Self-management behaviors in World Trade Center rescue and recovery workers with asthma

Rojano, Belen; West, Erin; Goodman, Elliot R.; Weiss, Jeffrey J.; Hoz, Rafael E. de la; Crane, Michael; Crowley, Laura; Harrison, Denise; Markowitz, Steven; Wisnivesky, Juan P.

doi:10.1080/02770903.2018.1462377

Cited by 6 publications

(9 citation statements)

References 54 publications

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“…Our findings demonstrate that half the enrollees who were prescribed a LTCM were incompletely adherent with their asthma regimen, and that a majority of enrollees had poorly or very poorly controlled asthma as measured by the ACT. Poor adherence is well described in the general asthma literature (23,(41)(42)(43), as well as a previous report of WTC RRW (24). Similarly, poor asthma control in the WTC disaster population has been noted previously (11,17).…”

Section: Discussionsupporting

confidence: 65%

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Mental health, long-term medication adherence, and the control of asthma symptoms among persons exposed to the WTC 9/11 disaster

et al. 2019

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Objective: A positive association between mental health conditions and poor asthma control has been documented in the World Trade Center-exposed population. Whether factors such as medication adherence mediate this association is unknown. Methods:The study population was drawn from adult participants of the World Trade Center Health Registry Cohort who self-reported as asthmatic after the disaster and who were currently prescribed a long-term control medication (LTCM). Multivariable linear regression was used to estimate the associations between mental health condition (PTSD, depression, or anxiety) and continuous adherence and Asthma Control Test (ACT) scores. Results:In the study sample of 1,293, 49% were not adherent to their LTCM and two thirds reported poorly or very poorly controlled asthma. Presence of any mental health condition was associated with a 2-point decline in ACT and half a point decrease in adherence scores. However, in the multivariable model, better adherence was statistically significantly associated with slightly worse control. Conclusions:The total effect of mental health on asthma control was opposite in sign from the product of the paths between mental health and adherence and adherence and asthma control; we therefore found no evidence to support the hypothesis that adherence mediated the negative association between poor mental health and adequate asthma control. More research is needed to understand the complex causal mechanisms that underlie the association between mental and respiratory health.

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Section: Discussionsupporting

confidence: 65%

“…Adherence to asthma treatments in adults is generally poor (50% for ICS) (23). Similarly, the only study to date of adherence in WTC RRW with asthma reported 44% (95% CI: 38-50%) overall adherence to asthma control medicines (24).…”

Section: Introductionmentioning

confidence: 99%

Mental health, long-term medication adherence, and the control of asthma symptoms among persons exposed to the WTC 9/11 disaster

et al. 2019

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“…The absence of peripheral blood Type 2 (T2) inflammatory signals in most of our patients is similar to the findings of Malo et al, who reported on long-term findings in a small group of subjects with irritant-induced asthma [69]. Our findings are also consistent with studies of WTC community members in which low FeNO values or IgE were identified, or in which elevated levels were identified in only a subset of patients with persistent respiratory symptoms [14,16,48,54,55]. The findings are also consistent with studies in firefighters, in which only a subset displayed persistently elevated eosinophil levels associated with decline in lung function [49].…”

Section: Discussionsupporting

confidence: 92%

“…Poor asthma control is usually ascribed to poor adherence with prescribed medications [ 14 , 54 , 55 , 56 , 57 ] and we assumed that many of the persistent symptoms in the WTC EHC patients would be due to failure to use appropriate medications. We therefore presumed that LRS would improve with adherence to a treatment of ICS/LABA and designed a run-in period to confirm adherence before defining study status as Uncontrolled or Controlled.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Persistent Uncontrolled Asthma Symptoms in Community Members Exposed to World Trade Center Dust and Fumes

Reibman

Caplan-Shaw

et al. 2020

IJERPH

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The destruction of the World Trade Center (WTC) towers on the 11th of September, 2001 released a vast amount of aerosolized dust and smoke resulting in acute and chronic exposures to community members as well as responders. The WTC Environmental Health Center (WTC EHC) is a surveillance and treatment program for a diverse population of community members, including local residents and local workers with WTC dust exposure. Many of these patients have reported persistent lower respiratory symptoms (LRS) despite treatment for presumed asthma. Our goal was to identify conditions associated with persistent uncontrolled LRS despite standard asthma management. We recruited 60 patients who were uncontrolled at enrollment and, after a three-month run-in period on high-dose inhaled corticosteroid and long acting bronchodilator, reassessed their status as Uncontrolled or Controlled based on a score from the Asthma Control Test (ACT). Despite this treatment, only 11 participants (18%) gained Controlled status as defined by the ACT. We compared conditions associated with Uncontrolled and Controlled status. Those with Uncontrolled symptoms had higher rates of upper airway symptoms. Many patients had persistent bronchial hyper-reactivity (BHR) and upper airway hyper-reactivity as measured by paradoxical vocal fold movement (PVFM). We found a significant increasing trend in the percentage of Controlled with respect to the presence of BHR and PVFM. We were unable to identify significant differences in lung function or inflammatory markers in this small group. Our findings suggest persistent upper and lower airway hyper-reactivity that may respond to standard asthma treatment, whereas others with persistent LRS necessitate additional diagnostic evaluation, including a focus on the upper airway.

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“…Measures reducing indoor and outdoor air pollution/irritants exposure, such as high-efficiency particulate air filtration system, can improve indoor air quality by reducing levels of PM 2.5 and particle count [26,27]. In addition, educating enrollees about trigger identification and avoidance may prevent exacerbations and help to improve overall asthma management [13,28,29,30]. Other sociodemographic factors, including older age, lower education level, and higher BMI also contributed to poorer asthma control, consistent with existing literature [2,10,30,31,32].…”

Section: Discussionmentioning

confidence: 99%

Air Pollution/Irritants, Asthma Control, and Health-Related Quality of Life among 9/11-Exposed Individuals with Asthma

Yung

Osahan

Friedman

et al. 2019

IJERPH

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Asthma control is suboptimal among World Trade Center Health Registry (WTCHR) enrollees. Air pollution/irritants have been reported as the most prevalent trigger among World Trade Center responders. We examined the relationship between air pollution/irritants and asthma control. We also evaluated the association of asthma control with health-related quality of life (HRQoL). We included 6202 enrollees age ≥18 with a history of asthma who completed the WTCHR asthma survey between 2015 and 2016. Based on modified National Asthma Education and Prevention Program criteria, asthma was categorized as controlled, poorly-controlled, or very poorly-controlled. HRQoL indicators include ≥14 unhealthy days, ≥14 activity limitation days, and self-rated general health. We used multinomial logistic regression for asthma control, and unconditional logistic regression for HRQoL, adjusting for covariates. Overall, 27.1% had poorly-controlled and 32.2% had very poorly-controlled asthma. Air pollution/irritants were associated with poorly-controlled (adjusted odds ratio (AOR) = 1.70; 95% CI = 1.45–1.99) and very poorly-controlled asthma (AOR = 2.15; 95% CI = 1.83–2.53). Poor asthma control in turn worsened the HRQoL of asthmatic patients. Very poorly-controlled asthma was significantly associated with ≥14 unhealthy days (AOR = 3.60; 95% CI = 3.02–4.30), ≥14 activity limitation days (AOR = 4.37; 95% CI = 3.48–5.50), and poor/fair general health status (AOR = 4.92; 95% CI = 4.11–5.89). Minimizing World Trade Center (WTC) asthmatic patients’ exposure to air pollution/irritants may improve their disease management and overall well-being.

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Self-management behaviors in World Trade Center rescue and recovery workers with asthma

Cited by 6 publications

References 54 publications

Mental health, long-term medication adherence, and the control of asthma symptoms among persons exposed to the WTC 9/11 disaster

Mental health, long-term medication adherence, and the control of asthma symptoms among persons exposed to the WTC 9/11 disaster

Characterization of Persistent Uncontrolled Asthma Symptoms in Community Members Exposed to World Trade Center Dust and Fumes

Air Pollution/Irritants, Asthma Control, and Health-Related Quality of Life among 9/11-Exposed Individuals with Asthma

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