ACE Scores and Asthma
/From a review of the recent literature available studying the connection between ACE scores and asthma I have come to find that there is a significant connection between reports of difficult childhoods events and the prevalence of asthma. First developed in the 1990's the ACE test is a survey designed to measure different types of abuse, neglect, and other hallmarks of a rough childhood. NPR's Laura Starecheski reports that, "according to the Adverse Childhood Experiences study, the rougher your childhood, the higher your score is likely to be and the higher your risk for later health problems". There are 10 types of childhood trauma measured in the ACE test. Five are related to personal issues such as physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect. Five are related to other family members such as growing up with an alcoholic parent, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, or experience the divorce or parents or death of a parent. In my research I found a number of interesting connections and limitations within the current body of research and studies that have been conducted over the past couple of years. Each one of the three studies I looked at found that increases in ACE scores accounted for a higher likelihood of asthma in the participants. Most of the articles had similar hypotheses for why this was but all the studies indicated a need for further research on the topic.
Two of the most discussed and hypothesized reasons for this were as follows. The first was because psychosocial stressors have been found to deregulate the sympathetic nervous system and the hypothalamic-pituitary-adrenocortical axis which then secretes higher levels of cortisol and catecholamines than normal. Because of this over secretion there is then a lack of cortisol that is needed to protect the body from inflammation. Such deregulation of the hypothalamic-pituitary-adrenocortical axis can cause the axis to become deregulated and cause either chronic under or over activity of the system. The second was because stress has been show through scientific research to increase airway inflammation making those with high stress more susceptible to conditions like asthma and other pulmonary disorders. The reason that high stress increases airway inflammation is because such stress and the over secretion of cortisol and catecholamines causes immune cells to be altered in their expression and activities.
Some of the most interesting findings were from one study that found that children 5 years old and younger who were exposed to at least 3 ACES had increased odds of reporting asthma by 5x, compared to those with none. This finding was much higher than that of older children indicating that exposure to ACEs at a younger age is more harmful and correlated to asthma than exposure at an older age. Also, one study found that a shocking 25% of children studied with exposure to at least 5 ACES reported having asthma. Further, another study pointed out that the harmful effects of psychosocial stress can be transgenerational and found that children born to mothers who experienced extreme stress during their pregnancy had 1.71 times the odds of having asthma later in life. Another interesting point that most studies spoke about briefly was a high correlation between higher ACE scores and smoking in participants. Most of the studies I read also indicated a higher correlations between ACE score and asthma and other COPDs for women than or men.
Each of one of these studies indicated a number of limitations to their studies and called for further research to be done. For instance, all three of the studies I read were self-report, which made them susceptible to under or over reporting. Also, most of the studies were not able to rule out confounding such as living conditions, allergen exposures, etc. which could contribute to asthma. Next, most of the studies could not identify timing of ACE exposures compared to the asthma diagnoses reported, meaning that the asthma diagnosis could have occurred before the time of the ACE exposure. A final major limitation of these studies were that they did not include institutionalized or hospitalized patients as well as people without landline telephones.
Resources
Cunningham, T. J., Ford, E. S., Croft, J. B., Merrick, M. T., Rolle, I. V., & Giles, W. H. (2014). Sex-specific relationships between adverse childhood experiences and chronic obstructive pulmonary disease in five states. International Journal of Chronic Obstructive Pulmonary Disease, 9, 1033–1043.
Remigio-Baker, R. A., Hayes, D. K., & Reyes-Salvail, F. (2015). Adverse Childhood Events Are Related to the Prevalence of Asthma and Chronic Obstructive Pulmonary Disorder Among Adult Women In Hawaii. Lung, 193(6), 885–891.
Starecheski, L. (2015, March 02). Take The ACE Quiz - And Learn What It Does And Doesn't Mean. Retrieved August 24, 2017, from http://www.npr.org/sections/health- shots/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean.
Wing, R., Gjelsvik, A., Nocera, M., & McQuaid, E. L. (2015). Association between adverse childhood experiences in the home and pediatric asthma. Annals of Allergy, Asthma & Immunology, 114(5), 379-384.
