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Morales-Raveendran E, Goodman E, West E, Cone JE, Katz C, Weiss J, Feldman JM, Harrison D, Markowitz S, Federman A, Wisnivesky JP. Associations between asthma trigger reports, mental health conditions, and asthma morbidity among world trade center rescue and recovery workers. J Asthma 2018; 56:833-840. [PMID: 30073876 DOI: 10.1080/02770903.2018.1502300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Aim: There is limited information regarding asthma triggers in World Trade Center (WTC) rescue and recovery workers (RRW) or how mental health conditions affect the perception of triggers. Methods: We included 372 WTC workers with asthma. The Asthma Trigger Inventory (ATI) assessed triggers along five domains: psychological, allergens, physical activity, infection, and pollution. We administered the Structured Clinical Interview to diagnose post-traumatic stress disorder (PTSD), major depression and panic disorder (PD). The Asthma Control Questionnaire (ACQ) and Mini Asthma Quality of Life Questionnaire (AQLQ) measured asthma control and quality of life, respectively. Linear regression models were fitted to examine the association of ATI total and subdomain scores with mental health conditions as well as the percent of ACQ and AQLQ variance explained by ATI subscales. Results: The most common triggers were air pollution (75%) and general allergens (68%). PTSD was significantly associated with psychological triggers (partial r2=0.05, p < 0.01), physical activity (partial r2=0.03, p < 0.01) and air pollution (partial r2=0.02, p = 0.04) subscales while PD was significantly associated with air pollution (partial r2=0.03, p = 0.03) and general allergens (partial r2=0.02, p = 0.03). ATI subscales explained a large percentage of variance in asthma control (r2=0.37, p < 0.01) and quality of life scores (r2=0.40, p < 0.01). Psychological subscale scores explained the largest portion of the total variability in ACQ (partial r2= 0.11, p = 0.72) and AQLQ (partial r2=0.14, p = 0.64) scores. Conclusion: RRW with mental health conditions reported more asthma triggers and these triggers were associated with asthma morbidity. These data can help support interventions in RRW with asthma.
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Affiliation(s)
- E Morales-Raveendran
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA.,c Ferkauf Graduate School of Psychology, Yeshiva University , Bronx , NY , USA
| | - E Goodman
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - E West
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - J E Cone
- b New York City Department of Health and Mental Hygiene, World Trade Center Health Registry , New York , NY , USA
| | - C Katz
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - J Weiss
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - J M Feldman
- c Ferkauf Graduate School of Psychology, Yeshiva University , Bronx , NY , USA.,d Department of Pediatrics (Academic General Pediatrics), Albert Einstein College of Medicine/Children's Hospital at Montefiore , Bronx , NY , USA
| | - D Harrison
- e Department of Medicine, New York University , New York , NY , USA
| | - S Markowitz
- f Queens College, City University of New York , Flushing , NY , USA
| | - Alex Federman
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - J P Wisnivesky
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA.,g Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
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Vernon MK, Wiklund I, Bell JA, Dale P, Chapman KR. What do we know about asthma triggers? a review of the literature. J Asthma 2013; 49:991-8. [PMID: 23574397 DOI: 10.3109/02770903.2012.738268] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE For patients with asthma, exacerbations and poor control can result from exposure to environmental triggers, such as allergens and air particulates. This study reviewed the international literature to determine whether a global checklist of common asthma triggers might be feasible for use as a research or management tool in clinical practice. METHODS Literature published from 2002 to 2012 was identified through PubMed and EMBASE using the following search terms: asthma, asthma triggers, prevalence, among others. A total of 1046 abstracts were found; 85 articles were reviewed covering six continents (number of articles): Africa (1), Asia (22), Australia (1), Europe (27), North America (22), and South America (4). RESULTS The literature consistently pointed to asthma triggers as one contributor to poor asthma control. Frequently cited triggers were similar across countries/regions and included allergens (particularly pollens, molds, dust, and pet dander), tobacco smoke, exercise, air pollutants/particulates, weather patterns/changes, and respiratory infections. Definitions of asthma triggers, how triggers are taken into account in definitions of asthma control, and scientific inquiry into optimal management techniques for triggers were inconsistent and sparse. CONCLUSIONS Given the apparent importance of triggers in attaining and maintaining asthma control, empirical research concerning optimal trigger management is needed. Results demonstrate that asthma triggers are similar across continents, suggesting a global checklist of triggers for use in research and clinical practice would be feasible.
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