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There is evidence that psychosocial stress may both induce asthma and make pre-existing asthma worse. A study in Glasgow (S Sandberg and colleagues.
) showed that among children with asthma a severely stressful life event increased the risk of an acute exacerbation 3–6 weeks after the event. High levels of chronic stress both increased the risk of an exacerbation of asthma after acute stress and reduced the length of time between the acute stress and the exacerbation. The dynamic logistic regression analysis used in that report used 2-week time periods and could not detect any effect of acute stress on asthma exacerbations soon after the stress. Now a survival analysis technique (hierarchical Cox regression) has been used on data from the same study to show that there is an effect in the first 2 days after acute stress (S Sandberg and colleagues.
This analysis was restricted to 60 of the 70 children in the study who did not have high chronic stress. They were aged 6–13 years (mean 8.5 years) and attending a hospital asthma clinic. They were followed up for 18 months with daily symptom diaries and peak flow measurements, and regular assessment of life events using a standardised interview (the Psychological Assessment of Childhood Experiences (PACE)). The children experienced 361 exacerbations of asthma and 124 severely negative life events during the study. During the first 2 days after a severely negative life event the risk of an asthma attack was increased 4.7-fold. At 3–7 days after the event the risk was not increased but between 5 weeks and 7 weeks after the event the risk was again increased (by 80%).
Among children with asthma, but without high levels of chronic stress, acute psychosocial stress has both an early and a late effect in increasing the risk of exacerbations of asthma. The early effect occurs in the first day or two after the stress and the late effect at weeks 5 to 7. The physiological mechanisms involved remain to be elucidated.
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