Fact checked byKristen Dowd

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May 21, 2023
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Violence, maltreatment associated with increased risk for asthma

Fact checked byKristen Dowd
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Key takeaways:

  • Each single-point increment in exposure to violence was associated with 1.13 to 1.18 times increased odds for asthma.
  • Odds for asthma increased by a factor of 1.26 with any child maltreatment.

WASHINGTON — Violence and maltreatment in childhood were linked to greater risk for asthma among patients with positive biomarkers of high Th2 immunity, according to data presented at the American Thoracic Society International Conference.

The study involved patients with high Th2 immunity drawn from three cohorts, Kristina M. Gaietto, MD, MPH, clinical instructor of pediatrics and postdoctoral scholar, division of pulmonology, department of pediatrics, University of Pittsburgh School of Medicine and UPMC Children’s Hospital of Pittsburgh, and colleagues wrote.

child abuse, maltreatment
Exposure to violence, violence-related distress and maltreatment during childhood were associated with increased risks for asthma among patients with positive biomarkers of Th2-high immunity. Image: Adobe Stock

Asthma mechanisms

“Acute and chronic stress have been linked to high Th2 immunity in prior studies of children with asthma,” Gaietto told Healio.

Kristina M. Gaietto

“We hypothesized that exposure to violence (ETV) or child maltreatment (CM), both significant stressors, may be associated with increased odds of asthma in individuals with high Th2 immunity,” she continued.

Also known as atopic asthma, Th2-high asthma is a very common asthma endotype in children and adults, Gaietto said, with many studies indicating that asthma’s inflammatory response involves a Th2 mechanism.

“What is not well understood is why some individuals with these biomarkers of Th2 immunity develop asthma, while others do not,” she said.

“One theory is that certain environmental exposures contribute to the development of asthma in this population with high Th2 immunity. We wanted to assess if there was an association between ETV and/or CM and asthma among these individuals,” she said.

Further, Gaietto noted that stress has been shown to influence DNA methylation and gene expression and to increase cortisol, epinephrine and cytokine levels, including some cytokines associated with Th2-high immunity.

“ETV and CM are significant stressors, so we suspect they too influence these biological pathways,” Gaietto said.

Study design, results

The population comprised 336 patients in the Puerto Rico Genetics of Asthma and Lifestyle (PR-GOAL) study and 406 from the Epigenetic Variation of Childhood Asthma in Puerto Ricans (EVA-PR) study, with both sets aged 9 to 20 years.

Also, the population included 53,066 adults from the United Kingdom Biobank (UKB). The researchers examined the PROPRA prospective study of 193 patients who participated in PR-GOAL and EVA-PR as well.

PR-GOAL and EVA-PR defined high Th2 immunity as one or more positive allergen-specific IgE and/or total IgE of 100 IU/ml or greater and/or an eosinophil count of at least 150 cells/µL. The UKB, which lacked IgE data, defined high Th2 immunity as an eosinophil count of 150 cells/µL or higher.

Also, PR-GOAL and EVA-PR used the validated ETV Scale and Checklist of Children’s Distress Symptoms (CCDS) to assess exposure to violence (ETV) and violence-related distress. UKB used the validated Childhood Trauma Screener to assess childhood maltreatment.

Multivariable analyses revealed an association between each single-point increment in ETV Scale scores and 1.13 to 1.18 times increased odds for asthma (P < .05). There was a similar association between each single-point increment in CCDS score and 1.45 to 1.54 increased odds for asthma (P < .05).

PROPRA found a significant association between persistently high ETV scores and asthma (P = .03) but not between persistently high CCDS scores and asthma. The odds for asthma increased by a factor of 1.26 with any child maltreatment in UKB (P < .01). Never smokers and former smokers had similar results in UKB.

Conclusions, next steps

Based on these findings, the researchers concluded that there was an association between ETV, violence-related distress and maltreatment during childhood and increased risk for asthma among patients with positive biomarkers of Th2-high immunity.

“We were struck by the parallel findings in two different populations, British adults and Puerto Rican children, with biomarkers of Th2-high immunity,” Gaietto said. “History of CM in the British adults and ETV in the Puerto Rican children were each significantly associated with the presence of asthma.”

These findings also indicate areas where stakeholders can make changes to improve outcomes, Gaietto said.

“Our findings further support policies that seek to prevent community violence and child maltreatment, since these exposures have far-reaching negative health effects,” she continued.

“Physicians caring for youth and adults with atopic asthma should be aware of possible co-existing and treatable conditions linked to ETV and CM, including depression- and anxiety-related disorders,” Gaietto said.

For more information:

Kristina M. Gaietto, MD, MPH, can be reached at kristina.gaietto@chp.edu.