Steven Stellman - Factors associated with poor control of 9/11-related asthma 10-11 years after the 2001 World Trade Center terrorist attacks

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      Jordan, H. T., Stellman, S. D., Reibman, J., Farfel, M. R.,   Brackbill, R. M., Friedman, S. M., Li, J., Cone, J. E.   52 (6) 630-7-

      Abstract: OBJECTIVE: To identify key factors   associated with poor asthma control among adults in the World   Trade Center (WTC) Health Registry, a longitudinal study of   rescue/recovery workers and community members who were directly   exposed to the 2001 WTC terrorist attacks and their aftermath.   METHODS: We studied incident asthma diagnosed by a physician from   12 September 2001 through 31 December 2003 among participants   aged >/=18 on 11 September 2001, as reported on an enrollment   (2003-2004) or follow-up questionnaire. Based on modified   National Asthma Education and Prevention Program criteria, asthma   was considered controlled, poorly-controlled, or very   poorly-controlled at the time of a 2011-2012 follow-up   questionnaire. Probable post-traumatic stress disorder,   depression, and generalized anxiety disorder were defined using   validated scales. Self-reported gastroesophageal reflux symptoms   (GERS) and obstructive sleep apnea (OSA) were obtained from   questionnaire responses. Multinomial logistic regression was used   to examine factors associated with poor or very poor asthma   control. RESULTS: Among 2445 participants, 33.7% had   poorly-controlled symptoms and 34.6% had very poorly-controlled   symptoms in 2011-2012. Accounting for factors including age,   education, body mass index, and smoking, there was a   dose-response relationship between the number of mental health   conditions and poorer asthma control. Participants with three   mental health conditions had five times the odds of poor control   and 13 times the odds of very poor control compared to   participants without mental health comorbidities. GERS and OSA   were significantly associated with poor or very poor control.   CONCLUSIONS: Rates of poor asthma control were very high in this   group with post-9/11 diagnosed asthma. Comprehensive care of   9/11-related asthma should include management of mental and   physical health comorbidities.

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