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

The role of acute and chronic stress in asthma attacks in children
The role of acute and chronic stress in asthma attacks in children
Background: High levels of stress have been shown to predict the onset of asthma in children genetically at risk, and to correlate with higher asthma morbidity. Our study set out to examine whether stressful experiences actually provoke new exacerbations in children who already have asthma.

Methods: A group of child patients with verified chronic asthma were prospectively followed up for 18 months. We used continuous monitoring of asthma by the use of diaries and daily peak-flow values, accompanied by repeated interview assessments of life events and long-term psychosocial experiences. The key measures included asthma exacerbations, severely negative life events, and chronic stressors.

Findings: Severe events, both on their own and in conjunction with high chronic stress, significantly increased the risk of new asthma attacks. The effect of severe events without accompanying chronic stress involved a small delay; they had no effect within the first 2 weeks, but significantly increased the risk in the subsequent 4 weeks (odds ratio 1·71 [95% Cl 1·04–2·82], p?0·05 for weeks 2–4 and 2·17 [1·32–3·57], p?0·01 for weeks 4–6). When severe events occurred against the backdrop of high chronic stress, the risk increased sharply and almost immediately within the first fortnight (2·98 [1·20–7·38], p?0–05). The overall attack frequency was affected by several factors, some related to asthma and some to child characteristics. Female sex, higher baseline illness severity, three or more attacks within 6 months, autumn to winter season, and parental smoking were all related to increased risk of new exacerbations; social class and chronic stress were not.

Interpretation: Severely negative life events increase the risk of children's asthma attacks over the coming few weeks. This risk is magnified and brought forward in time if the child's life situation is also characterised by multiple chronic stressors.
0140-6736
982-987.
Sandberg, Seija
11c05503-fae1-4d53-bfae-c38da775c5af
Paton, James
0df584a6-e49f-413c-9927-232df350bbbc
Ahola, Sara
cebb03cc-2c5d-4baf-a482-30618e6fe80c
McCann, Donna
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McGuinness, David
214dd98e-0849-4f22-946a-0f3f3132f4d8
Hillary, Clive R.
002fdc34-4ea1-45ed-a44b-084947c71ed0
Oja, Hannu
a8aab709-12ef-4f0f-9fd3-5cd5c63400e5
Sandberg, Seija
11c05503-fae1-4d53-bfae-c38da775c5af
Paton, James
0df584a6-e49f-413c-9927-232df350bbbc
Ahola, Sara
cebb03cc-2c5d-4baf-a482-30618e6fe80c
McCann, Donna
8c5e4455-018a-475e-a2e3-3faca15f7ddf
McGuinness, David
214dd98e-0849-4f22-946a-0f3f3132f4d8
Hillary, Clive R.
002fdc34-4ea1-45ed-a44b-084947c71ed0
Oja, Hannu
a8aab709-12ef-4f0f-9fd3-5cd5c63400e5

Sandberg, Seija, Paton, James, Ahola, Sara, McCann, Donna, McGuinness, David, Hillary, Clive R. and Oja, Hannu (2000) The role of acute and chronic stress in asthma attacks in children. The Lancet, 356 (9234), 982-987.. (doi:10.1016/S0140-6736(00)02715-X).

Record type: Article

Abstract

Background: High levels of stress have been shown to predict the onset of asthma in children genetically at risk, and to correlate with higher asthma morbidity. Our study set out to examine whether stressful experiences actually provoke new exacerbations in children who already have asthma.

Methods: A group of child patients with verified chronic asthma were prospectively followed up for 18 months. We used continuous monitoring of asthma by the use of diaries and daily peak-flow values, accompanied by repeated interview assessments of life events and long-term psychosocial experiences. The key measures included asthma exacerbations, severely negative life events, and chronic stressors.

Findings: Severe events, both on their own and in conjunction with high chronic stress, significantly increased the risk of new asthma attacks. The effect of severe events without accompanying chronic stress involved a small delay; they had no effect within the first 2 weeks, but significantly increased the risk in the subsequent 4 weeks (odds ratio 1·71 [95% Cl 1·04–2·82], p?0·05 for weeks 2–4 and 2·17 [1·32–3·57], p?0·01 for weeks 4–6). When severe events occurred against the backdrop of high chronic stress, the risk increased sharply and almost immediately within the first fortnight (2·98 [1·20–7·38], p?0–05). The overall attack frequency was affected by several factors, some related to asthma and some to child characteristics. Female sex, higher baseline illness severity, three or more attacks within 6 months, autumn to winter season, and parental smoking were all related to increased risk of new exacerbations; social class and chronic stress were not.

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

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Published date: 2000
Organisations: Clinical Neurosciences

Identifiers

Local EPrints ID: 40394
URI: http://eprints.soton.ac.uk/id/eprint/40394
ISSN: 0140-6736
PURE UUID: 663804d7-3cdf-4601-b33b-46b5dde6cddf

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Date deposited: 19 Jul 2006
Last modified: 15 Mar 2024 08:19

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Contributors

Author: Seija Sandberg
Author: James Paton
Author: Sara Ahola
Author: Donna McCann
Author: David McGuinness
Author: Clive R. Hillary
Author: Hannu Oja

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