Comorbid Obesity and Depressive Symptoms in Childhood Asthma: A Harmful Synergy
Chiun Yu Hsu1, Heather K Lehman2, Beatrice L Wood3
1Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY; Child and Family Asthma Studies Center, Oishei Children's Hospital, Buffalo, NY.
Insights
Overweight/obesity and depression worsen asthma control in children. Depression in overweight/obese children with asthma may increase airway resistance through vagal bias, suggesting new treatment avenues.
Area of Science:
- Pediatric Pulmonology
- Child Psychology
- Autonomic Nervous System Research
Background:
- Childhood asthma severity is linked to overweight/obesity (OV/OB) and depression.
- The combined impact and underlying pathways of OV/OB and depression on childhood asthma remain unclear.
Purpose of the Study:
- To investigate the interrelationship between OV/OB, depressive symptoms, and childhood asthma.
- To explore psychobiologic pathways, including autonomic nervous system (ANS) dysregulation, linking these conditions.
Main Methods:
- 250 children (7-17 years) with asthma were assessed for OV/OB, depressive symptoms (Children's Depression Inventory - CDI), and asthma severity.
- Lung function (FEV1) and airway resistance (Rint) were measured before and after emotional stress (film viewing).
- ANS reactivity (vagal and sympathetic) was evaluated during emotional stress.
Main Results:
- In OV/OB children with asthma, depressive symptoms correlated with lower baseline FEV1.
- CDI scores predicted vagal bias under emotional stress.
- Vagal bias was associated with increased airway resistance (Rint).
Conclusions:
- This is the first study to link OV/OB and depressive symptoms in childhood asthma.
- Depression may exacerbate airway compromise in OV/OB children with asthma via vagal bias.
- Further research into antidepressant and anticholinergic therapies for this subgroup is warranted.
Background:
Overweight/obesity (OV/OB) and depression have each been separately associated with worsened childhood asthma severity and control. Pathways by which these factors may jointly affect childhood asthma have not been elucidated.
Objective:
To examine the interrelationship of OV/OB and depressive symptoms with childhood asthma and explore associated psychobiologic pathways. The present study investigated whether comorbid OV/OB and depressive symptoms are associated with impaired baseline lung function and increased airway resistance during emotional stress, and to assess whether such effects may be mediated by autonomic nervous system (ANS) dysregulation, specifically through predominance of vagal over sympathetic reactivity (vagal bias).
Methods:
A total of 250 children with asthma, aged 7 to 17, were assessed for OV/OB using body mass index, depressive symptoms using the Children's Depression Inventory (CDI), and asthma severity using National Asthma Education and Prevention Program Expert Panel Report 3 criteria. Baseline pulmonary function (forced expiratory volume in 1 second [FEV1]) was assessed. The film "E.T. the Extra-Terrestrial" was used in a laboratory paradigm to evoke emotional stress/arousal. Airway resistance (Rint) was measured before and after the film to determine changes in airway function. ANS reactivity was assessed by measuring parasympathetic/vagal and sympathetic reactivity throughout the film.
Results:
In OV/OB children with asthma, depressive symptoms predicted lower baseline FEV1 (β = -0.67, standard error [SE] = 0.24, P = .008), CDI predicted vagal bias under emotion stress/arousal (β = 0.27, SE = 0.09, P = .009), and vagal bias predicted increased Rint (β = 3.55, SE = 1.54, P = .023).
Conclusion:
This study is the first to link OV/OB and depressive symptoms in their relationship to childhood asthma. In OV/OB children with asthma, depression may potentiate airway compromise, mediated by vagal bias. Use of antidepressant and anticholinergic therapies should be studied in this subgroup of patients.
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