Psychological factors associated with pediatric asthma death: a review

The preceding review of the literature on pediatric asthma death encompasses a broad range of emotional and psychological variables, some of which may ultimately prove to be meaningfully related to asthma death in childhood. However, the essential question of the role of psychological factors in pediatric asthma death remains unanswered. This area of investigation is still in its earliest stages, having relied heavily to date on retrospection, anecdotal recordings, and theoretical speculation. Additionally, conceptualization of the problem has been impeded not only by the remaining medical mysteries of asthma, but by considerable overlap among the psychological constructs considered, and a lack of clarity and confirming evidence about the physiological and/or behavioral mechanisms which would mediate the influence of proposed psychological factors on the course of the disease. As has been common in the history of psychosomatic research, there has been a tendency to search for a unitary underlying psychological factor that would account for asthma death (e.g., anxiety, psychopathology, a symbiotic mother-child relationship, or nebulizer overuse). However, a perusal of the literature casts doubt on the likelihood that a single psychological factor will provide the answers. Rather, serious problems in pediatric asthma management and fatal outcome appear more likely to be the end result of disruptions in the complex interactions and delicate balance among physiological, pharmacological, environmental, and interpersonal factors. The interpersonal milieu itself may represent potentially complicated and dangerous elements as it consists of medical staff, patient, and family members, each with his or her own limitations of intellect, judgment, and capacity to cope with emotional stress and the stress engendered by a chronic, sometimes frustrating, and potentially lethal disease. Nevertheless, the literature offers a variety of features which thus far have been found to characterize at least some cases of pediatric asthma death. There is fairly consistent agreement demographically that children under 5 yr of age and between the ages of 10 and 14 yr are at increased risk, as are nonwhite children. Sex-related differences are less clear. While a standard medical profile of the pediatric asthma patient at high risk for a fatal outcome does not yet exist, a number of "increased risk" indicators have been suggested, including for example, a history of particularly severe asthma, rapid onset attacks, and medical complications.(ABSTRACT TRUNCATED AT 400 WORDS)