Epidemiology of Stress and Asthma: From Constricting Communities and Fragile Families to Epigenetics
Section snippets
Need for a prospective developmental framework
This overview considers the developmental origins of both asthma risk1 and lung structure and function2 given that both involve coordinated maturation of interrelated systems: immune, neural, and endocrine. Moreover, although the origins of chronic lung diseases are multifactorial, the underlying mechanisms leading to reduced lung function and exaggerated airway responsiveness involve chronic airway inflammation associated with a cycle of injury, repair, and remodeling.5, 6 Airway inflammation
Genetics
Most advances in our knowledge of the genetic and molecular events underlying the neurobiology of the stress response have occurred in animal models140 and psychiatric outcomes in humans.141 These animal data suggest that studies to determine the role of genetics in modifying the risk of the social/physical environment experienced through psychological stress may further inform pathways through which stress may affect asthma expression. Genetic factors of potential importance include those that
Epigenetics: a fundamental programming mechanism
Programming effects of stress on respiratory outcomes may operate at a more fundamental molecular level, through epigenetic programming. Epigenetics may be at the roots of developmental plasticity imprinting environmental experiences on the fixed genome,148 although data are scare for respiratory health and allergic disorders.149, 150 Determining the range of environmental exposures that affect the epigenome during development was a research priority identified at the recent National Heart Lung
Summary
The evidence points toward the need to consider social environmental factors (ie, stress) as mainstream in asthma epidemiologic research. The likelihood of multiple mechanistic pathways with complex interdependencies must be considered when examining the integrative influence of stress independently, as well as the interaction of social and physical environmental toxins on asthma and atopy. Because these factors tend to cluster in the most socially disadvantaged, this line of research may
References (185)
Perinatal stress and early life programming of lung structure and function
Biol Psychol
(2010)- et al.
Contemporaneous maturation of immunologic and respiratory functions during early childhood: implications for development of asthma prevention strategies
J Allergy Clin Immunol
(2005) The development of respiratory inflammation in children
Paediatr Respir Rev
(2006)- et al.
An immunoepidemiological approach to asthma: identification of in-vitro T-cell response patterns associated with different wheezing phenotypes in children
Lancet
(2005) - et al.
How epidemiology has challenged 3 prevailing concepts about atopic dermatitis
J Allergy Clin Immunol
(2006) - et al.
The atopic march: the pattern of allergic disease development in childhood
Immunol Allergy Clin North Am
(2005) Protective and damaging effects of stress mediators: the good and bad sides of the response to stress
Metabolism
(2002)- et al.
Physiological stress reactivity in human pregnancy – a review
Neurosci Biobehav Rev
(2005) - et al.
Do early-life events permanently alter behavioral and hormonal responses to stressors?
Int J Dev Neurosci
(1998) - et al.
Immunologic messenger molecules: cytokines, interferons, and chemokines
J Allergy Clin Immunol
(2010)
Noneosinophilic asthma: a distinct clinical and pathologic phenotype
J Allergy Clin Immunol
Stress-induced neurogenic inflammation in murine skin skews dendritic cells towards maturation and migration. Key role of intercellular adhesion molecule-1/leukocyte function-associated antigen interactions
Am J Pathol
Reduced interferon-gamma secretion in neonates and subsequent atopy
Lancet
Tucson children’s respiratory study: 1980 to present
J Allergy Clin Immunol
Prenatal, perinatal, and heritable influences on cord blood immune responses
Ann Allergy Asthma Immunol
Chronic caregiver stress and IgE expression, allergen-induced proliferation and cytokine profiles in a birth cohort predisposed to atopy
J Allergy Clin Immunol
Early sensitization and development of allergic airway disease – risk factors and predictors
Paediatr Respir Rev
Distress and expression of natural killer receptors on lymphocytes
Brain Behav Immun
Stress and inflammation in exacerbations of asthma
Brain Behav Immun
Glucocorticoids, feto-placental 11-beta-hydroxysteroid dehydrogenase type 2, and the early life origins of adult disease
Steroids
Glucocorticoid programming of the fetus: adult phenotypes and molecular mechanisms
Mol Cell Endocrinol
Maternal stress and T-cell differentiation of the developing immune system: possible implications for the development of asthma and atopy
J Allergy Clin Immunol
Stress and atopic disorders
J Allergy Clin Immunol
Increased responsiveness of the hypothalamus-pituitary-adrenal (HPA) axis to stress in newborns with atopic disposition
Psychoneuroendocrinology
Social stress and asthma: the role of corticosteroid insensitivity
J Allergy Clin Immunol
Oxidative stress modulates theophylline effects on steroid responsiveness
Biochem Biophys Res Commun
Molecular mechanisms of corticosteroid resistance
Chest
How early do airway inflammation and remodeling occur?
Allergol Int
Parental support and cytokine activity in childhood asthma: the role of glucocorticoid sensitivity
J Allergy Clin Immunol
Measuring cortisol in human psychobiological studies
Physiol Behav
Stress in pregnancy and infant HPA axis function: conceptual and methodological issues relating to the use of salivary cortisol as an outcome measure
Psychoneuroendocrinology
Assessing salivary cortisol in large-scale, epidemiological research
Psychoneuroendocrinology
Hair as a retrospective calendar of cortisol production – increased cortisol incorporation into hair in the third trimester of pregnancy
Psychoneuroendocrinology
Development of cortisol circadian rhythm in infancy
Early Hum Dev
Evolution an ontogeny of stress response to social challenge in the human child
Dev Rev
Child’s stress hormone levels correlate with mother’s socioeconomic status and depressive state
Biol Psychiatry
The emergence of adrenocortical circadian function in newborns and infants and its relationship to sleep, feeding, and maternal adrenocortical activity
Early Hum Dev
Prenatal maternal stress and early caregiving experiences: implications for childhood asthma risk
Paediatr Perinat Epidemiol
Environmental health disparities: a framework integrating psychosocial and environmental concepts
Environ Health Perspect
Moving towards making social toxins mainstream in children’s environmental health
Curr Opin Pediatr
Asthma: a dynamic disease of inflammation and repair
Markers of eosinophilic inflammation and tissue re-modelling in children before clinically diagnosed bronchial asthma
Pediatr Allergy Immunol
Airway inflammation is present during clinical remission of atopic asthma
Am J Respir Crit Care Med
Outcome of asthma and wheezing in the first 6 years of life: follow-up through adolescence
Am J Respir Crit Care Med
Risk factors for airway remodeling in asthma manifested by a low postbronchodilator FEV1/vital capacity ratio: a longitudinal population study from childhood to adulthood
Am J Respir Crit Care Med
The early-life origins of asthma
Curr Opin Allergy Clin Immunol
Phenotypic plasticity and the epigenetics of human disease
Nature
Differences in familial segregation of FEV1 between asthmatic and nonasthmatic families: role of maternal component
Am J Respir Crit Care Med
Genetics of asthma: a molecular biologist perspective
Clin Mol Allergy
Parental history and the risk for childhood asthma. Does mother confer more risk than father?
Am J Respir Crit Care Med
Cited by (113)
Multiple adverse childhood experiences and asthma onset in adulthood: Role of adulthood risk factors as mediators
2021, Journal of Psychosomatic ResearchA Current Overview of the Psychological Aspects of Asthma in Adults
2020, Archivos de BronconeumologiaAssociations of urban greenness with asthma and respiratory symptoms in Mexican American children
2019, Annals of Allergy, Asthma and ImmunologyCompounding Effects of Social Vulnerability and Recurring Natural Disasters on Mental and Physical Health
2022, Disaster Medicine and Public Health Preparedness
During preparation of this manuscript Dr Wright was supported by R01HL080674 and R01HL095606.