March 16, 2001 -- Children with asthma may wear their hearts on their sleeves, and that can be dangerous, according to new research from childhood asthma experts presented at the recent annual meeting of the American Psychosomatic Society.
Many asthma experts -- and most parents of children with asthma -- have firsthand experience watching emotions trigger an asthma attack, says Bruce D. Miller, MD, professor of psychiatry and pediatrics at the State University of New York (SUNY) in Buffalo. Whether it is an angry exchange with a brother or sister, or a frightening encounter with a playground bully, getting fired up often has the child or parent reaching for an inhaler.
Miller and colleague Beatrice L. Wood, PhD, also a professor of psychiatry and pediatrics at SUNY, have been conducting a series of studies to better understand the link between emotions and asthma. Miller tells WebMD it is very difficult to control childhood asthma -- meaning to reduce the number of visits to physicians' offices or emergency rooms -- and many experts claim the difficulty is caused by children and their families failing to follow instructions from their physicians.
Miller thinks, however, that childhood asthma is more complicated than simply following doctors' orders.
In a search for a better explanation, he recently began to suspect that children with asthma actually might have no control over the way they respond to emotions. The response, he suggests, actually is the result of a difference in the wiring of the child's autonomic nervous system.
This system, as the name suggests, works in an involuntary or reflexive way to control many functions, including that of the heart. In a child with asthma, an emotional reaction signals the system to begin reacting in a way that can lead to an asthma attack, he says.
To test his theory, Miller used a surefire emotional detonator: the Steven Spielberg classic movie ET, well known for its ability to push every emotional button of those who watch it. He showed the movie to a group of 20 healthy children as well as 24 children with severe asthma.
While the children were watching the movie, they were hooked up to special monitors that recorded patterns of heart fluctuations. These heart tracings allowed scientists to track the types of messages the autonomic nervous system was sending to the heart and lungs.
By the time EThad rejoined the crew of his spaceship, Miller had enough data to demonstrate that the children with asthma "had much more dramatic shifts" in the messages sent by their autonomic nervous systems. And those shifts, he says, corresponded to "the emotional triggers in the movie."
Spielberg's film clearly is designed to get the heart pumping, Wood says, but children with asthma may experience daily emotional roller coasters in their home environment. She has been investigating homegrown emotional triggers in childhood asthma.
In a second study, Wood and Miller again showed ET to different groups of healthy children and children with asthma, while again tracking heartbeat. This time, however, in addition to the movie, the researchers videotaped each child in "an emotionally challenging" family task with both parents.
They found that children with asthma who blamed themselves for a family disturbance were at increased risk for an asthma attack. Wood says it is not simply conflict or arguments that trigger attacks, but rather an "overreaction, self-blaming" response in the child that can increase risk.
Does this mean that children with asthma have to be shielded from all emotions? No, say Miller and Wood, but there are some clear messages for parents and physicians.
The findings, they say, have the greatest value for those children whose asthma is poorly controlled. In those cases, Miller says, it is time to "consider seeking a consultation with a psychiatrist or psychologist for a psychosocial evaluation."
Miller says he doesn't recommend a psychiatric consult for every child with asthma, but says that treating the emotional triggers, or in some cases "depression or hopelessness that some of these children experience," can significantly improve the child's overall health.