Worsened Asthma Symptoms After Sept. 11 Linked to Environmental, Psychological Factors

NEW YORK CITY, Sept. 5 - Psychological and environmental impacts of the Sept. 11 attacks on the World Trade Center probably contributed to an increase in asthma severity reported by some adult asthma-sufferers, according to a new study by The New York Academy of Medicine. The study will appear in the Friday, Sept. 6 issue of the CDC???s Morbidity and Mortality Weekly Report.

The study was based on a telephone survey of approximately 1,000 adults residing south of 110th Street in Manhattan, conducted 5 to 9 weeks after the terrorist attacks. About 13 percent of those adults reported a past asthma diagnosis. Of those asthmatics, 27 percent said they suffered more severe asthma symptoms in weeks after Sept. 11 compared to the 4 weeks prior to the attacks.

Although asthma typically increases in severity in the fall, worsened symptoms were more commonly reported by asthmatics who had both suffered significant psychological distress before or after the terrorist attacks, or, who had difficulty breathing because of smoke and debris during the attacks. Psychological stresses associated with worsened asthma included: a panic attack at the time of the World Trade Center tragedy or shortly thereafter, depression in the past month, symptoms of post-traumatic stress disorder related to the attacks or life stressors in the year prior to Sept. 11. (Life stressors include divorce, marriage, or death of a close friend or family member).

Asthma patients and their doctors should be aware of the role these factors can play in exacerbating asthma symptoms after disasters, said Joanne Fagan, Ph.D., an Academy consultant and lead author of the study.

???People probably knew that environmental exposure to a disaster like Sept. 11 could trigger worsening of their asthma,??? said Fagan, who is also an assistant professor at the Joseph L. Mailman School of Public Health at Columbia University. ???But I???m not sure people knew that how they reacted psychologically to the event could make their asthma worse.???

The authors note that the study has some limitations, including its reliance on self-reported symptoms and exposure. The study cannot establish a proven causal relationship between worsening of asthma and psychological/environmental impacts of Sept. 11. However, the study???s findings are consistent with past research linking worsened asthma with environmental factors and psychological stress.

???We know that people with asthma can be affected by both environmental changes and psychological stress,??? said Dr. Thomas Matte, an Investigator in the Center for Urban Epidemiologic Studies at The New York Academy of Medicine, and an epidemiologist with the Centers for Disease Control and Prevention. ???In addition, the findings are consistent with past studies showing increased rates of physical health problems and symptoms in those suffering from psychological trauma.???

Asthma is a chronic disease of the lungs that affects approximately 14 million U.S. residents. Asthma attacks can be triggered by particulate matter and other components of smoke, such as that which filled the air after the World Trade Center buildings collapsed. An increase in episodes of asthma and other respiratory illnesses have been reported after other large structural fires and during brush or forest fires near urban areas.

The precise mechanism of how psychological stress triggers worsening of asthma is not well understood but several theories exist. Stress affects the nervous system and certain body chemicals in ways that could cause inflammation of the airway lining and airflow obstruction. Stress may also lower resistance to respiratory infections that can worsen asthma, or may lead people to become less diligent in their asthma management.

Because this study was conducted last fall, it does not provide any information about longer-term respiratory health impacts from the World Trade Center attacks. Researchers are currently analyzing data from surveys conducted four and six months after Sept. 11 to determine whether links persist between psychological stressors and asthma symptoms.

Asthma patients should control their symptoms by working with a health care provider to establish a management plan that may include anti-inflammatory medicines, daily monitoring of symptoms and avoidance of asthma-triggers.

The New York Academy of Medicine is a non-profit institution founded in 1847 that is dedicated to enhancing the health of the public through research, education and advocacy, with a particular focus on the problems affecting disadvantaged urban populations.

Read media coverage of the study:

• CNN
• HealthScout

Posted on September 5, 2002

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Contact:
Andrew J. Martin
Director of Communications
The New York Academy of Medicine
1216 Fifth Avenue
New York, New York 10029
212-822-7285
amartin@nyam.org

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