Asthma and post-traumatic stress disorder (PTSD) are the most common conditions in World Trade Center (WTC) rescue and recovery workers. A large number of WTC workers continue to report poor asthma control and impaired quality of life. Thus, asthma is a major cause of morbidity in this population. Several studies show a strong relationship between PTSD and increased asthma morbidity. PTSD is associated with systemic inflammation (increased levels of interleukin [IL]-1?, IL-2, IL-6, and tumor necrosis factor-alpha [TNF-?]). Some of these pro-inflammatory cytokines have been linked to more severe asthma phenotypes, potentially explaining the relationship between PTSD and worse asthma outcomes. However, biological pathways are likely only part of the drivers of asthma morbidity. Several observations suggest that PTSD has a stronger association with subjective (asthma symptoms, use of rescue medication, and quality of life) than objective (pulmonary function) markers of asthma morbidity, suggesting over-perception of symptoms. Additionally, theory and empirical evidence suggest that inaccurate perception of asthma symptoms and maladaptive illness and medication beliefs in patients with PTSD may lead to lower adherence to asthma self-management behaviors (SMB), a key determinant of asthma outcomes. With adherence to controller medications being low among asthma patients in general, behavioral mechanisms may also contribute to the association between PTSD and increased asthma morbidity in WTC workers. Our goal is to examine the interaction of biology and behavior in WTC workers with asthma and PTSD and use this information to design and pilot test an intervention to improve their care.
The Specific Aims are to: 1. assess the relationship of PTSD with systemic and airway inflammatory patterns in WTC workers with asthma and evaluate the association with asthma control; 2. examine the longitudinal association between PTSD and symptom perception in WTC workers with asthma; 3. assess the relationship between PTSD and adherence to asthma SMB (medication adherence, trigger avoidance, and inhaler technique) in WTC workers and identify the pathways linking them; and 4. develop and pilot test an integrated intervention for asthma and PTSD by adapting the Relaxation Response Resiliency Program, a mind-body program, with counseling to promote asthma SMB, and education to correct over-perception of asthma symptoms. In order to accomplish these Aims, we will recruit 400 WTC workers with a physician diagnosis of asthma from the WTC Health Program. Study subjects will undergo a comprehensive baseline evaluation and will be followed at 6 and 12 months to diagnose PTSD using a structured psychiatric interview, assess systemic and airway inflammatory markers, symptom perception in naturalistic settings, objective measures of medication adherence, and information about asthma outcomes. Using these data, we will evaluate the interplay of biological and behavioral pathways underlying the relationship of PTSD with increase asthma morbidity and adapt and pilot test a novel intervention to improve outcomes of WTC workers.
Asthma and post-traumatic stress disorder (PTSD) are the most common conditions in World Trade Center (WTC) rescue and recovery workers. In this study, we will evaluate the interplay of biological and behavioral mechanisms explaining the relationship of PTSD with increase asthma morbidity and adapt and pilot test a novel intervention to improve outcomes of WTC workers.
