Inflammatory Markers in World Trade Center Workers with Asthma: Associations with Post Traumatic Stress Disorder

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2024 Feb 13

PMID 38349898

Authors

Juan P Wisnivesky

Nikita Agrawal

Jyoti Ankam

Adam Gonzalez

Alex Federman

Steven B Markowitz

Janette M Birmingham

Paula J Busse

Affiliations

Soon will be listed here.

Abstract

Background: Post-traumatic stress disorders (PTSD) is associated with worse asthma outcomes in individuals exposed to the World Trade Center (WTC) site.

Research Question: Do WTC workers with coexisting PTSD and asthma have a specific inflammatory pattern that underlies the relationship with increased asthma morbidity?

Study Design And Methods: We collected data on a cohort of WTC workers with asthma recruited from the WTC Health Program. Diagnosis of PTSD was ascertained with a Structured Clinical Interview for DSM-5 (Diagnostic and Statistical Manuel of Mental Disorders) and the severity of PTSD symptoms was assessed with the PTSD Checklist 5. We obtained blood and sputum samples to measure cytokines levels in study participants.

Results: Of the 232 WTC workers with diagnosis of asthma in the study, 75 (32%) had PTSD. PTSD was significantly associated with worse asthma control (p = 0.002) and increased resource utilization (p = 0.0002). There was no significant association (p>0.05) between most blood or sputum cytokines with PTSD diagnosis or PCL-5 scores both in unadjusted and adjusted analyses.

Interpretation: Our results suggest that PTSD is not associated with blood and sputum inflammatory markers in WTC workers with asthma. These findings suggest that other mechanisms likely explain the association between PTSD and asthma control in WTC exposed individuals.

References

Agache I, Akdis C, Jutel M, Virchow J . Untangling asthma phenotypes and endotypes. Allergy. 2012; 67(7):835-46. DOI: 10.1111/j.1398-9995.2012.02832.x. View

Busse P, Birmingham J, Calatroni A, Manzi J, Goryachokovsky A, Fontela G . Effect of aging on sputum inflammation and asthma control. J Allergy Clin Immunol. 2016; 139(6):1808-1818.e6. PMC: 5385166. DOI: 10.1016/j.jaci.2016.09.015. View

Brackbill R, Hadler J, DiGrande L, Ekenga C, Farfel M, Friedman S . Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack. JAMA. 2009; 302(5):502-16. DOI: 10.1001/jama.2009.1121. View

Xu K, Goodman E, Goswami R, Crane M, Crowley L, Busse P . Determinants of asthma morbidity in World Trade Center rescue and recovery workers. Ann Allergy Asthma Immunol. 2016; 117(5):568-570. PMC: 5123696. DOI: 10.1016/j.anai.2016.08.033. View

Wisnivesky J, Becker J, Ankam J, Markowitz S, Doernberg M, Dickens B . The Relationship Between Post-Traumatic Stress Disorder and Self-Management Behaviors in World Trade Center Workers with Asthma. J Allergy Clin Immunol Pract. 2021; 10(1):242-249. PMC: 8973280. DOI: 10.1016/j.jaip.2021.08.035. View

Blevins C, Weathers F, Davis M, Witte T, Domino J . The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation. J Trauma Stress. 2015; 28(6):489-98. DOI: 10.1002/jts.22059. View

Oglodek E, Szota A, Mos D, Araszkiewicz A, Szromek A . Serum concentrations of chemokines (CCL-5 and CXCL-12), chemokine receptors (CCR-5 and CXCR-4), and IL-6 in patients with posttraumatic stress disorder and avoidant personality disorder. Pharmacol Rep. 2015; 67(6):1251-8. DOI: 10.1016/j.pharep.2015.05.023. View

Wisnivesky J, Teitelbaum S, Todd A, Boffetta P, Crane M, Crowley L . Persistence of multiple illnesses in World Trade Center rescue and recovery workers: a cohort study. Lancet. 2011; 378(9794):888-97. PMC: 9453925. DOI: 10.1016/S0140-6736(11)61180-X. View

Williams D, Sternthal M, Wright R . Social determinants: taking the social context of asthma seriously. Pediatrics. 2009; 123 Suppl 3:S174-84. PMC: 3489274. DOI: 10.1542/peds.2008-2233H. View

10.

Wisnivesky J, Agrawal N, Ankam J, Gonzalez A, Busse P, Lin J . World Trade Center workers with asthma and post-traumatic stress disorder perceive airflow limitation more accurately. Ann Allergy Asthma Immunol. 2023; 132(1):62-68. DOI: 10.1016/j.anai.2023.08.005. View

11.

Khusial R, Honkoop P, van der Meer V, Snoeck-Stroband J, Sont J . Validation of online Asthma Control Questionnaire and Asthma Quality of Life Questionnaire. ERJ Open Res. 2020; 6(1). PMC: 6983500. DOI: 10.1183/23120541.00289-2019. View

12.

Wenzel S, Szefler S, Leung D, Sloan S, Rex M, Martin R . Bronchoscopic evaluation of severe asthma. Persistent inflammation associated with high dose glucocorticoids. Am J Respir Crit Care Med. 1997; 156(3 Pt 1):737-43. DOI: 10.1164/ajrccm.156.3.9610046. View

13.

Wisnivesky J, Markowitz S, James S, Stone K, Dickens B, Busse P . Comorbid posttraumatic stress disorder and major depressive disorder are associated with asthma morbidity among World Trade Center workers. Ann Allergy Asthma Immunol. 2020; 126(3):278-283. DOI: 10.1016/j.anai.2020.10.007. View

14.

Passos I, Vasconcelos-Moreno M, Costa L, Kunz M, Brietzke E, Quevedo J . Inflammatory markers in post-traumatic stress disorder: a systematic review, meta-analysis, and meta-regression. Lancet Psychiatry. 2015; 2(11):1002-12. DOI: 10.1016/S2215-0366(15)00309-0. View

15.

Turner M, Hussack P, Sears M, Dolovich J, Hargreave F . Exacerbations of asthma without sputum eosinophilia. Thorax. 1995; 50(10):1057-61. PMC: 475018. DOI: 10.1136/thx.50.10.1057. View

16.

Allgire E, McAlees J, Lewkowich I, Sah R . Asthma and posttraumatic stress disorder (PTSD): Emerging links, potential models and mechanisms. Brain Behav Immun. 2021; 97:275-285. PMC: 8453093. DOI: 10.1016/j.bbi.2021.06.001. View

17.

Moore W, Meyers D, Wenzel S, Teague W, Li H, Li X . Identification of asthma phenotypes using cluster analysis in the Severe Asthma Research Program. Am J Respir Crit Care Med. 2009; 181(4):315-23. PMC: 2822971. DOI: 10.1164/rccm.200906-0896OC. View

18.

Juniper E, OByrne P, Guyatt G, Ferrie P, King D . Development and validation of a questionnaire to measure asthma control. Eur Respir J. 1999; 14(4):902-7. DOI: 10.1034/j.1399-3003.1999.14d29.x. View

19.

OToole B, Catts S . Trauma, PTSD, and physical health: an epidemiological study of Australian Vietnam veterans. J Psychosom Res. 2007; 64(1):33-40. DOI: 10.1016/j.jpsychores.2007.07.006. View

20.

Jia C, Zhang H, Lv Y, Liang R, Jiang Y, Powell H . The Asthma Control Test and Asthma Control Questionnaire for assessing asthma control: Systematic review and meta-analysis. J Allergy Clin Immunol. 2012; 131(3):695-703. DOI: 10.1016/j.jaci.2012.08.023. View