title: Post-traumatic Stress Disorder, Bronchodilator Response, and Incident Asthma in World Trade Center Rescue and Recovery Workers.
abstract: 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.
  
  
  
  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).
  
  
  
  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 FEV1after 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.
  
  
  
  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.
authors.affiliation: 1 Department of Preventive Medicine and.|2 Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Rafael E
authors.identifier: 0000-0002-8949-9279
authors.initials: RE
authors.lastname: de la Hoz
authors.affiliation: 1 Department of Preventive Medicine and.
authors.forename: Yunho
authors.initials: Y
authors.lastname: Jeon
authors.affiliation: 3 Department of Psychology, Northwestern University, Evanston, Illinois; and.
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Miller
authors.affiliation: 2 Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Wisnivesky
authors.affiliation: 4 Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Juan C
authors.identifier: 0000-0002-6139-5320
authors.initials: JC
authors.lastname: Celedón
mesh_terms: D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D015897:Comorbidity; D060731:Emergency Responders / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D016017:Odds Ratio; D012307:Risk Factors; D047851:September 11 Terrorist Attacks; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D001993:Bronchodilator Agents
keywords: World Trade Center; bronchodilator response; incident asthma; post-traumatic stress disorder