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Asthma Increases From Ptsd



From Medscape Medical News

Symptoms of PTSD Linked to Increased Prevalence of Asthma

News Author: Laurie Barclay, MD

CME Author: Penny Murata, MD

Authors and Disclosures

CME Released: 11/29/2007; Valid for credit through 11/29/2008

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    November 29, 2007 — Symptoms of posttraumatic stress disorder (PTSD) are linked to increased prevalence of asthma even after careful adjustment for familial or genetic factors and other potential confounders, according to an analysis of data from the Vietnam Era Twin Registry reported in the November 15 issue of the American Journal of Respiratory & Critical Care Medicine.

    "Studies have suggested heightened anxiety among adults with asthma; the mechanism of this association is not known," write Renee D. Goodwin, PhD, MPH, from Columbia University in New York, NY, and colleagues. "Evidence to date suggests that panic disorder and post–traumatic stress disorder (PTSD) are the anxiety disorders most strongly associated with asthma in clinical samples. . . . The goals of the current study are as follows: (1) to determine the strength of the relationship between PTSD symptoms and asthma and (2) to examine if the association is due to familial or genetic confounding factors."

    The Vietnam Era Twin Registry includes male veteran twin pairs born between 1939 and 1956 who served from 1965 to 1975 during the Vietnam era. Variables included a symptom scale for PTSD, history of clinician-diagnosed asthma, and sociodemographic and health confounding factors. Mixed-effects logistic regression was used to account for the paired structure of the twin data and to evaluate the association between PTSD symptoms and asthma in all twins. Separate analyses were conducted within twin pairs and were based on zygosity.

    Even after adjustment for confounding factors, such as smoking and body mass index, PTSD symptoms were associated with a significantly increased likelihood of asthma (P for trend < .001). Compared with twins in the lowest quartile of PTSD symptoms, those in the highest quartile were 2.3 times as likely (95% confidence interval [CI], 1.4 - 3.7) to have asthma. Results were similar when evaluated within twin pairs and after stratification by zygosity.

    Limitations of the study include lack of data concerning some risk factors for asthma, such as exposure to cockroach allergen and environmental tobacco smoke during childhood; lack of information on timing or severity of asthma; measurement of PTSD symptoms not contemporaneous with the measurement of a lifetime history of asthma; lack of data on other types of anxiety; sample limited to men; possible bias if individuals with more PTSD symptoms seek out medical care more often vs those with fewer symptoms; possible overreporting of physical illnesses in patients with PTSD; and cross-sectional analysis.

    "Symptoms of PTSD were associated with an elevated prevalence of asthma," the study authors write. "Even after careful adjustment for familial/genetic factors and other potential confounding factors, an association between PTSD symptoms and asthma remains. Efforts to understand this comorbidity may be useful in identifying modifiable environmental risk factors contributing to this pattern and therefore in developing more effective prevention and intervention strategies."

    The US Department of Veterans Affairs has provided financial support for the development and maintenance of the Vietnam Era Twin Registry. The study authors have disclosed no relevant financial relationships.

    Am J Respir Crit Care Med. 2007;176:983-987.

    Clinical Context

    Asthma has been linked to mental disorders. According to a study by Kean and colleagues in the January 2006 issue of the Journal of the American Academy of Child and Adolescent Psychiatry, PTSD was associated with severity of asthma in adolescents. In the July 2002 issue of Psychiatric Services, Weisberg and colleagues noted an association between PTSD and asthma in adults. However, the role of risk factors, including genetic factors, has not been determined.

    This study of male veteran twin pairs evaluates whether PTSD symptoms are associated with the likelihood of asthma and the role of familial or genetic factors in the association between PTSD and asthma.

    Study Highlights

    • 7375 male twin pairs born between 1939 and 1957 who had active duty during the Vietnam era were enrolled in the Vietnam Era Twin Registry.
    • Data on twins who responded to the 1987 survey that assessed zygosity and PTSD symptoms and the 1991 survey that assessed asthma were analyzed.
    • Zygosity was based on a survey similarity algorithm and blood group typing.
    • PTSD was based on 15 questions about frequency of symptoms in the previous 6 months; the questions came from criteria of the Diagnostic and Statistical Manual of Mental Disorders (Third Edition).
    • Prevalence of asthma, based on self-report of clinician-diagnosed asthma, was 6% (346/5804).
    • Twins with asthma were younger vs twins without asthma (38 vs 38.4 years; P < .05) and were more likely to report clinician-diagnosed depression (12% [40/346] vs 7% [358/5458]; P < .001).
    • Twins with asthma vs those without asthma did not differ in zygosity, mean body mass index, educational level, cigarette smoking history, or combat exposure.
    • Twin correlations for asthma were greater in the monozygotic vs the dizygotic pairs.
    • Twin correlations for the PTSD symptom scale were greater in the monozygotic vs the dizygotic pairs.
    • PTSD was associated with increased prevalence of asthma ( P for trend < .001), even after adjustment for educational level, combat exposure, cigarette smoking, age, body mass index, and depression.
    • Twins in the higher quartile of PTSD symptoms had higher prevalence of asthma vs twins in the lowest quartile (odds ratio [OR], 2.3; 95% CI, 1.4 - 3.7), even after adjustment for familial and genetic factors within twin pairs (OR, 2.0; 95% CI, 1.1 - 3.6).
    • PTSD association with asthma was significant within dizygotic pairs ( P for trend, =.04) and less significant within monozygotic pairs ( P for trend, =.08).
    • Twins in the higher quartile of PTSD symptoms had higher prevalence of asthma vs twins in the lowest quartile both within monozygotic (OR, 1.8; 95% CI, 0.7 - 4.9) and dizygotic pairs (OR, 2.0; 95% CI, 0.9 - 4.4).
    • Limitations of the study included lack of data on timing and severity of asthma and inability to generalize results to women.

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This study also,is all well and good but for it to apply to a claim

a doctor must state in writing, that this relates directly to the claimant

and support it with full medical rationale.

Studies in general relate to the populace as a whole.

For it to be beneficial for a claimant, the doctor must relate it directly

to the claimant.

If not, VA will give little weight to this evidence and state it is speculation.


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I have asthma and Panic Disorder and I can't sleep either

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