Chaos in the house and asthma in children – the connection

By Dr. Ananya Mandal, MDJul 10 2019

A chaotic household is one in which there is a lot of disorganized behaviour and noise. This makes relaxation impossible and often leads to stress and anxiety. Studies have associated chaotic households with anxiety and depressive disorders in both children and adults.

A new study has found that children belonging to minority groups and living in urban areas often have worsening of their symptoms of asthma if they are living in chaotic households. The study titled, “Family Chaos and Asthma Control,” was published in the latest issue of the journal Pediatrics.

Medical equipment and medicines for treatment of asthma. Image Credit: OnlyZoia / Shutterstock

Sally Weinstein, Associate professor of clinical psychiatry in the University of Illinois at Chicago College of Medicine and associate director of the University of Illinois Center on Depression and Resilience, led this study. She explained, “Higher levels of chaos - lack of organization or set routines, among other things - seems to be a pathway linking parental depression and worse child asthma control.”

The team found that urban youth belonging to minority groups were more likely to suffer from asthma and also have a poorer asthma control and increased risk of dying of asthma compared to the general population. The researchers add that there are several studies that connect environmental factors and medications with asthma. This study links environmental psychosocial factors and asthma.

Depression and anxiety disorders among children is associated with worse asthma outcomes and also more use of rescue medications due to exacerbations. Parental depression and family conflict has also been associated with worsening of asthma among children, the team wrote.

This study focussed on the interplay between the child and his or her family members as well as their functioning and attempted to gauge its connection with asthma worsening. They targeted urban children and youth belonging to minority groups with uncontrolled asthma for their study. The team defines uncontrolled asthma as asthma with excessive symptoms and frequent exacerbations requiring rescue medication use.

The team included 223 children aged between 5 and 16 years and checked to see if they or one or both of their parents suffered from depression and post-traumatic stress disorder, or PTSD symptoms. They also checked asthma control in these participants. This was part of a longitudinal study (called the Erie trial) where asthma control was being improved using Asthma Action, which was educational interventions for asthma control.

Each of the participants were interviewed to detect depression or PTSD or family chaos in the children before the start of the study. Asthma control was measured over the duration of the study using the Asthma Control Test. This test is a standardized evaluation technique to detect asthma severity and symptoms in the children. Each family was asked to enumerate the number of days a child was incapacitated in the previous two weeks due to symptoms of asthma. The team evaluated family chaos using a 15-item questionnaire. There were questions such as, “No matter how hard we try, we always seem to be running late,” “We can usually find things when we need them,” “We always seem to be rushed,” or “Our home is a good place to relax,” etc.

Results showed that both parental and childhood depressive symptoms were linked to worsening of asthma control. Symptoms of PTSD however was not linked to worse asthma control. Greater levels of family chaos was associated with worse asthma control found the researchers. The parental and child depression factors were controlled and then the effects of family chaos was evaluated in the children. The association between family chaos and asthma worsening remained strong even after such adjustment.

Authors write, “Emotional triggers of asthma also mediated the parent depression-asthma relationship.”

Weinstein said, “When a parent is depressed, it's harder to keep the family routines running smoothly, and it's also harder to manage the daily demands of caring for their child's asthma, which can require multiple medications and avoidance of triggers.” She added, “We saw that in families with greater household chaos, child asthma control tended to be worse.” Authors of the write conclude, “Addressing parent and child depression, family routines, and predictability may optimize asthma outcomes.”

Principal investigator of the study, Dr. Molly Martin, associate professor of pediatrics in the UIC College of Medicine, in a statement said, “Our findings highlight the role of family chaos in worse asthma outcomes for children in these families. Pediatricians and asthma specialists should consider and address parent and child depression and provide support to optimize household routines as a way to help improve children's asthma control.”

This study was supported by the National Heart, Lung, and Blood Institute.