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ptsd Asthma Increases From Ptsd
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DenDowhy
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
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.
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