Double-exposure to acute stress and chronic family stress is associated with immune changes in children with asthma

Abstract

Objective: To understand how psychological stress heightens risk for asthma flare-ups, we examined the relationship between acute stress, chronic family stress, and the production of asthma-related cytokines.

Methods: Seventy-one children with asthma and 76 medically healthy children completed interviews regarding life stress, and peripheral blood samples were collected. After mononuclear cells had been mitogenically stimulated, production of the cytokines interleukin (IL)-4, IL-5, IL-13, and IFN-gamma was measured. All measurements were repeated every 6 months for 2 years. Children reported on their asthma symptoms for 14 days after each study visit.

Results: Children with asthma who had higher levels of chronic family stress showed increased production of IL-4, IL-5, and IFN-gamma at times when they had experienced an acute event compared with times when they had not. These stress-related changes did not occur in asthmatic children with lower levels of chronic family stress, or in healthy controls. The combination of acute and chronic stress was also associated with increased asthma symptoms.

Conclusion: These findings suggest that acute negative life events have a particularly strong impact among a subgroup of children with asthma who are under high chronic family stress. The heightened inflammatory profile in this group suggests an explanation for why children experiencing life stressors are at greater risk for asthma exacerbations.

Figure 1

Predicted values of stimulated interleukin-4 at the 25^th and 75^th percentiles of chronic family stress for asthma patients who had and had not experienced a significant life event (n=71).

Figure 2

Predicted values of stimulated interleukin-5 at the 25^th and 75^th percentiles of chronic family stress for asthma patients who had and had not experienced a significant life event (n=71).

Figure 3

Predicted values of stimulated interferon-gamma at the 25^th and 75^th percentiles of chronic family stress for asthma patients who had and had not experienced a significant life event (n=71).

Figure 4

Predicted symptom scores at the 25^th and 75^th percentiles of chronic family stress for asthma patients who had and had not experienced a significant life event. These data represent a subgroup of children who have moderate to severe asthma (n=32).