Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
J Allergy Clin Immunol Pract. 2022 Jan;10(1):242-249. doi: 10.1016/j.jaip.2021.08.035. Epub 2021 Sep 14.
Comorbid posttraumatic stress disorder (PTSD) is highly prevalent and associated with increased morbidity among World Trade Center (WTC) rescue and recovery workers with asthma. However, the potential behavioral pathways underlying this relationship remain unclear.
To evaluate whether PTSD is associated with lower adherence to asthma self-management behaviors among WTC workers with asthma.
We used data from a prospective cohort of WTC workers with a physician diagnosis of asthma who were prescribed controller medications. Presence of comorbid PTSD was determined based on structured clinical interviews. Asthma self-management behaviors included medication adherence, inhaler technique, use of action plans, and trigger avoidance. We conducted unadjusted and multiple regression analyses to evaluate the association of PTSD with asthma self-management.
Overall, 30% of 276 WTC workers with asthma had comorbid PTSD. Posttraumatic stress disorder was associated with worse asthma control and poorer quality of life. However, PTSD was not significantly associated with medication adherence (odds ratio [OR] -0.15; 95% confidence interval [CI] -0.5 to 0.2), inhaler technique (OR -0.12; 95% CI -0.7 to 0.5), use of action plans (OR 0.8; 95% CI 0.4 to 1.8), or trigger avoidance (OR 0.9; 95% CI 0.4 to 1.8).
We did not find significant differences in key asthma self-management behaviors between WTC workers with and without PTSD. These results suggest that other mechanisms, such as differences in symptom perception or inflammatory pathways, may explain the association between PTSD and increased asthma morbidity.
创伤后应激障碍（PTSD）共病在世界贸易中心（WTC）救援和恢复工作者中哮喘患者中发病率较高，并与发病率增加相关。然而，这种关系潜在的行为途径仍不清楚。
评估 PTSD 是否与 WTC 哮喘患者哮喘自我管理行为的依从性降低有关。
我们使用了一个有医师诊断为哮喘的 WTC 工人前瞻性队列的数据，这些工人开了控制器药物。根据结构临床访谈确定是否存在共病 PTSD。哮喘自我管理行为包括药物依从性、吸入器技术、使用行动计划和避免诱因。我们进行了未调整和多元回归分析，以评估 PTSD 与哮喘自我管理的关系。
总体而言，276 名 WTC 哮喘患者中有 30%患有共病 PTSD。创伤后应激障碍与哮喘控制较差和生活质量较差有关。然而，PTSD 与药物依从性（比值比 [OR] -0.15；95%置信区间 [CI] -0.5 至 0.2）、吸入器技术（OR -0.12；95% CI -0.7 至 0.5）、行动计划使用（OR 0.8；95% CI 0.4 至 1.8）或诱因回避（OR 0.9；95% CI 0.4 至 1.8）无显著相关性。
我们没有发现 PTSD 组和无 PTSD 组之间关键哮喘自我管理行为有显著差异。这些结果表明，其他机制，如症状感知或炎症途径的差异，可能解释了 PTSD 与哮喘发病率增加之间的关联。
