The Effects of Cognitive Stress on Asthma Exacerbations among University Students

Abstract

Introduction: Many asthmatics complain of worsening respiratory symptoms during periods of stress. This study evaluated the relationship among asthma symptoms, lung physiology, inflammatory parameters and perceived cognitive stress and quality of life in healthy adult students. This relationship was assessed at two time points: a time of normal activity and at a time of cognitive stress during academic examinations. Methods: Subjects attended the University of Alberta Hospital for a screening visit, which included a clinical exam, spirometry, methacholine challenge, allergen skin tests to assess atopy status and Mini International Neuropsychiatric Interview (MINI). Eligible subjects returned for a low stress visit (LSV) at least 14 days prior to an exam and a high stress visit (HSV) within 24 hours of an exam. Spirometry, and methacholine challenge were performed during both LSV and HSV along with the collection of urine (tested for cortisol), and the administration of 4 questionnaires to assess perceived stress and quality of life. Results: Subjects showed no significant change in psychosocial or quality of life questionnaires between LSV and HSV. No significant change was noted in lung function or urine cortisol. There was an unexpected high rate of pre-existing psychiatric comorbidities in this population (based on the MINI screen failure rate). Conclusion: We did not find a significant change in quality of life, psychosocial wellbeing or pulmonary function or inflammation, measured by urine cortisol, during a high stress period. The high rate of comorbidities would be important to consider as part of evaluation used in clinical asthma studies in the future.