Depressed children with asthma evidence increased airway resistance: "Vagal bias" as a mechanism?
- Authors
- Miller, Bruce D.; Wood, Beatrice L.; Lim, JungHa; Ballow, Mark; Hsu, ChiunYu
- Issue Date
- Jul-2009
- Publisher
- MOSBY-ELSEVIER
- Keywords
- depression; children; vagal; pulmonary function; airway resistance; autonomic nervous system; dysregulation; Asthma
- Citation
- JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, v.124, no.1, pp.66 - 73
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
- Volume
- 124
- Number
- 1
- Start Page
- 66
- End Page
- 73
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/119725
- DOI
- 10.1016/j.jaci.2009.04.038
- ISSN
- 0091-6749
- Abstract
- Background: Depression is prevalent in pediatric asthma, and implicated in asthma morbidity and mortality. Pathways linking stress, depression, and asthma are unknown. Objectives: To examine, under controlled laboratory conditions, pathways by which depressive states affect airway function via autonomic dysregulation. Methods: Participants were 171 children with asthma, age 7 to 17 years, presenting to an emergency department for asthma exacerbation. Forty-five children with asthma and high depressive symptoms (D) were contrasted with 45 with low/no depressive symptoms (ND). Depressive symptoms, asthma disease severity, vagal and sympathetic reactivity to film stressors, airflow (FEV1), and airway resistance were compared between the groups. A subgroup with greater airway reactivity (nonmedicated FEV1<80% predicted) was also studied. Correlations among variables were examined for the entire sample. Results: Groups did not differ in demographics, disease severity, medications, or adherence. The D group with FEV1<80% predicted showed greater airway resistance throughout all conditions (P = .03), and vagal bias in the film stressors. The D group's vagal response was significant for the sad stimuli: family distress/loss (P = .03), dying (P = .003), and death (P = .03). The ND group showed sympathetic activation to sad stimuli: lonely (P = .04) and dying (P = .04). Depressive symptoms were correlated with respiratory resistance (r = .43; P = .001) and vagal bias in scene 3 (r = .24; P = .03), and vagal bias (scene 3) was correlated with postmovie airway resistance (r = 0.39; P = .004). Conclusions: Children with asthma and depressive symptoms manifest vagal bias when emotionally stressed. Those with depressive symptoms and FEV1<80% manifest greater air-way resistance. Depression, vagal bias, and airway resistance were intercorrelated for the full sample. (J Allergy Clin Immunol 2009;124:66-73.)
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