To the Editor:
As an avid reader of Pediatric Annals, I thoroughly enjoyed the editorial in the January 1999 issue concerning asthma.1 The questions raised can be answered by one common factor not routinely mentioned in recent literature: the emotional component of the patient. Asthma will appear when an individual's emotional component is breached (ie, living with stress, depression, or conflict). In the past two decades, stress or depressive factors have manifested themselves in the forms of increased divorce, daily street crime, occasional homicide, news media sensationalism, dysfunctional families, dysfunctional school environments, and increased occurrence of being falsely accused of something.
The emotional component is certainly breached in the five main points of the editorial1: point 1 - there is a higher prevalence in the inner city (more stress in the inner city); point 2 - the speed of the epidemic is equal to the speed of stress factors (not to the speed of genetic mutations); point 3 - arid climates of the United States have the same stress factors as the more humid states; point 4 - a more laid-back town has less stress (although more pollution) than an intense metropolis (eg, Munich); and point 5 - mortality is increased because when you have enough stress to provoke asthma, you want to die.
Physicians should reexamine the emotional component in their patients. Current bandwagon ideology emphasizes inflammation of the bronchioles as the cause of asthma. What brought on the inflammation? There are patients who develop wheezing with narrowing of the airways purely due to emotional factors. This suggests another avenue of therapy. Counseling may be a part of asthma therapy.
1. Altemeier WA III. Asthma: something is wrong. Pediatr Ann. 1999;28:14-15.
Jack Leong, MD
Cicero Prompt Care &
Family Medical Center
Dr. Altemeier's response:
Dr. Leong presents an interesting hypothesis about why the incidence of asthma seems to be rising. Twenty years ago and earlier, we paid much more attention to stress. When a child with asthma was not in good control despite the usual treatments, the first place we looked for an explanation was in his or her psychosocial environment. The hypothesis does fit many of the epidemiologic mysteries of asthma and deserves further thought.