Depression and Asthma: Need to Consider Autonomic Imbalance in Asthma Management.
Depression and Asthma: Need to Consider Autonomic Imbalance in Asthma Management.
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抑郁症和哮喘：哮喘管理中需要考虑自主神经失衡。
DOI：
10.1016/j.jaip.2023.01.001
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Wright,RosalindJ
中科院分区：
文献类型：
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作者：
Frost,Allison;Wright,RosalindJ
不良童年经历（ACE），包括贫困、人际暴力和照顾者抑郁，可预测22名儿童的哮喘发作和哮喘症状严重程度增加1。然而，针对儿童哮喘的预防和干预计划通常侧重于物理环境（如灰尘，空气污染），营养或药理学目标。24在常见的童年逆境中，母亲抑郁症被认为是一种有希望的干预途径。一个重要的研究机构链接照顾者抑郁症和26名儿童的哮喘发病率，虽然证据主要是横截面。在1月27日出版的《变态反应和临床免疫学杂志：实践》中，Brown et al 3.通过前瞻性研究29名照顾者抑郁的改善与随后儿童哮喘控制和肺功能改善之间的关系，为这篇文献增加了28个显著性。[30]这些研究人员招募了基线时符合31项重度抑郁症标准的照顾者（主要是母亲）及其7-17岁患有持续性哮喘的儿童。他们进行了一项前瞻性研究，检查33个照顾者抑郁症状的重复评估与主观（标准化哮喘控制测试）和34个客观（1秒内用力呼气量的变化（FEV1%预测值））儿童测量之间的关联。35名进行照顾者抑郁评估的研究人员对儿童结局36项评估不知情，反之亦然。这项研究表明，在患有抑郁症的母亲中，研究期间缓解时间的增加与其子女哮喘控制的改善以及肺功能的改善有关。这些研究结果强调了39个心理社会干预计划的潜力，重点是照顾者的心理健康，以解决儿童的40呼吸道疾病的发病率。41 Brown及其同事还深入研究了将母亲抑郁症与哮喘控制联系起来的途径42，并提出了可能发挥根本作用的神经机制的作用。我们在一个更广泛的框架内扩展了这一讨论，该框架考虑了照顾者抑郁症如何在行为上，心理上和生物学上嵌入儿童，以及这如何影响哮喘的严重程度和控制。如图1所示，照顾者抑郁症和儿童呼吸健康之间相关性的潜在机制是多因素的，并且可能是双向的。48
Adverse childhood experiences (ACEs), including poverty, interpersonal violence, and caregiver 21 depression, are predictive of asthma onset and increased severity of asthma symptoms in 22 children1. Yet, prevention and intervention programs that target childhood asthma typically focus 23 on physical environmental (eg, dust, air pollution), nutritional, or pharmacological targets2. 24 Among common childhood adversities, maternal depression has been considered as a 25 promising avenue for intervention. A significant body of research links caregiver depression and 26 children’s asthma morbidity, although the evidence has largely been cross-sectional. In the 27 January issue of the Journal of Allergy and Clinical Immunology: In Practice, Brown et al3. add 28 significantly to this literature by prospectively examining relationships between improvement in 29 caregiver depression and subsequent improvement in child asthma control and lung function. 30 These investigators enrolled caregivers (primarily mothers) who at baseline met criteria for 31 major depressive disorder and their children aged 7-17 years with persistent asthma. They 32 conducted a prospective study examining associations between repeated assessment of 33 caregiver depressive symptoms and both subjective (standardized Asthma Control Test) and 34 objective (change in forced expired volume in 1 second (FEV1% predicted)) child measures. 35 Research staff conducting caregiver depression assessments were blinded to child outcome 36 assessments and vice versa. This study demonstrates that, among mothers with depression, 37 increased time in remission over the study period was associated with improved asthma control 38 in their children as well as improved lung function. These findings highlight the potential for 39 psychosocial intervention programs focused on caregivers’ mental health to address children’s 40 respiratory disease morbidity. 41Brown and colleagues also provide insight into pathways linking maternal depression to asthma 42 control and suggest a role for neural mechanisms that may be playing a fundamental role. We 43 expand on that discussion within a broader framework that considers how caregiver depression 44 is behaviorally, psychologically, and biologically embedded in children and how this can 45 influence asthma severity and control. As depicted in Figure 1, mechanisms underlying 46 associations between caregiver depression and childhood respiratory health are multifactorial 47 and potentially bidirectional. 48