Domestic violence exposure, even remote, may lead to worse asthma
Published: August 4, 2021
Intimate partner violence (IPV), also referred to as domestic violence, affects many Americans. All communities are affected, regardless of education level; income; race; and rural, suburban, versus urban settings. IPV can involve multiple forms of abuse to include physical, emotional, and sexual abuse; social isolation; power and control dynamics; and stalking. IPV has been connected with higher levels of multiple health conditions such as problems with pregnancy, sleep, and heart disease. For asthma, multiple studies show increased rates of asthma in both adults and children of adults exposed to IPV. However, it is not known whether history of IPV is connected with worsened asthma symptoms and flares.
This study by Wang et al. published in The Journal of Allergy and Clinical Immunology: In Practice, examined 2,634 adults with asthma who participated in a Centers for Disease Control and Prevention’s telephone-based annual health study. These adults were from 7 different states (Virginia, Vermont, Rhode Island, Ohio, Iowa, Missouri, and Arizona) that included questions on asthma and intimate partner violence. Questions on IPV included whether they ever had experienced threatened, attempted, or completed physical violence and whether they experienced unwanted sex by a current or former intimate partner. There were also questions about whether they had recently experienced such violence or injuries from it.
Wang et al. found that one third of asthmatics reported a history of physical or sexual violence from an intimate partner. Therefore, IPV is a very common issue affecting a great number of adult asthmatics across the U.S. This likely underestimates how many are affected as the questions on IPV were focused on physical and sexual violence and did not include those suffering from other forms of abuse, such as emotional abuse or stalking.
Compared to those without any history of IPV exposure, persons with asthma reporting IPV had more asthma flares, needed to go to the emergency department or urgent care for their asthma more often, and needed to see their health care provider urgently for their asthma more often. Also, they had more asthma symptoms including symptoms during the day and symptoms that woke them up at night. In addition, they more often reported that their asthma affected their ability to do their work or usual activities. These findings remained strong regardless of sex, race/ethnicity, age, smoking history, weight, education level, and health care coverage status. In addition, these findings remained strong even for those who reported remote IPV exposure, in other words, those who had not been exposed to IPV for over 1 year. This suggests that IPV may have some lasting influences on asthma, even if the violence occurred in the past.
Therefore, history of intimate partner violence may be important for both patients and providers to consider in cases of difficult to control asthma. This is the first study in a diverse, large U.S. population to demonstrate IPV’s significant connection with worse asthma, and highlights the importance of gaining better understanding of the role of IPV— a common, under-addressed, and impactful health phenomenon—on asthma.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.