Rosalind J. Wright, MD, MPH
Horace W. Goldsmith Professor of Children's Health Research
Vice Chair, Clinical Translational Research
Kravis Children's Hospital
Department of Pediatrics
Icahn School of Medicine at Mount Sinai
The Stress Factor in Asthma
About 25 million Americans -- one in 12 -- have asthma. According to the Centers for Disease Control and Prevention, that number is growing every year. Rapidly expanding new research that links psychological stress to the onset of asthma may have important implications for slowing this epidemic and lowering children's risk of developing this lifelong disease.
What Is Asthma?
Asthma is a chronic inflammatory disease that causes the airways in the lungs to swell and narrow. The underlying biology that drives the disease is disrupted immune function, resulting in hypersensitivity to certain substances and environmental factors, as well as altered airway function. Symptoms include coughing, wheezing, chest tightness, and shortness of breath.
Most asthma is allergic, with symptoms triggered by exposure to such allergens as pollen, grass, dust mites and cockroaches. Other people experience symptoms when exposed to environmental irritants like air pollution, tobacco smoke and chemicals. And, for those people who are living with chronic stress or are particularly sensitive to stress or emotional upset, psychological stress can trigger changes in the immune system and airways, and manifest as asthma.
Not only can stress exacerbate asthma once you have it, but evidence suggests it also likely plays a role in the onset of asthma, which usually starts in childhood. Effects of stress on a child's developing respiratory and immune systems begin in pregnancy, and young (preschool-aged) children who are genetically predisposed to asthma remain particularly sensitive to stress as these systems continue to mature during this time.
The Mind-Body Connection
As a clinician, I have always been interested in the mind-body connection, and at the Mount Sinai Health System, we are continuing groundbreaking research investigating the role psychological stress plays in the onset of asthma. Since environmental influences start very early -- during prenatal development -- we are looking at how stress in pregnant women might affect the expression of asthma in their children in the future.
We know that psychological stress disrupts critical regulatory systems in the body that, when optimally functioning, keep us healthy. Central among these is the immune system (think of the student who gets a cold or flu after finishing a stressful exam period). Our bodies like to keep these systems operating in some optimal balance. When we are under chronic stress, our stress-response systems release consistently higher- or lower-than-normal levels of the stress hormones cortisol and epinephrine, resulting in long-term wear and tear on our bodies' processes, including those of the brain, heart, immune system, and lungs.
Our research, along with that of others, has shown that stress during pregnancy can influence the programming of a developing fetus's immune system, and affect how it works by the time the baby is born. There is also evidence that stress during pregnancy is associated with a higher risk of having a child who goes on to develop early onset asthma.
In our lab, we have found that stress experienced by women during pregnancy is also associated with poor lung growth and development in utero, leading to lower levels of lung function in children by age six years. Other data show that children with lower levels of lung function at that age are more likely to develop chronic obstructive pulmonary disease, early mortality, and heart disease later in life.
Evidence also shows that if you already have asthma, stress can be a trigger that makes it worse. This is true for many patients, and can lead to poorly controlled disease and more symptoms if clinicians don't recognize and consider stress when caring for patients with asthma.
Aiming for Less Stress
It's clear that managing psychological stress is important during the prenatal period because it can affect not only the mother's health, but also that of her developing child, even having lifelong consequences. Reducing stress during pregnancy is just as imperative as eating a healthy diet and avoiding tobacco smoke when it comes to minimizing asthma risk in children, and effects on their lungs in general.
Examining one's life and reducing stress as much as you can is important for everyone, not just pregnant women. Think about what's worrying or distressing you. What can you do to either eliminate those stressors, or adopt a means of reducing them? There are many different ways to approach stress management, and it's important to figure out what works for you. Here are just a few suggestions:
In addition, you can talk to your doctor. Clinicians are becoming aware that sometimes just acknowledging the connection between stress and asthma can help people manage their disease better. Your doctor may also be able to help with additional resources, such as making a referral to a social worker for assistance with housing or financial issues, or a referral to a counselor or therapist for individual or group therapy. If you have asthma, addressing stress in these ways can improve management of your disease and help reduce symptoms.