Synergism of triggers for loss of asthma control in children during wartime

Abstract

Abstract Background Children with asthma living in areas affected by armed conflict are exposed to a unique combination of psychological stress, environmental hazards, healthcare disruption, and adverse social conditions that may contribute to poorer asthma control. Although these factors have been investigated individually, their integrated pathophysiological interactions have not been comprehensively synthesized. Objective To synthesize current evidence on the psychoneuroimmunological, environmental, and behavioral mechanisms that may contribute to loss of asthma control in children exposed to armed conflict and to summarize potential implications for clinical management. Materials and methods A targeted narrative review was conducted using PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and the Vernadsky National Library of Ukraine. Evidence from conflict-related asthma studies was integrated with mechanistic research on psychoneuroimmunology, environmental health, and pediatric asthma, together with current international clinical guidelines. Results Available evidence suggests that asthma destabilization during armed conflicts is multifactorial. Chronic psychological stress may alter brain-lung axis signaling, contributing to neuroimmune dysregulation and reduced glucocorticoid responsiveness. Simultaneously, exposure to particulate air pollution, combustion products, indoor dampness, and shelter-associated allergens may amplify airway inflammation. Healthcare disruption, forced displacement, and family disorganization may further reduce treatment adherence and continuity of care. Together, these interacting factors may contribute to poorer asthma control and increased exacerbation risk in susceptible children. Conclusions Current evidence supports a multidimensional model in which psychological, environmental, and healthcare-related factors interact to influence asthma outcomes during armed conflicts. Asthma management in humanitarian settings should prioritize continuity of inhaled corticosteroid-containing therapy according to contemporary international guidelines, individualized asthma action plans, objective monitoring whenever feasible, and integration of psychological support into comprehensive pediatric asthma care. Further prospective studies are needed to clarify the relative contribution of these mechanisms and to strengthen the evidence base for clinical recommendations.