PROJECT SUMMARY/ABSTRACTAsthma 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 controland impaired quality of life. Thus, asthma is a major cause of morbidity in this population. Several studies showa strong relationship between PTSD and increased asthma morbidity. PTSD is associated with systemicinflammation (increased levels of interleukin [IL]-1α, IL-2, IL-6, and tumor necrosis factor-alpha [TNF-α]). Someof these pro-inflammatory cytokines have been linked to more severe asthma phenotypes, potentiallyexplaining the relationship between PTSD and worse asthma outcomes. However, biological pathways arelikely only part of the drivers of asthma morbidity. Several observations suggest that PTSD has a strongerassociation 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 illnessand medication beliefs in patients with PTSD may lead to lower adherence to asthma self-managementbehaviors (SMB), a key determinant of asthma outcomes. With adherence to controller medications being lowamong asthma patients in general, behavioral mechanisms may also contribute to the association betweenPTSD and increased asthma morbidity in WTC workers. Our goal is to examine the interaction of biology andbehavior in WTC workers with asthma and PTSD and use this information to design and pilot test anintervention to improve their care. The Specific Aims are to: 1. assess the relationship of PTSD with systemicand airway inflammatory patterns in WTC workers with asthma and evaluate the association with asthmacontrol; 2. examine the longitudinal association between PTSD and symptom perception in WTC workers withasthma; 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 ResponseResiliency Program, a mind-body program, with counseling to promote asthma SMB, and education to correctover-perception of asthma symptoms. In order to accomplish these Aims, we will recruit 400 WTC workers witha physician diagnosis of asthma from the WTC Health Program. Study subjects will undergo a comprehensivebaseline evaluation and will be followed at 6 and 12 months to diagnose PTSD using a structured psychiatricinterview, assess systemic and airway inflammatory markers, symptom perception in naturalistic settings,objective measures of medication adherence, and information about asthma outcomes. Using these data, wewill evaluate the interplay of biological and behavioral pathways underlying the relationship of PTSD withincrease asthma morbidity and adapt and pilot test a novel intervention to improve outcomes of WTC workers.
|Effective start/end date||1/09/16 → 31/08/21|
- National Institute for Occupational Safety and Health: $599,999.00