Impact of Chronic Stress and Trauma on Asthma Pathophysiology and Outcomes.

PURPOSE OF REVIEW: Chronic stress and trauma are potent risk factors for worsened asthma outcomes. We summarize recent research discoveries surrounding chronic stress, adverse childhood experiences (ACEs), and intimate partner abuse (IPA) and their impacts on asthma pathophysiology and outcomes. We also highlight treatment and precision medicine implications. RECENT FINDINGS: Chronic stress and trauma have distinct yet persistent effects on asthma pathophysiology through multiple pathways, including the hypothalamic-pituitary-adrenal axis, neuroimmune signaling, central nervous system activity, and immune shifts. New research highlights stress and trauma's strong associations with increased asthma morbidity. Improvements in the understanding of underlying mechanisms highlight the potential of tailored or novel interventions. Despite significant leaps in our understanding of chronic stress and trauma's pervasive and enduring impacts on asthma, key actions-including clinical screening and broader inclusion in research-remain deficient. Improved recognition paired with targeted therapies offers the opportunity to improve the lives of many who are disproportionately burdened with increased asthma morbidity.