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JACI Highlights - July 2009Depressed asthmatic youth at increased riskStress and depression have been implicated in asthma morbidity and mortality, and depression is prevalent (16%) in pediatric asthma. However, pathways linking stress, depression, and asthma have not been fully elucidated. In a recent study of 171 asthmatic children and adolescents, Bruce Miller and colleagues compared depressed with nondepressed asthmatic youth under laboratory-controlled, emotional stress conditions. They tested an hypothesized autonomic (vagal/cholinergic) pathway by which stress and depression influence airway function in asthma. Subjects viewed the film E.T.: The Extra-Terrestrial while vagal and sympathetic reactivity were continuously measured. Pulmonary function (FEV1 and airway resistance) was measured before and after the film. Demographics, adherence, and disease severity did not differ by group. Depressed subjects showed a preponderance of vagal over sympathetic reactivity (i.e., “vagal bias”) during targeted film scenes. Vagal bias was most prominent during sad scenes depicting family distress and interpersonal loss. Depression and vagal bias were associated with increased airway resistance, thus supporting a depression-vagal bias-airway resistance pathway. On the basis of their findings, the authors suggest that screening for depressive symptoms and stressful life events can be important in asthma management. They further propose that psychosocial intervention and targeted use of antidepressant medications and/or anticholinergic asthma medications might prove beneficial adjuncts in the treatment of pediatric asthma. They note, however, that further research is needed to validate these clinical assertions. “Depressed asthmatic children evidence increased airway resistance: ‘Vagal bias’ as a mechanism?” by Miller BD et al. (JACI July 2009 Volume 124 No. 1) |
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