Hsu Chiun Yu, Lehman Heather K, Wood Beatrice L, Benipal Jaspreet, Humayun Quratulain, Miller Bruce D
Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY; Child and Family Asthma Studies Center, Oishei Children's Hospital, Buffalo, NY.
Child and Family Asthma Studies Center, Oishei Children's Hospital, Buffalo, NY; Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY; Allergy & Immunology, Oishei Children's Hospital, Buffalo, NY.
J Allergy Clin Immunol Pract. 2020 Sep;8(8):2689-2697. doi: 10.1016/j.jaip.2020.03.036. Epub 2020 Apr 15.
Overweight/obesity (OV/OB) and depression have each been separately associated with worsened childhood asthma severity and control. Pathways by which these factors may jointly affect childhood asthma have not been elucidated.
To examine the interrelationship of OV/OB and depressive symptoms with childhood asthma and explore associated psychobiologic pathways. The present study investigated whether comorbid OV/OB and depressive symptoms are associated with impaired baseline lung function and increased airway resistance during emotional stress, and to assess whether such effects may be mediated by autonomic nervous system (ANS) dysregulation, specifically through predominance of vagal over sympathetic reactivity (vagal bias).
A total of 250 children with asthma, aged 7 to 17, were assessed for OV/OB using body mass index, depressive symptoms using the Children's Depression Inventory (CDI), and asthma severity using National Asthma Education and Prevention Program Expert Panel Report 3 criteria. Baseline pulmonary function (forced expiratory volume in 1 second [FEV]) was assessed. The film "E.T. the Extra-Terrestrial" was used in a laboratory paradigm to evoke emotional stress/arousal. Airway resistance (R) was measured before and after the film to determine changes in airway function. ANS reactivity was assessed by measuring parasympathetic/vagal and sympathetic reactivity throughout the film.
In OV/OB children with asthma, depressive symptoms predicted lower baseline FEV (β = -0.67, standard error [SE] = 0.24, P = .008), CDI predicted vagal bias under emotion stress/arousal (β = 0.27, SE = 0.09, P = .009), and vagal bias predicted increased R (β = 3.55, SE = 1.54, P = .023).
This study is the first to link OV/OB and depressive symptoms in their relationship to childhood asthma. In OV/OB children with asthma, depression may potentiate airway compromise, mediated by vagal bias. Use of antidepressant and anticholinergic therapies should be studied in this subgroup of patients.
超重/肥胖（OV/OB）和抑郁症各自都与儿童哮喘严重程度和控制情况恶化有关。这些因素可能共同影响儿童哮喘的途径尚未阐明。
研究OV/OB和抑郁症状与儿童哮喘之间的相互关系，并探索相关的心理生物学途径。本研究调查了合并OV/OB和抑郁症状是否与基线肺功能受损以及情绪应激期间气道阻力增加有关，并评估这种影响是否可能由自主神经系统（ANS）失调介导，特别是通过迷走神经相对于交感神经反应性占优势（迷走神经偏向）。
对250名7至17岁的哮喘儿童进行评估，使用体重指数评估OV/OB，使用儿童抑郁量表（CDI）评估抑郁症状，使用国家哮喘教育和预防计划专家小组报告3标准评估哮喘严重程度。评估基线肺功能（1秒用力呼气量[FEV]）。在实验室范式中使用电影《E.T.外星人》引发情绪应激/唤醒。在电影前后测量气道阻力（R）以确定气道功能的变化。通过在整个电影过程中测量副交感神经/迷走神经和交感神经反应性来评估ANS反应性。
在患有哮喘的OV/OB儿童中，抑郁症状预示着较低的基线FEV（β = -0.67，标准误[SE] = 0.24，P = .008），CDI预示着情绪应激/唤醒下的迷走神经偏向（β = 0.27，SE = 0.09，P = .009），迷走神经偏向预示着R增加（β = 3.55，SE = 1.54，P = .023）。
本研究首次将OV/OB和抑郁症状与儿童哮喘的关系联系起来。在患有哮喘的OV/OB儿童中，抑郁症可能通过迷走神经偏向介导加剧气道损害。应在这一亚组患者中研究使用抗抑郁药和抗胆碱能疗法。
