Child Maltreatment and Asthma

A growing body of evidence suggests a link between child maltreatment and asthma. Determining whether and how child maltreatment causes or worsens asthma would have major implications for disease prevention, treatment, and public health policy. This article examines epidemiologic studies of child maltreatment and asthma and asthma-related outcomes, reviews the available evidence for potential mechanisms underlying the child maltreatment-asthma association, and discusses future directions in this area. To date, child maltreatment has been associated with asthma in most but not all observational studies of children and adults, with discrepant findings likely explained by differences in study design. All studies have been limited by potential under-reporting of child maltreatment, selection bias, and limited assessment of asthma. Despite these limitations, the aggregate evidence from epidemiologic studies suggests a causal link between child maltreatment and asthma, though the relative contributions of various types of maltreatment (physical, sexual, emotional, or neglect) are unclear. To date, there is weak and insufficient evidence of an association between child maltreatment and lung function or severe asthma exacerbations in children or adults. Limited evidence further suggests that child maltreatment could influence the development or severity of asthma through direct effects on regulation of stress responses, immunity, and airway inflammation, as well as indirect effects such as increased risk of obesity. Future prospective studies should aim to adequately characterize both child maltreatment and asthma, while also obtaining high-quality data on relevant covariates and biomarkers of stress, immune, and therapeutic responses