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Stress Effects on Lung Function in Asthma are Mediated by Changes in Airway Inflammation

From the Department of Environmental Health (A.K.), Harvard University, Boston, MA; Department of Psychology (D.R., T.R.), Southern Methodist University, Dallas, Texas; Department of Psychology (B.D.), University of Hamburg, Hamburg, Germany; Pulmonary Research Institute (H.M., F.K.), Hospital Grosshansdorf, Grosshansdorf, Germany.

Address correspondence and reprint requests to Antje Kullowatz, 401 Park Drive, Landmark Center, Rm. 404 West, Boston, MA 02215. E-mail: akullowa{at}hsph.harvard.edu

Objective: To examine the association of changes in current negative mood and long-term daily hassles with changes in lung function and airway inflammation in patients suffering from asthma and in healthy controls. Associations between psychological factors and asthma symptoms have been documented, but the relationship between airway inflammation and psychological factors has been largely unexplored.

Method: Data were analyzed from 46 asthma patients and 25 controls who completed questionnaires on current mood and daily hassles at two assessments 3 months apart. Lung function was measured by spirometry (forced expiratory volume in the first second (FEV₁)) and airway inflammation by the fraction of nitric oxide in exhaled air (FeNO). Regression analyses controlling for allergen load and air pollution (ozone) were calculated to study the association between changes in psychological factors and changes in lung function and airway inflammation, and to examine the mediational role of airway inflammation in the stress-lung function association.

Results: In patients with asthma, increases in negative affect were associated with decreases in FEV₁ and increases in FeNO. For daily hassles, a reverse pattern of associations was found, with decreases in daily hassles linked to decreases in FEV₁ and increases in FeNO. Mediation analyses showed that FeNO was a significant mediator of the association of both negative affect and daily hassles with lung function changes. No significant associations were found for healthy controls.

Conclusion: Psychological variables are consistently associated with spirometric lung function and airway inflammation in asthma patients. For asthma patients, effects of acute negative affect must be distinguished from more chronic distress due to daily hassles.

Key Words: asthma • mood • daily hassles • airway inflammatory status • lung function

Abbreviations: FEV₁ = forced expiratory volume in the first second; FeNO = fraction of exhaled nitric oxide; DH = daily hassles; PANAS = Positive Affect Negative Affect Schedule; NA = current negative affect; ATI = Asthma Trigger Inventory; ICS = inhaled corticosteroids.