the protective role of maternal involvement and warmth in health-related biological processes modulated by family SES among youth with asthma.

Exposure to violence, chronic stress, nasal DNA methylation, and atopic asthma in children

BACKGROUND

Exposure to violence (ETV) or chronic stress may influence asthma through unclear mechanisms.

METHODS

Epigenome-wide association study (EWAS) of ETV or chronic stress measures and DNA methylation in nasal epithelium from 487 Puerto Ricans aged 9-20 years who participated in the Epigenetic Variation and Childhood Asthma in Puerto Ricans study [EVA-PR]). We assessed four measures of ETV and chronic stress in children (ETV scale, gun violence, and perceived stress) and their mothers (perceived stress). Each EWAS was conducted using linear regression, with CpGs as dependent variables and the stress/violence measure as a predictor, adjusting for age, sex, the top five principal components, and SVA latent factors. We then selected the top 100 CpGs (by p value) associated with each stress/violence measure in EVA-PR and conducted a meta-analysis of the selected CpGs and atopic asthma using data from EVA-PR and two additional cohorts (Project Viva and PIAMA).

RESULTS

Three CpGs (in SNN, PTPRN2, and LINC01164) were associated with maternal perceived stress or gun violence (p = 1.28-3.36 × 10^-7 ), but not with atopic asthma, in EVA-PR. In a meta-analysis of three cohorts, which included the top CpGs associated with stress/violence measures in EVA-PR, 12 CpGs (in STARD3NL, SLC35F4, TSR3, CDC42SE2, KLHL25, PLCB1, BUD13, OR2B3, GALR1, TMEM196, TEAD4, and ANAPC13) were associated with atopic asthma at FDR-p < .05.

CONCLUSIONS

Pending confirmation in longitudinal studies, our findings suggest that nasal epithelial methylation markers associated with measures of ETV and chronic stress may be linked to atopic asthma in children and adolescents.

Association of stress management skills and stressful life events with allergy risk: a case-control study in southern China

BACKGROUND

Psychosocial stress and stressful life events are known to aggravate allergic diseases. Less is known about the impact of stress management skills on allergies. Here we sought to determine whether stress management skills are associated with the allergies and to assess the combined effects of stress management skills and stressful events on allergy risk.

METHODS

A survey on risk factors for self-reported allergic diseases was carried out among 28,144 southern Chinese people; 14 stressful life events and 8 stress management skills were retrospectively recorded in a case-control setting with multivariate logistic regression analysis. Multiplicative and additive interactions between stressful events and stress management skills were evaluated.

RESULTS

Stressful events significantly increased allergy risk. The odds ratio (OR) for allergies was 1.65 (95% confidence interval CI, 1.41-1.93) for those reporting one or two stressful events and 3.10 (95% CI, 2.55-3.79) for those reporting more than three stressful events compared to participants without stressful events. Stress management skills were adversely associated with allergic risk for people experiencing stressful events (OR, 0.71; 95% CI, 0.53-0.97) when adjusted demographically, particularly "concentrate on pleasant thoughts at bedtime" (OR, 0.67; 95% CI, 0.51-0.89), "pace myself to prevent tiredness" (OR, 0.67; 95% CI, 0.54-0.83), "get enough sleep" (OR, 0.48; 95% CI, 0.32-0.72) and "take some time for relaxation each day" (OR, 0.55; 95% CI, 0.37-0.80). But in people without stressful events, no association was observed. There was a significant linear trend for allergy risk from good stress management skills with no stressful events to poor stress management skills with stressful events (P < 0.001), with significant interaction in additive models (P = 0.006).

CONCLUSIONS

There are independent and antagonistic combined associations of stressful life events and stress management skills with allergy risk. The data supports the use of stress management skills in managing allergic disease among people with stressful life events.

Overview of severe asthma, with emphasis on pediatric patients: a review for practitioners

Asthma is the most common life-threatening chronic disease in children. Although guidelines exist for the diagnosis and treatment of asthma, treatment of severe, pediatric asthma remains difficult. Limited studies in the pediatric population on new asthma therapies, complex issues with adolescence and adherence, health disparities, and unequal access to guideline-based care complicate the care of children with severe, persistent asthma. The purpose of this review is to provide an overview of asthma, including asthma subtypes, comorbidities, and risk factors, to discuss diagnostic considerations and pitfalls and existing treatments, and then present existing and emerging therapeutic approaches to asthma management. An improved understanding of asthma heterogeneity, clinical characteristics, inflammatory patterns, and pathobiology can help further guide the management of severe asthma in children. More studies are needed in the pediatric population to understand emerging therapeutics application in children. Effective multimodal strategies tailored to individual characteristics and a commitment to address risk factors, modifiers, and health disparities may help reduce the burden of asthma in the USA.

[Chronic diseases among medical students in Morocco: What are the interactions with psychosocial stress?]

OBJECTIVES

To evaluate the prevalence and factors associated with Chronic psychiatric and somatic illness among medical students in Morocco.

METHODS

A multicentric cross-sectional study during a period of four weeks in February 2019 involving 605 students of 1st, 2nd and 3rd cycle of medical studies of the faculties of medicine in Morocco.

RESULTS

41.5% (251) of students confirmed having a chronic disease, among which 80% were under treatment. Psychiatric conditions represented the most frequent chronic illnesses among medical students (28%), followed by dermatological (16%), allergic and respiratory (12.2%), and gastroenterological (11%) conditions. Chronic illnesses among medical students were significantly associated with female gender (P: 0.0000000037), level of education (P: 0.0000), personal history of suicide attempts (P: 0.0000259), and a consumption of psychoactive substances (P: 0.0000029046).

CONCLUSION

Chronic illnesses are frequent, underestimated and undertreated among medical students in Morocco. The link with stress has been suggested as the value of establishing a program to train medical students in stress management.

Physical activity, sleep, and quality of life of patients with asthma during the COVID-19 pandemic

OBJECTIVE

There is limited information in literature on how coronavirus disease-2019 (COVID-19) pandemic period affects people with asthma. This study aimed to compare levels of physical activity, stress, and fear and quality of life and sleep quality between patients with asthma and healthy individuals during the pandemic.

METHODS

Twenty-two patients with asthma and 22 healthy individuals aged between 18 and 65 years were included. Physical activity level using "International Physical Activity Questionnaire"; stress level, using "Perceived Stress Scale-14"; fear level, using "Fear of COVID-19 Scale"; sleep quality, using "Pittsburgh Sleep Quality Index"; and quality of life, using "World Health Organization Quality of Life" were evaluated.

RESULTS

Total physical activity level, vigorous physical activity level, and walking score of patients with asthma were lower than healthy individuals (p < .05). Sitting time of patients with asthma was higher than healthy individuals (p < .05). Subjective sleep quality, latency, duration, efficiency, sleeping medication use, and daytime dysfunction of both were similar (p > .05). Only sleep disturbance score of patients with asthma were higher than healthy individuals (p < .05). Quality of life, stress, and fear levels of both were similar (p > .05).

CONCLUSION

During pandemic, patients with asthma are more inactive than healthy individuals regardless of the presence of a chronic disease; pandemic negatively affected stress, fear levels, sleep, and quality of life. To minimize the effects of restrictions and psychological burden caused by pandemic and to encourage patients with asthma to perform physical activities, conducting studies to control stress levels and increasing quality of life and sleep of all individuals are important.

The Association of Asthma, Sexual Identity, and Inhaled Substance Use among U.S. Adolescents

Rationale: Minority sexual identity appears to confer asthma risks. Although associations between inhaled substances and asthma are established, these have not been examined among sexual minority youths. Given sexual minority adolescents' disproportionately high rates of substance use, research is needed to fill this important gap.Objectives: Using a representative sample of adolescents from the United States, we 1) examined associations among asthma, sexual identity, and inhaled substance use and tested 2a) whether sexual identity moderates relationships between asthma and inhaled substance use and 2b) whether inhaled substance use mediates associations between sexual identity and asthma.Methods: Data are from the 2015 and 2017 Youth Risk Behavior Surveillance Survey. Adolescents (n = 30,113) reported if they were ever diagnosed with asthma, current use of cigarettes, cigars and/or cigarillos, marijuana, and electronic vapor products and if they ever used inhalants or synthetic marijuana. We used logistic regression to examine associations between asthma, sexual identity, and inhaled substance use controlling for age, race or ethnicity, and body mass index percentile, stratified by sex.Results: Lesbian, gay, and bisexual respondents had higher relative risks for asthma than heterosexual youth. Sexual minority female youths had significantly higher relative risks than heterosexual female youths for use of every inhaled substance. There were few sexual identity differences in inhaled substance use among male youths. Inhaled substance use was significantly associated with higher risks for asthma. In general, associations between each individual inhaled substance and asthma did not differ between sexual minority and heterosexual youths. However, when all inhaled substances were added into the models concurrently, inhaled substance use appeared to mediate associations with asthma among lesbian and bisexual female youths, and partially mediated these associations among sexual minority male youths.Conclusions: Sexual identity and inhaled substance use appear to play important roles in asthma risk. However, these variables do not fully explain the risk, suggesting that other unmeasured variables (e.g., stress and victimization) may be implicated in risks for both inhaled substance use and asthma. It is important that clinicians providing care to adolescents ask about sexual identity and inhaled substance use. Effective approaches to reducing inhaled substance use among adolescents, especially sexual minorities, are needed.

Exposure to violence, chronic stress, nasal DNA methylation, and atopic asthma in children

Background

Exposure to violence (ETV) or stress may cause asthma through unclear mechanisms.

Methods

Epigenome-wide association study (EWAS) of DNA methylation in nasal epithelium and four ETV or chronic stress measures in 487 Puerto Ricans aged 9-20 years who participated in the Epigenetic Variation and Childhood Asthma in Puerto Ricans study [EVA-PR]). We assessed measures of ETV or chronic stress in children (ETV scale, gun violence, and perceived stress) and their mothers (perceived stress). Each EWAS was conducted using linear regression, with CpGs as dependent variables and the stress/violence measure as a predictor, adjusting for age, sex, the top five principal components, and SVA latent factors. We then selected the top 100 CpGs (by P-value) associated with each stress/violence measure in EVA-PR and conducted a meta-analysis of the selected CpGs and atopic asthma using data from EVA-PR and two additional cohorts (Project Viva and PIAMA).

Results

In the EWAS of stress/violence in EVA-PR, gun violence was associated with methylation of cg18961589 in LINC01164 (β=0.03, P =1.28×10 ^-7 ), and maternal stress was associated with methylation of cg03402351 in SNN (β=0.04, P =1.69×10 ^-7 ) and cg19064846 in PTPRN2 (β=0.03, P =3.36×10 ^-7 ). In a meta-analysis of three cohorts, which included the top CpGs associated with stress/violence in EVA-PR, CpGs in STARD3NL, SLC35F4, TSR3, CDC42SE2, KLHL25, PLCB1, BUD13, OR2B3, GALR1, TMEM196, TEAD4 and ANAPC13 were associated with atopic asthma at FDR- P < 0.05.

Conclusions

ETV and chronic stress may increase the risk of atopic asthma through DNA methylation in airway epithelium, though this needs confirmation in future longitudinal studies.

Maternal common mental disorder over time and asthma control: The role of social support

BACKGROUND

Despite therapeutic advances, asthma prevalence remains high. Psychosocial factors, including maternal mental disorders, may be involved. This study aims to evaluate the association of maternal common mental disorders (CMDs) and their change over time with asthma morbidity in the child and to observe the effect of social support on this association.

METHODS

This prospective study involved 189 dyads of mothers and their asthmatic children aged between 2 and 14 years, assisted in specialized outpatient clinics. We measured the association of maternal CMD evolution (absent, maintained, or improved over time) with asthma control and visits to the emergency department (ED) due to asthma attacks through Poisson regression analysis. We further stratified the sample according to social support levels to identify a possible effect of this variable on the association of maternal psychological symptoms with asthma morbidity.

RESULTS

Compared with mothers who maintained CMD over time, maternal CMD absence had a protective effect on the occurrence of visits to the ED (RR: 0.45; 95% CI: 0.26-0.79) and maternal CMD improvement was associated with lower risk of uncontrolled asthma in the child (RR: 0.60; 95% CI: 0.37-0.97). There was a stronger association of maternal CMD improvement with asthma control in the child only for the stratum of mothers with high social support in its three dimensions (affective-social interaction, emotional-informational, and material dimensions).

CONCLUSIONS

Maternal CMD absence and improvement over the study period were protective factors for uncontrolled asthma in the child, mainly in the presence of high social support.

Chronic stress and asthma in adolescents

OBJECTIVE

First, to review and critically discuss published evidence on psychosocial stressors, stress, and asthma in adolescents and, then, discuss potential future directions in this field.

DATA SOURCES

The data source is the National Library of Medicine (PubMed database).

STUDY SELECTIONS

A literature search was conducted for human studies on stressors or stress and asthma between 2000 and 2020. Studies that were published in English, contained a full text, and included adolescents were considered for inclusion in this review.

RESULTS

Compared with the available body of evidence in children and adults, relatively few studies have been published in adolescents. Current evidence suggests that exposure to stressors (at the individual, family, and community levels) or stress (acute and chronic) is associated with asthma and worse asthma outcomes, but such evidence must be cautiously interpreted owing to limitations in the design or the analytical approach of the published studies.

CONCLUSION

Future large studies with a prospective design should determine whether and how stressors or stress causes or worsens asthma in adolescents. At present, clinicians should assess exposure to stressors (eg, violence or abuse) and screen for anxiety and depressive disorders when caring for adolescents with asthma in addition to providing referrals to social workers or mental health professionals when appropriate. Public health policies are needed to reduce psychosocial stressors, such as gun violence and racism, in adolescents.

Structural and Social Determinants of Health in Asthma in Developed Economies: a Scoping Review of Literature Published Between 2014 and 2019

PURPOSE OF REVIEW

Using the WHO Conceptual Framework for Action on the Social Determinants of Health, this review provides a discussion of recent epidemiologic, mechanistic, and intervention studies of structural and social determinants of health and asthma outcomes covering the period from 2014 to 2019.

RECENT FINDINGS

A majority of studies and interventions to date focus on the intermediary determinants of health (e.g., housing), which as the name suggests, exist between the patient and the upstream structural determinants of health (e.g., housing policy). Race/ethnicity remains a profound social driver of asthma disparities with cumulative risk from many overlapping determinants. A growing number of studies on asthma are beginning to elucidate the underlying mechanisms that connect social determinants to human disease. Several effective interventions have been developed, though a need for large-scale policy research and innovation remains. Strong evidence supports the key role of the structural determinants, which generate social stratification and inequity, in the development and progression of asthma; yet, interventions in this realm are challenging to develop and therefore infrequent. Proximal, intermediary determinants have provided a natural starting point for interventions, though structural interventions have the most potential for major impact on asthma outcomes. Further research to investigate the interactive effect of multiple determinants, as well as intervention studies, specifically those that are cross-sector and propose innovative strategies to target structural determinants, are needed to address asthma morbidities, and more importantly, close the asthma disparity gap.

Is there association between stress and periodontitis?

OBJECTIVE

This study estimated the association between stress and periodontitis.

MATERIALS AND METHODS

A cross-sectional study was conducted with a sample of 621 individuals. Information about individuals was obtained through a questionnaire. Stress was evaluated using the Perceived Stress Scale. The diagnosis of periodontitis was based on a complete periodontal examination including clinical attachment level, probing depth, and bleeding on probing. Prevalence ratios (PR), crude and adjusted, and their respective 95% confidence intervals (95%CI) were estimated by Poisson regression analysis.

RESULTS

In the final sample, 48.47% (301) of the individuals were classified as having stress, of which, 23.92% (72) had the diagnosis of periodontitis. Association measurements between stress and probing depth ≥ 4 mm (PR_adjusted = 1.28, 95%CI [1.04 to 1.58]), stress and clinical attachment level ≥ 5 mm (PR_adjusted = 1.15, 95%CI [1.01 to 1.31]), and stress and periodontitis (PR_adjusted = 1.36, 95%CI [1.01 to 1.83]) showed that the frequency of these outcomes among those exposed to stress was 15-36% higher than those without the condition of stress, after adjustment for age, sex, schooling level, current smoking habit, pulmonary disease, and body mass index.

CONCLUSIONS

The findings showed positive association between exposure to stress and the presence of periodontitis, reaffirming the need to prevent and control stress.

CLINICAL RELEVANCE

Although there are limitations in this study, the results showed that an association exists between stress and periodontitis, signaling the necessity of a multidisciplinary attention when considering the psychological status in the management of oral and general health conditions of the individual.