Published Online: December 7, 2012
Experiences of violence contribute to the occurrence of childhood asthma but there is little information on the effect of early life abuse on adult-onset asthma. Several cross sectional studies have shown a higher prevalence of respiratory problems and asthma in adults who were abused as children, but no prospective studies have been conducted.
In an article recently published in The Journal of Allergy & Clinical Immunology (JACI), Coogan et al used data from the prospective Black Women’s Health Study (BWHS) to test the hypothesis that abuse during childhood and/or adolescence increased the incidence of adult-onset asthma. Fifty-nine thousand African American women enrolled in BWHS in 1995. Information on disease and a wide variety of demographic, lifestyle, and health data have been reported every 2 years on self-administered questionnaires. The present study included over 28,000 women who, at baseline, had never had asthma and who answered questions about abuse during childhood (up to age 11) and adolescence (ages 12-18) on the 2005 questionnaire. The women were followed for 16 years for new diagnoses of adult-onset asthma.
The researchers found that women who reported abuse as a child had a significantly higher incidence of adult-onset asthma than women who were not abused as children or adolescents. The increase in risk of asthma was higher for childhood physical abuse (a statistically significant 26% increase) than for sexual abuse (a 15% increase). There was little evidence that abuse during adolescence was associated with increased risk of adult-onset asthma. The increase in risk associated with childhood physical abuse was stronger in women who also reported feeling in danger in the home, which might indicate more severe abuse, and was stronger in older compared to younger women.
This is the first longitudinal study to provide evidence of a positive association between childhood physical abuse and adult-onset asthma. The authors suggest that the mechanism linking abuse to asthma incidence is stress and its physiologic consequences, including effects on the immune system and airway development. In light of the high prevalence of abuse and of asthma in African American women, the association is of public health importance. Clinicians should be vigilant to screen for and to intervene to stop child abuse not only to prevent acute physical injuries and psychological effects but also to prevent long-term medical sequelae such as asthma.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.