A recent review paper outlines the many risk factors for asthma including those that are psychological, social, and lifestyle-related.
The most common chronic illness that affects children in the United States is asthma. Approximately 14.5% of children have this disease and it adversely affects their physical and psychosocial health. Many environmental, psychological, and social factors play a role in asthma and there have been many studies that explore these risk factors for asthma.
An American group of researchers recently put together a review article that summarizes what we know about the risk factors for asthma in childhood and the types of interventions that aim to prevent or improve this disease. The results were recently published in the World Allergy Organization Journal.
Children from different socioeconomic backgrounds and races are unequally affected by asthma. The rate of asthma prevalence is much higher in low-income and minority youth. Furthermore, minorities have higher rates of exacerbations and mortality from asthma. Studies have suggested that a low-income household correlates with more polluted environments and an increase in stress due to family conflicts or neighborhood conflicts. A possible link between stress and asthma is the fact that stress can induce inflammation in the body, and hence influence asthma symptoms.
Other studies have noted that children from low-income backgrounds have less support and involvement from their parents, who play the most important role in ensuring the children receive proper asthma management and treatment. In addition, lower parental education, which is associated with low-income, leads to lower adherence to asthma medication. Another reason for lower adherence is less community support, which is more common in lower-income neighborhoods. There is evidence that children with asthma display more behavioral and psychological problems than children without asthma. It is also stressful for caregivers of children with asthma and there is an increased risk for psychological difficulties in caregivers as well.
Many lifestyle factors influence asthma as well. Obesity and asthma are correlated with children, and obesity also complicates asthma management. Additionally, children with asthma perform less physical activity when compared to their healthy peers. Children with asthma, however, have better mental health when they perform more physical activity. In the same vein, unhealthy diets can also influence asthma. More specifically, one that is high in fats and processed foods appears to increase asthma prevalence rates in children, compared to diets with less fat and processed foods.
There are many strategies aside from using medications to relieve the adverse effects of asthma. Psychosocial interventions, such as educational programs, cognitive-behavioral therapy, and community-based interventions, are available for children with asthma. These programs appear to have some benefits for the affected individuals, but more evidence is required to definitively validate the benefits. Self-management training and education can be effective in improving adherence and reducing symptoms, but this strategy differs greatly across the world in effectiveness due to the wide variety of educational materials. Nevertheless, there is a necessity for additional resources to ensure that children with asthma have multiple types of intervention in order to more effectively improve health outcomes.
Hence, there is currently a large push towards integrated care, which aims to address mental health, patient education, family functioning, and medical care. This approach has been shown to demonstrate great improvements in asthma symptoms and quality of life for caregivers and children. This approach is promising in addressing the many aspects of asthma, rather than only in the traditional medical sense. This holistic plan can at once limit many of the complex risk factors for asthma exacerbations and morbidity. Additional research conducted in integrated care will be useful not only in improving health outcomes for asthma patients but also potentially for other diseases that involve multiple inter-related risk factors.
Written by Branson Chen, BHSc
Reference: Oland AA, Booster GD, Bender BG. Psychological and lifestyle risk factors for asthma exacerbations and morbidity in children. World Allergy Organization Journal. 2017 Oct 17;10(1):35.