title: Factors associated with poor control of 9/11-related asthma 10-11 years after the 2001 World Trade Center terrorist attacks.
abstract: OBJECTIVE
  To identify key factors associated with poor asthma control among adults in the World Trade Center (WTC) Health Registry, a longitudinal study of rescue/recovery workers and community members who were directly exposed to the 2001 WTC terrorist attacks and their aftermath.
  
  
  METHODS
  We studied incident asthma diagnosed by a physician from 12 September 2001 through 31 December 2003 among participants aged ≥18 on 11 September 2001, as reported on an enrollment (2003-2004) or follow-up questionnaire. Based on modified National Asthma Education and Prevention Program criteria, asthma was considered controlled, poorly-controlled, or very poorly-controlled at the time of a 2011-2012 follow-up questionnaire. Probable post-traumatic stress disorder, depression, and generalized anxiety disorder were defined using validated scales. Self-reported gastroesophageal reflux symptoms (GERS) and obstructive sleep apnea (OSA) were obtained from questionnaire responses. Multinomial logistic regression was used to examine factors associated with poor or very poor asthma control.
  
  
  RESULTS
  Among 2445 participants, 33.7% had poorly-controlled symptoms and 34.6% had very poorly-controlled symptoms in 2011-2012. Accounting for factors including age, education, body mass index, and smoking, there was a dose-response relationship between the number of mental health conditions and poorer asthma control. Participants with three mental health conditions had five times the odds of poor control and 13 times the odds of very poor control compared to participants without mental health comorbidities. GERS and OSA were significantly associated with poor or very poor control.
  
  
  CONCLUSIONS
  Rates of poor asthma control were very high in this group with post-9/11 diagnosed asthma. Comprehensive care of 9/11-related asthma should include management of mental and physical health comorbidities.
authors.affiliation: a World Trade Center Health Registry , New York City Department of Health and Mental Hygiene , Queens , NY , USA .
authors.forename: Hannah T
authors.initials: HT
authors.lastname: Jordan
authors.forename: Steven D
authors.initials: SD
authors.lastname: Stellman
authors.forename: Joan
authors.initials: J
authors.lastname: Reibman
authors.forename: Mark R
authors.initials: MR
authors.lastname: Farfel
authors.forename: Robert M
authors.initials: RM
authors.lastname: Brackbill
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Friedman
authors.forename: Jiehui
authors.initials: J
authors.lastname: Li
authors.forename: James E
authors.initials: JE
authors.lastname: Cone
mesh_terms: D000328:Adult; D001249:Asthma / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology*; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D018635:Rescue Work; D047851:September 11 Terrorist Attacks; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors
keywords: Anxiety; World Trade Center; asthma control; cohort study; epidemiology; management/control; post-traumatic stress disorder