Asthma Development in Early Childhood May Hinge on Early Life Stress

“The mother-child pairs included in this study were part of the Polish Mother and Child Cohort (REPRO_PL), a multicenter prospective cohort established in 2007 to evaluate environmental factors contributing to the pregnancy outcomes, children’s health,” noted lead author Katarzyna Smejda, MD, PhD, from the Department of Pediatrics and Allergy at the Medical University of Lodz in Poland. “The whole cohort comprises 1700 mother-child pairs followed from pregnancy up to 2 years of age, with the ongoing stage of the study focused on children at age 7.”

Societal Stress and Asthma

Thakur and colleagues sought to determine how exogenous stressors such as discrimination affects asthma.⁴ The stress of discrimination against minorities suggests that society can exert undue pressure on the immune system of youngsters.⁴ This study cohort included African American (n=954), Mexican American (n=1086), other Latino (n=522), and Puerto Rican Islander (n=1025) youth aged 8 to 21 years.⁴

African American children who reported discrimination as measured by the Experiences of Discrimination questionnaire had a 78% higher odds for asthma development compared with those who did not report discrimination (OR, 1.78; 95% CI,1.33-2.39). African American children who felt discriminated against were also more likely to have poor asthma control compared with their peers who did not report discrimination (OR, 1.97; 95% CI, 1.42-2.76).⁴

Although similar findings were not apparent in any of the Latino cohorts, researchers found that a difference in socioeconomic status (SES) in Latino youth affected their asthma outcomes.⁴ Discrimination in Mexican youth in low SES categories (interaction P value =.01) was greater than that of other Latinos who were part of higher SES categories (interaction P value =.04).⁴

“Despite a 2-decade effort by the National Heart Lung Blood Institute and other organizations to improve asthma morbidity, the disparity in asthma-related outcomes among low-income minority children persists,” study coauthor Luisa N. Borrell, DDS, PhD, from the Graduate School of Public Health and Health Policy at the City University of New York in New York City, said in an interview with Pulmonology Advisor. “While clinicians cannot eliminate discrimination, the recognition that the stress associated with discrimination affects asthma and patient’s response to medications could help clinicians tailor their treatments for those most affected, such as African American youth.”

Summary & Clinical Applicability

Mounting evidence points to modifiable risk factors to prevent asthma in children. Prenatal and early life stress, including discrimination, are among the aspects that may contribute to wheezing and respiratory distress in childhood.

Limitations & Disclosures

None.

References

1. Rosa MJ, Lee AG, Wright RJ. Evidence establishing a link between prenatal and early-life stress and asthma development. Curr Opin Allergy Clin Immunol. 2018;18(2):148-158.
2. Busse WW, Kiecolt-Glaser JK, Coe C, Martin RJ, Weiss ST, Parker SR. NHLBI workshop summary: stress and asthma. Am J Respir Crit Care Med. 1995;151(1):249-252.
3. Smejda K, Polanska K, Merecz-Kot D, et al. Maternal stress during pregnancy and allergic diseases in children during the first year of life. Respir Care. 2018;63(1):70-76.
4. Thakur N, Barcelo NE, Borrell LN, et al. Perceived discrimination associated with asthma and related outcomes in minority youth: the GALA II and SAGE II studies. Chest. 2017;151(4):804-812.