NIOSHTIC-2 Publications Search

Post-traumatic stress disorder, bronchodilator response, and incident asthma in World Trade Center rescue and recovery workers.

de la Hoz RE; Jeon Y; Miller GE; Wisnivesky JP; Celedón JC

Am J Respir Crit Care Med 2016 Dec; 194(11):1383-1391

https://doi.org/10.1164/rccm.201605-1067OC

20049282

Rationale: Post-traumatic stress disorder (PTSD) has been associated with asthma in cross-sectional studies. Whether PTSD leads to clinically significant bronchodilator response (BDR) or new-onset asthma is unknown. Objectives: We sought to determine the relationship between probable PTSD and both BDR and incident asthma in a high-risk cohort of World Trade Center workers in New York (NY). Methods: This study was conducted on data from a high-risk cohort of 11,481 World Trade Center workers in New York, including 6,133 never smokers without a previous diagnosis of asthma. Of the 6,133 never smokers without asthma, 3,757 (61.3%) completed a follow-up visit several years later (mean = 4.95 yr, interquartile range = 3.74-5.90 yr). At the baseline visit, probable PTSD was defined as a score 44 points or greater in the PTSD Checklist questionnaire, and BDR was defined as both a change of 12% or greater and an increment of 200 ml or greater in FEV1 after bronchodilator administration. Incident asthma was defined as a self-report of new physician-diagnosed asthma after the baseline visit. Multivariable logistic regression was used for the analysis of probable PTSD and baseline BDR or incident asthma. Measurements and Main and Results: At baseline, probable PTSD was associated with BDR among all participants (adjusted odds ratio = 1.43; 95% confidence interval = 1.19-1.72), with similar results among never smokers without asthma. Among 3,757 never smokers, probable PTSD at baseline was associated with incident asthma, even after adjustment for baseline BDR (odds ratio = 2.41; 95% confidence interval = 1.85-3.13). This association remained significant in a confirmatory analysis after excluding 195 subjects with baseline BDR. Conclusions: In a cohort of adult workers exposed to a severe traumatic event, probable PTSD is significantly associated with BDR at baseline and predicts incident asthma.

World Trade Center; WTC; Post-traumatic stress disorder; PTSD; Cross sectional studies; Asthma; Bronchial asthma; Risk factors; Questionnaires; Cohort studies; Regression analysis; Statistical analysis; Respiratory system disorders; Medical examinations; Medical monitoring; Surveillance; Breathing; Traumatic incident stress; Clinical diagnosis; Author Keywords: post-traumatic stress disorder; bronchodilator response; incident asthma; World Trade Center

Juan C. Celedón, M.D., Dr.P.H., Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA 15224

AJCMED

20161201

Journal Article

juan.celedon@chp.edu

Cooperative Agreement; Contract

2017

Cooperative-Agreement-Number-U01-OH-010407; Contract-200-2011-39377; Contract-200-2011-39356; Cooperative-Agreement-Number-U01-OH-010401

11

1073-449X

American Journal of Respiratory and Critical Care Medicine

NY; IL; PA

Icahn School of Medicine at Mount Sinai, New York