de la Hoz Rafael E, Jeon Yunho, Miller Gregory E, Wisnivesky Juan P, Celedón Juan C
1 Department of Preventive Medicine and.
2 Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Am J Respir Crit Care Med. 2016 Dec 1;194(11):1383-1391. doi: 10.1164/rccm.201605-1067OC.
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 FEV 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.
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.
在横断面研究中，创伤后应激障碍（PTSD）与哮喘有关。PTSD是否会导致临床上显著的支气管扩张反应（BDR）或新发哮喘尚不清楚。
我们试图确定纽约世界贸易中心高危队列中可能的PTSD与BDR和哮喘发病之间的关系。
本研究基于纽约11481名世界贸易中心高危队列工作者的数据进行，其中包括6133名既往未诊断哮喘的从不吸烟者。在6133名未患哮喘的从不吸烟者中，3757名（61.3%）在数年后完成了随访（平均 = 4.95年，四分位间距 = 3.74 - 5.90年）。在基线访视时，可能的PTSD定义为PTSD检查表问卷得分44分或更高，BDR定义为支气管扩张剂给药后FEV变化12%或更大且增加200 ml或更大。哮喘发病定义为基线访视后新的医生诊断哮喘的自我报告。多变量逻辑回归用于分析可能的PTSD与基线BDR或哮喘发病情况。测量指标及主要结果：在基线时，所有参与者中可能的PTSD与BDR相关（调整后的优势比 = 1.43；95%置信区间 = 1.19 - 1.72），在未患哮喘的从不吸烟者中结果相似。在3757名从不吸烟者中，即使在调整基线BDR后，基线时可能的PTSD与哮喘发病相关（优势比 = 2.41；95%置信区间 = 1.85 - 3.13）。在排除195名有基线BDR的受试者后的验证性分析中，这种关联仍然显著。
在暴露于严重创伤事件的成年工作者队列中，可能的PTSD与基线BDR显著相关，并可预测哮喘发病。
