COMMENTARY

Stress and Adult Asthma: The Link Gets Stronger

A Best Evidence Review

Charles P. Vega, MD

Disclosures

February 07, 2013

In This Article

Best Evidence Review of Stress and Risk for Asthma

Reference

Rod NH, Kristensen TS, Lange P, Prescott E, Diderichsen F. Perceived stress and risk of adult-onset asthma and other atopic disorders: a longitudinal cohort study. Allergy. 2012;67:1408-1414.

Introduction

The prevalence of asthma is on the rise. Could our stressful, chaotic lives contribute to its risk?

The current study followed more than 5000 adults for incident cases of asthma over 10 years, and the researchers found that higher levels of stress doubled the risk for asthma, even after adjustment for multiple confounding variables. Although not conclusive, these findings bear scrutiny and strong consideration of stress as a novel risk factor for asthma.

Background

Asthma is a common medical condition that affects millions of US adults. A study of data from the National Health and Nutrition Survey 2001-2004 demonstrated that the prevalence of current asthma was 8.8% and 5.8% among women and men, respectively[1]; 13.7% of women and 10.4% of men had been diagnosed with asthma at some point during their lifetime.

Not only is asthma common, but its prevalence is rising.[2] The overall number of persons in the United States diagnosed with current asthma more than doubled between 1980 and 2005. The increase in prevalence among children was particularly striking, which suggests that asthma will continue to become more common over time.

What is causing the rising prevalence of asthma? Many factors have been cited. Exposure to air pollution is associated with a higher risk for asthma, particularly among children.[3] More broadly, poverty has been associated with a higher risk for asthma among children.[4] Obesity seems to promote a modest but significant increase in the risk for asthma among children and also increases the risk, particularly for nonallergic asthma, among adults.[5,6]

Stress has not been widely evaluated as contributing to the risk for asthma, but its ubiquity cannot be denied. In a 2011 report from the Centers for Disease Control, the prevalence of serious psychological distress in the past 30 days among US adults was 3%-4%.[7] Over 10% of days in the past month were considered mentally unhealthy by study participants. Although physicians may see only part of the impact of mental distress and mental illness among adults, 5% of all outpatient visits to a physician are due to these issues. This translates to nearly 50 million office visits per year.

Previous research has evaluated the potential link between stress and asthma, with mixed results. A study of 686 hospital admissions found that both stress and mood disorders were associated with a higher risk for hospitalization for asthma.[8] However, a systematic review focusing on the relationship between stress and serious asthma outcomes found substantial heterogeneity in the collective literature.[9] The authors conclude that evidence is insufficient to suggest that psychological factors significantly affect the risk for fatal or near-fatal asthma events.

The association between stress and asthma clearly needs more investigation, and the current study addresses this issue. With a large patient database and clever solutions to the inherent limitations of the research design, this study merits attention.

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