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J Asthma. 2017 Sep;54(7):723-731. doi: 10.1080/02770903.2016.1263650. Epub 2016 Dec 1.

Post-traumatic stress disorder dimensions and asthma morbidity in World Trade Center rescue and recovery workers.

Author information

a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.
b The Graduate Center, City University of New York , New York , NY , USA.
c Queens College, City University of New York , Flushing , NY , USA.
d Department of Psychiatry , Icahn School of Medicine at Mount Sinai , New York , NY , USA.
e Department of Preventive Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.
f Division of Pulmonary , Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA.



Using data from a cohort of World Trade Center (WTC) rescue and recovery workers with asthma, we assessed whether meeting criteria for post-traumatic stress disorder (PTSD), sub-threshold PTSD, and for specific PTSD symptom dimensions are associated with increased asthma morbidity.


Participants underwent a Structured Clinical Interview for Diagnostic and Statistical Manual to assess the presence of PTSD following DSM-IV criteria during in-person interviews between December 2013 and April 2015. We defined sub-threshold PTSD as meeting criteria for two of three symptom dimensions: re-experiencing, avoidance, or hyper-arousal. Asthma control, acute asthma-related healthcare utilization, and asthma-related quality of life data were collected using validated scales. Unadjusted and multiple regression analyses were performed to assess the relationship between sub-threshold PTSD and PTSD symptom domains with asthma morbidity measures.


Of the 181 WTC workers with asthma recruited into the study, 28% had PTSD and 25% had sub-threshold PTSD. Patients with PTSD showed worse asthma control, higher rates of inpatient healthcare utilization, and poorer asthma quality of life than those with sub-threshold or no PTSD. After adjusting for potential confounders, among patients not meeting the criteria for full PTSD, those presenting symptoms of re-experiencing exhibited poorer quality of life (p = 0.003). Avoidance was associated with increased acute healthcare use (p = 0.05). Sub-threshold PTSD was not associated with asthma morbidity (p > 0.05 for all comparisons).


There may be benefit in assessing asthma control in patients with sub-threshold PTSD symptoms as well as those with full PTSD to more effectively identify ongoing asthma symptoms and target management strategies.


9/11; Asthma; PTSD; WTC; asthma management; asthma morbidity; asthma outcomes; stress; sub-threshold PTSD; trauma

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