Sandberg S, Paton J Y, Ahola S, McCann D C, McGuinness D, Hillary C R, Oja H
Hospital for Children and Adolescents, University of Helsinki, Finland.
Lancet. 2000 Sep 16;356(9234):982-7. doi: 10.1016/S0140-6736(00)02715-X.
High levels of stress have been shown to predict the onset of asthma in children genetically at risk, and to correlate with higher asthma morbidity. Our study set out to examine whether stressful experiences actually provoke new exacerbations in children who already have asthma.
A group of child patients with verified chronic asthma were prospectively followed up for 18 months. We used continuous monitoring of asthma by the use of diaries and daily peak-flow values, accompanied by repeated interview assessments of life events and long-term psychosocial experiences. The key measures included asthma exacerbations, severely negative life events, and chronic stressors.
Severe events, both on their own and in conjunction with high chronic stress, significantly increased the risk of new asthma attacks. The effect of severe events without accompanying chronic stress involved a small delay; they had no effect within the first 2 weeks, but significantly increased the risk in the subsequent 4 weeks (odds ratio 1.71 [95% CI 1.04-2.82], p < or = 0.05 for weeks 2-4 and 2.17 [1.32-3.57], p < or = 0.01 for weeks 4-6). When severe events occurred against the backdrop of high chronic stress, the risk increased sharply and almost immediately within the first fortnight (2.98 [1.20-7.38], p < or = 0.05). The overall attack frequency was affected by several factors, some related to asthma and some to child characteristics. Female sex, higher baseline illness severity, three or more attacks within 6 months, autumn to winter season, and parental smoking were all related to increased risk of new exacerbations; social class and chronic stress were not.
Severely negative life events increase the risk of children's asthma attacks over the coming few weeks. This risk is magnified and brought forward in time if the child's life situation is also characterised by multiple chronic stressors.
研究表明，高水平压力可预测有遗传风险儿童哮喘的发病，并与更高的哮喘发病率相关。我们的研究旨在探讨压力性经历是否真的会引发已有哮喘儿童的新的病情加重。
对一组确诊为慢性哮喘的儿童患者进行为期18个月的前瞻性随访。我们通过日记和每日峰值呼气流速值持续监测哮喘情况，并对生活事件和长期心理社会经历进行反复访谈评估。关键指标包括哮喘病情加重、严重负面生活事件和慢性应激源。
严重事件单独发生或与高慢性压力共同作用时，都会显著增加新的哮喘发作风险。无慢性压力伴随的严重事件的影响有一个小的延迟；在最初2周内无影响，但在随后4周内显著增加风险（第2 - 4周比值比为1.71 [95%可信区间1.04 - 2.82]，p≤0.05；第4 - 6周为2.17 [1.32 - 3.57]），p≤0.01）。当严重事件在高慢性压力背景下发生时，风险在头两周内急剧且几乎立即增加（2.98 [1.20 - 7.38]，p≤0.05）。总体发作频率受多种因素影响，一些与哮喘有关，一些与儿童特征有关。女性、基线疾病严重程度较高、6个月内发作3次或更多次、秋冬季节以及父母吸烟均与新病情加重风险增加有关；社会阶层和慢性压力则无关。
严重负面生活事件会增加儿童在未来几周内哮喘发作的风险。如果儿童的生活状况同时还存在多种慢性应激源，这种风险会被放大并提前出现。
