School examinations enhance airway inflammation to antigen challenge

Lin Ying Liu, Christopher L. Coe, Cheri A. Swenson, Elizabeth A. Kelly, Hirohito Kita, William W. Busse

Research output: Contribution to journalArticlepeer-review

214 Scopus citations


Psychological stress can lead to asthma exacerbations in some patients. It is our hypothesis that the stress effect can occur through an enhancement of allergic inflammatory response. To investigate this possibility, airway antigen challenge was evaluated in 20 college students with mild asthma during both a low-stress phase (midsemester or two weeks postfinal examination) and a stress phase (final examination week). Subjects completed questionnaires to assess psychological state and underwent inhaled antigen challenge. Sputum samples were collected before challenge, and six and 24 hours and seven days postchallenge. Leukocytes were counted and eosinophil-derived neurotoxin (EDN) was measured in sputum supernates. Sputum cells were cultured and stimulated ex vivo with phytohemagglutinin (10 μg/ml), and culture supernates were assayed for interleukin-5 (IL-5) and interferon-γ, by enzyme-linked immunosorbent assay. Sputum eosinophils and EDN levels significantly increased at six and 24 hours postchallenge and were enhanced during the stress phase (p < 0.01). IL-5 generation by sputum cells was also increased at 24 hours during stress and correlated with airway eosinophils (rs = 0.65, p < 0.05). Students' anxiety and depression scores were significantly higher during the examination period. Our findings suggest that stress associated with final examinations can act as a cofactor to increase eosinophilic airway inflammation to antigen challenge and thus may enhance asthma severity.

Original languageEnglish (US)
Pages (from-to)1062-1067
Number of pages6
JournalAmerican journal of respiratory and critical care medicine
Issue number8
StatePublished - Apr 15 2002


  • Allergy
  • Eosinophil
  • Interleukin-5
  • Sputum induction
  • Stress

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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