Effects of Stress and Depression on Asthma

The effect of emotional distress on asthma has been controversial over the years. Although emotional compromise has an effect on adherence to appropriate medical management, robust evidence also indicates that direct psychobiological pathways and mechanisms link stress and emotions with disease activity (Chen and Miller 2007; B.D. Miller and Wood 2003; G.E. Miller and Chen 2006; Wright et al. 1998). Evidence links negative family emotional climate to child depression, emotional triggering of asthma episodes (Wood et al. 2007), and worse disease activity (Wood et al. 2006).

Mounting evidence indicates that chronic and acute extreme stress contributes to the worsening of pediatric asthma (Chen and Miller 2007; Sandberg et al. 2000, 2004). The most significant stressors are family-related circumstances and relational pro cesses. A series of multimethod (self-report, clinician report, family observation) studies has demonstrated that the chronic stress of negative family emotional climate, marital conflict, and negative parent-child relationship contributes to child anxiety and depression, which in turn are associated with increased asthma disease activity (Lim et al. 2008; Wood et al. 2006, 2008). These findings are consistent with a longitudinal study in which Klinnert et al. (2008) reported that a negative emotional environment was associated with active asthma and adjustment problems at age 4 in a high-risk population of children whose parents have asthma.

Before the psychobiological pathways contributing to asthma disease activity can be traced, the biological mechanisms by which stress and emotions influence asthma airway function need to be established. The two mechanisms of airway compromise in asthma (immune/inflammatory and cholinergic/ vagal) point to two possible psychobiological pathways with associated mechanisms: 1) psycho-neuroimmunological and 2) psychophysiological (autonomic).

Greg Miller and Edith Chen are developing and examining a model focusing on immunological pathways. The premise is that psychological stress operates by altering the magnitude of the airway inflammatory response that irritants, allergens, and infections bring about in persons with asthma. The asthma-relevant biological stress pathways they have examined include the hypothalamic-pituitary-adrenal axis and the sympathoadrenal-medullary system (Chen and Miller 2007; Chen et al. 2006; G.E. Miller and Chen 2006). Chronic stress is believed to alter the hypothalamic-pituitary-adrenal axis, sympathoadrenal-medullary system, and auto-nomic nervous system pathways in ways that reduce their regulation of immune system function. The proximal (to the airway) elements in this cascade of effects are specific cytokines that promote airway inflammation and obstruction.

Bruce Miller's autonomic nervous system dysreg-ulation model is similarly a potentiating model. However, this model focuses on the effect of depressive emotional states on airway function, mediated by a preponderance of vagal/parasympathetic over sympathetic activation (i.e., vagal bias) (B.D. Miller and Wood 1997). This relatively high level of vagal activation and reactivity is proposed to potentiate the effect of irritants, allergens, infections, and emotional distress on vagally (i.e., cholinergically) mediated airway constriction.

Studies from both laboratories provide support for both models, which together provide a comprehensive paradigm including both major mechanisms of airway compromise—that is, cholinergically mediated airway constriction (B.D. Miller et al. 2009) and immune-mediated airway inflammation (Wolf et al. 2008a, 2008b). Of note, both laboratories demonstrate the impact of family relational stressors as critical sources of chronic stress. Although compelling, this research is still in early stages, and many questions remain to be answered in the realm of psychobiological pathways and mechanisms in asthma.

Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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