Stress and airway resistance in children with asthma

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Abstract

Objective: The present study implements an experimental paradigm to examine airway reactivity to stress in children with asthma and controls. Method: 114 children with asthma and 30 controls (ages 9–15) participated. The protocol involved 5 min of baseline physiological measurements followed by a 5-min stressful task. Skin conductance (EDG), skin temperature, and heart rate were measured continuously. Airway resistance was measured at baseline and after the task. Results: 110 children (76% of the sample) were significantly “stressed” as shown by physiological changes. Asthmatics and controls differed on overall airway resistance, F(1,108)=12.3, P<.001. The entire sample demonstrated a trend toward increased airway resistance in response to stress, F(1,108)=3.1, P<.08. A portion of asthmatics (22%) had increases of greater than 20% of baseline airway resistance. Changes in airway resistance in response to stress were unrelated to asthma severity, F(2,78)=2.0, ns. Conclusion: Children with asthma and controls demonstrate variation in airway function in response to stress, although increases are likely more meaningful for children with asthma. Further research is needed to examine the mechanisms underlying this response.

Section snippets

Subjects

Participants were children attending a week long summer camp for children with asthma, and healthy controls recruited from the community. Data were collected as part of a larger study investigating psychological factors and changes in physiology in children with asthma [11]. Children ranged in age from 9 to 15 years. Participants with asthma were recruited at camp enrollment by team researchers, who assessed parent and child interest in participating in a brief study on emotions and asthma

Baseline differences between children with asthma and controls

A preliminary set of analyses examined whether children with asthma and healthy controls differed on any baseline physiologic measures. These results indicated no initial differences between children with asthma and controls on baseline measures of EDG and skin temperature. Children with asthma did have significantly higher baseline heart rate (t=−3.40, P<.001), and significantly higher intrinsic airway resistance (t=−3.83, P<.001) measured at baseline. Means by group are presented in Table 1.

Effects of stress on EDG, temperature, and heart rate

Discussion

The intrinsic physiological abnormality in asthma is a predisposition to bronchial hyperreactivity [18]. Clinical impressions and reviews of existing literature indicate that for a proportion of individuals with asthma, emotions such as stress can trigger asthma exacerbations [2]. The present study is an initial investigation of this phenomenon in the pediatric asthma population through an experimental paradigm designed to induce mild levels of stress in children.

Acknowledgements

This research was supported by NICHD grant R03-HD37023 and American Lung Association Grant CG-002 awarded to the first author, and NHLBI grant R01-HL45157 awarded to the second author. Special thanks to Sheryl Kopel, Kimberly Howard, and Keren Rosenblum for their valuable assistance on this project.

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