Stress and Negative Affect as Mediators in the Association between Parental Social Support and Lung Function in Adolescents with Asthma

Asthma is the leading chronic condition amongst children in the United States as 7.5% of children are diagnosed with asthma. Studies have shown that positive social support is associated with positive asthma management. A strong social support system predicts good management of asthma symptoms; however, current literature has not yet examined how social support impacts lung function as opposed to merely symptom management. Stress and negative affect have been revealed to be associated with worse asthma control, as well as exacerbation of symptoms. Stressful situations, such as the death of a family member, unemployment, and familial tensions lead to worsening asthma symptoms, caused by the release of hormones. Similarly, negative affect has been analyzed as a causal factor for worsening asthmatic symptoms. Therefore, this pilot study sought to assess parental social support, adolescent stress and negative affect, and adolescent biological lung function to determine whether these affective processes (negative affect and stress) might serve as mediators in the association between social support and lung function. Adolescents suffering from asthma ages 12-17 (mean age = 13.9) (n = 21) were recruited from the pediatric asthma clinic at CHOC Children’s Hospital of Orange County for this pilot study. Participants were asked to complete a baseline survey upon recruitment assessing parental social support and stress. Seven consecutive days thereafter, for 4 times a day, participants were given a spirometer and asked to record lung function values including Peak Expiratory Flow (PEF) and Forced Expiratory Volume in 1 second (FEV1) as well as negative affect emotionality. Regression analysis revealed that higher levels of parental social support were associated with lower negative affect, b = -0.44, p \u3c 0.05, and stress, b = -0.40, p \u3c 0.05. However, there was no association between parental social support and lung function, for both PEF and FEV1 values. Implications for this study suggest that children with asthma who have more social support from parents have less stress and less negative affect. Next steps in this work are to analyze these mediators again, by recruiting more participants to the present study. Research should continue to consider psychological factors on children’s asthma in hopes of improving quality of their life

Pediatric Asthma and Psychological Resilience: Examining Whether Family Functioning and Social Support Relate to Asthma Symptoms and Lung Function

Upwards of 6 million children in the United States are afflicted with pediatric asthma. While previous research has linked asthma to multiple contributing biological and environmental factors, recent research suggests that psychological and social factors may have an impact on physiological outcomes of asthma like lung function and lung inflammation. Therefore, we suggest the need to study the impact of positive psychological factors such as a well-functioning family environment and beneficial social support on symptoms and lung function of children diagnosed with asthma. In the present pilot study, we recruited a total of 15 children with a confirmed asthma diagnosis and their parents from the Division of Pulmonology at the Children’s Hospital of Orange County. Participants were asked to complete an initial baseline assessment as well as ecological momentary assessments four times a day for seven days followed by a final follow up survey. Asthma symptoms and pulmonary function were measured using a 7-item Asthma Control Diary, and peak expiratory flow (PEF) values were gathered using data from self-administered spirometer recordings during the ecological momentary assessment portion of the study. This pilot study demonstrates the feasibility in collecting ecological momentary assessments surrounding positive psychological factors. Further, in testing the associations between family functioning and social support on children’s asthma symptoms and lung function, children who received more support from teachers (b = 0.03, t = 2.34, p = 0.048) and close friends (b = 0.04, t = 3.88, p = 0.006) had worse symptoms and lung function. Family functioning was not significantly associated with asthma symptoms and lung function (b = -0.00, t = -0.03, p = 0.975). Based on the results obtained, significant associations were only found in some aspects of social support. Interestingly, it seems as though children with more social support had worse asthma symptoms and lung function. This negative association might be an issue of reverse causality in which children who need more assistance receive more support. Next steps in this work include testing these associations in a larger-scale study. In sum, as pediatric asthma’s prevalence continues to rise, future studies should further examine the relationship between positive psychological factors and children’s asthma resilience

Modulation of S. epidermidis-induced innate immune responses in neonatal whole blood

Background: Coagulase-negative staphylococci (CoNS) such as Staphylococcus epidermidis are highly prevalent pathogens for sepsis in neonates. The interaction between host, environment and pathogenic factors of S. epidermidis are still poorly understood. Our objective was to address the role of several pathogenic factors of S. epidermidis on neonatal cytokine responses and to characterize the influence of three immunomodulatory drugs. Methods: We performed an ex-vivo model of S. epidermidis sepsis by assessment of blood cytokine production in neonatal whole blood stimulation assays (ELISA). S. epidermidis strains with different characteristics were added as full pathogen to umbilical cord blood cultures and the influence of indomethacin, ibuprofen and furosemide on neonatal immune response to S. epidermidis was evaluated (Flow cytometry). Results: Stimulation with S. epidermidis sepsis strains induced higher IL-6 and IL-10 expression than stimulation with colonization strains. Biofilm formation in clinical isolates was associated with increased IL-10 but not IL-6 levels. In contrast, stimulation with mutant strains for biofilm formation and extracellular virulence factors had no major effect on cytokine expression. Notably, addition of ibuprofen or indomethacin to S. epidermidis inoculated whole blood resulted in mildly increased expression of TNF-α but not IL-6, while frusemide decreased the production of pro-inflammatory cytokines, i.e. IL-6 and IL-8. Conclusions: The virulence of sepsis strains is coherent with increased cytokine production in our whole-blood in-vitro sepsis model. Biofilm formation and expression of extracellular virulence factors had no major influence on readouts in our setting. It is important to acknowledge that several drugs used in neonatal care have immunomodulatory potential. Keywords: Cytokines, Immunomodulatory drugs, Modulation of innate immune responses, Neonate, Staphylococcus epidermidi