title: Asthma exacerbations in children immediately following stressful life events: a Cox's hierarchical regression.
abstract: BACKGROUND
  A recent prospective study of children with asthma employing a within subject, over time analysis using dynamic logistic regression showed that severely negative life events significantly increased the risk of an acute exacerbation during the subsequent 6 week period. The timing of the maximum risk depended on the degree of chronic psychosocial stress also present. A hierarchical Cox regression analysis was undertaken to examine whether there were any immediate effects of negative life events in children without a background of high chronic stress.
  
  
  METHODS
  Sixty children with verified chronic asthma were followed prospectively for 18 months with continuous monitoring of asthma by daily symptom diaries and peak flow measurements, accompanied by repeated interview assessments of life events. The key outcome measures were asthma exacerbations and severely negative life events.
  
  
  RESULTS
  An immediate effect evident within the first 2 days following a severely negative life event increased the risk of a new asthma attack by a factor of 4.69, 95% confidence interval 2.33 to 9.44 (p<0.001) [corrected] In the period 3-10 days after a severe event there was no increased risk of an asthma attack (p = 0.5). In addition to the immediate effect, an increased risk of 1.81 (95% confidence interval 1.24 to 2.65) [corrected] was found 5-7 weeks after a severe event (p = 0.002). This is consistent with earlier findings. There was a statistically significant variation due to unobserved factors in the incidence of asthma attacks between the children.
  
  
  CONCLUSIONS
  The use of statistical methods capable of investigating short time lags showed that stressful life events significantly increase the risk of a new asthma attack immediately after the event; a more delayed increase in risk was also evident 5-7 weeks later.
authors.affiliation: Department of Mental Health Sciences, Royal Free and University College London Medical School, London, UK. s.sandberg@ucl.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: Sandberg
authors.forename: S
authors.initials: S
authors.lastname: Järvenpää
authors.forename: A
authors.initials: A
authors.lastname: Penttinen
authors.forename: J Y
authors.initials: JY
authors.lastname: Paton
authors.forename: D C
authors.initials: DC
authors.lastname: McCann
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001249:Asthma / Q000523:psychology*; D002648:Child; D002908:Chronic Disease; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D013315:Stress, Psychological / Q000150:complications*