Exposure to Violence, Psychosocial Stress, and Asthma

Over the last two decades, a growing body of evidence has linked chronic psychosocial stress to asthma. Exposure to violence can lead to chronic stress and has received recent attention in the asthma literature, as is a common exposure for people living in urban settings, particularly in the U.S. Improving our understanding of whether and how exposure to chronic stressors causes or worsens asthma could help us gain insights into disease pathogenesis, design public health policies, and develop new interventions. In this essay, the evidence linking violence or stress to asthma is explored, including recent insights on potential mechanisms, and a discussion on current challenges and future directions. To date, experimental and observational studies support a causal association between chronic stress and worse asthma control, and increasing evidence suggests that pre- or post-natal chronic stress may lead to new-onset asthma. Such evidence supports conducting randomized controlled trials of stress-reduction interventions to improve asthma control in subjects with high chronic stress. On the other hand, more experimental and longitudinal studies are needed to better understand if violence exposure leads to asthma or worse asthma outcomes. Longitudinal studies with assessment of co-exposures and coping mechanisms are key to not only better understand the independent effects of violence or stress on asthma but also to identify factors that could ameliorate or worsen such effects.