Stress and asthma: novel insights on genetic, epigenetic and immunologic mechanisms

In the U.S., ethnic minorities and the economically disadvantaged are disproportionately exposed to chronic psychological stressors such as poverty, discrimination and violence. Recent findings support a causal link between exposure to these stressors at the individual or community level and asthma morbidity. Moreover, current evidence suggests that the relation between stress and asthma is complex and partially mediated or modified by environmental exposures, adherence with treatment, co-morbidities and coping mechanisms.

In a review article, Rosenberg et al discuss recent findings suggesting potential biologic mechanisms for stress-related asthma, including changes in the methylation and expression of genes that regulate behavioral, autonomic, neuroendocrine, and immunologic responses to stress (J Allergy Clin Immunol 2014; 134(5): 1009-1015). For example, there may be susceptibility genes that predispose chronically stressed youth to both post-traumatic stress disorder and asthma. Moreover, recent studies show that low socioeconomic status in early life may program sustained resistance to glucocorticoid signaling, which could undermine the efficacy of steroid therapy in subjects who develop asthma.

The authors emphasize that the development of novel indicators or biomarkers of chronic stress is imperative, given that current stress measures cannot be used in young children or are difficult to implement in large studies. In addition, adequate phenotypic assessment of asthma, accounting for mediators and modifiers of the effects of stress on asthma, and studying the role of stress on treatment responses in vivo are key elements of future longitudinal studies of stress and asthma. Ultimately, further mechanistic insights on stress-related asthma should improve the prevention and treatment of asthma, particularly in vulnerable populations.