Post-traumatic Stress Disorder, Bronchodilator Response, and Incident Asthma in World Trade Center Rescue and Recovery Workers
Post-traumatic Stress Disorder, Bronchodilator Response, and Incident Asthma in World Trade Center Rescue and Recovery Workers
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DOI：
10.1164/rccm.201605-1067oc
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发表时间：
2016-12-01
影响因子：
24.7
通讯作者：
Celedon, Juan C.
中科院分区：
文献类型：
--
作者：
de la Hoz, Rafael E.;Jeon, Yunho;Celedon, Juan C.
基本原理：在横断面研究中，创伤后应激障碍（PTSD）与哮喘相关。PTSD是否会导致临床显著的支气管扩张反应（BDR）或新发哮喘尚不清楚。目的：我们试图在纽约（NY）世贸中心工作人员的高危队列中确定可能的PTSD与BDR和新发哮喘之间的关系。方法：这项研究的数据来自纽约11,481名世界贸易中心工作人员的高风险队列，其中包括6,133名从未吸烟且先前没有哮喘诊断的人。在6，133名无哮喘的从不吸烟者中，3，757名（61.3%）在几年后完成了随访（平均值= 4.95年，四分位数间距= 3.74-5.90年）。在基线访视时，PTSD检查表中的PTSD评分≥ 44分定义为可能的PTSD，BDR定义为支气管扩张剂给药后FEV 1变化≥ 12%且增量≥ 200 ml。哮喘事件定义为基线访视后新医生诊断为哮喘的自我报告。多变量逻辑回归用于分析可能的PTSD和基线BDR或事件asthm.Measurements和主要和结果：在基线，可能的PTSD与BDR在所有参与者（调整比值比= 1.43; 95%置信区间= 1.19-1.72），与类似的结果，从不吸烟者无哮喘。在3，757名从不吸烟者中，基线时可能的PTSD与哮喘事件相关，即使在校正基线BDR后也是如此（比值比= 2.41; 95%置信区间= 1.85-3.13）。排除195例基线BDR.Conclusions：在一个队列的成年工人暴露于严重的创伤性事件，可能的PTSD是显着相关的BDR在基线和预测哮喘事件后，这种关联仍然显着的验证性分析。
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.