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Review of psychosocial stress and asthma: an integrated biopsychosocial approach
  1. Rosalind J Wrighta,
  2. Mario Rodriguezb,
  3. Sheldon Cohenc
  1. aChanning Laboratory, Department of Medicine, Brigham and Women’s Hospital, and the Pulmonary/ Critical Care Division, Boston’s Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA, bDepartment of Medicine, Allegheny University of the Health Sciences, Philadelphia, Pennsylvania, USA, cDepartment of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
  1. Dr R J Wright, Channing Laboratory, 181 Longwood Avenue, Boston, Massachusetts 02115, USA.

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Although consensus has emerged from the clinical, social science, psychological, and biological literature that psychosocial factors affect asthma morbidity in children, their role in the genesis, incidence, and symptomatology of asthma remains controversial since mechanisms are not well understood. Three recent trends in medical research have led both clinicians and investigators to reconsider the role of psychosocial stress in asthma. Firstly, efforts to define the aetiological risk factors for the development and expression of disease have intensified in the face of rising trends in the prevalence and severity of asthma observed worldwide.1 Thus far, focus on traditional environmental risk factors has not fully explained these trends. Secondly, evidence evolved over the last two decades of important interactions among behavioural, neural, endocrine, and immune processes provides fresh insight into means by which psychosocial stressors may influence the development and expression of inflammatory diseases.2 3 This insight emerged in parallel with our increased understanding of the complex cellular and molecular basis of asthma as a chronic inflammatory disorder.4 Finally, hypotheses about the substantial role of the social environment and social integration in health and disease in general have gained significant emphasis over the last decade.5 6 In particular, prospective epidemiological studies have demonstrated associations between life stress, social position or status, and quality of social relationships—that is, social networks, an individual’s ties to friends, family, work, and community through social and religious groups—and health.6 7 All have led to a paradigm shift that reconsiders the overlap between biological determinates and psychosocial factors in understanding the rising asthma burden.8

This review highlights significant insights into this field from a multidisciplinary (psychoanalytical, behavioural, psychosocial, epidemiological, and immunological) perspective rather than being an exhaustive overview of the subject. We examine behavioural, neural, and immunological pathways, underscoring reciprocal relations that …

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