The Impact of War Trauma on the Mental Health of Children with Asthma: A Systematic Review

Introduction War is a major stressor for children, with profound effects on those with chronic respiratory conditions such as asthma. Factors associated with conflict, including psychological stress, inadequate hygiene, and exposure to polluted environments, increase the risk of allergic diseases and exacerbate existing respiratory conditions. Limited and delayed access to medical care further worsens these challenges. Substandard shelters, overcrowding, insufficient resources, and poor sanitation contribute to deteriorating health. Children with asthma are particularly vulnerable to these conditions and stress, placing them at higher risk of exacerbations and complications. Identifying children with uncontrolled or undiagnosed asthma is critical to implement preventive strategies and targeted management to reduce disease progression. Delayed diagnosis, severe asthma cases, frequent exacerbations, and comorbidities may reflect the negative impact of conflict. Limited access to healthcare and medication shortages are directly linked to wartime conditions. Objective This study aimed to examine the impact of war-related trauma on the physical and mental health of children, particularly those with asthma, and to assess the association between armed conflict and the worsening of chronic respiratory and psychiatric conditions. Environmental and familial factors influencing health deterioration were also evaluated. Methods This systematic review included ۳۸ studies examining the effects of war on asthma and mental health in children. An initial search identified ۱۲۴ articles, of which ۳۸ met inclusion and quality criteria. Both qualitative and quantitative studies reporting respiratory and psychological outcomes were included. Data were extracted from PubMed, Web of Science, Scopus, and other databases. Articles were selected based on relevance, scientific quality, and inclusion criteria. Keywords included Asthma, Children, War / Armed conflict, and Mental health. Findings Asthma prevalence in shelters was approximately ۸.۵%, consistent with ISAAC and WHO-GARD estimates. Children with uncontrolled asthma had poor quality of life, low inhaled corticosteroid use, and incorrect inhaler technique. War and displacement exposed children to new triggers, including odors, secondhand smoke, stress, and chemicals. Nighttime symptoms were the most sensitive asthma indicator; ۴۴.۲% of undiagnosed children reported nocturnal symptoms, and ۳۵.۱% showed PTSD signs. Additional risk factors included indoor cooking, PM۲.۵ exposure, cleaning agents, secondhand smoke, and poverty. Conclusion War-related trauma adversely affects asthma control and mental health in children, increasing the risk of psychiatric disorders and functional impairments. Family support, medical access, and environmental management can mitigate these effects. Comprehensive psychosocial and educational programs for children with asthma in conflict zones are urgently needed.

کلیدواژه ها:

Asthma ، Children ، War / Armed conflict ، Mental health