PTSD and lower respiratory symptoms: A systematic review of longitudinal associations in early 9/11 World Trade Center responders

Objective: The objective of this systematic review is to examine longitudinal associations between post-traumatic stress disorder (PTSD) and lower respiratory symptoms (LRS) specifically among responders present at the World Trade Center (WTC) site on September 11, 2001 (9/11). This group, which we refer to as "9/11 early responders," appears to have particularly high rates of both mental and physical illness relative to other 9/11-exposed populations.Methods: We performed a systematic literature review to examine associations between PTSD and LRS among 9/ 11 early responders in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. After a structured search of Pubmed and the Fire Department of New York (FDNY) WTC bibliography for relevant articles, we identified 4 articles commenting on associations between PTSD and LRS in this population; all 4 passed quality review and were included in our primary analysis. 10 other articles we found in our research discussed rates of PTSD and LRS, but not associations between them, in the population in question; we commented on these in a secondary analysis.Results: The data demonstrate that there are significant associations between PTSD and LRS among 9/11 early responders. The data also suggest that both of these phenomena are more prevalent among 9/11 early responders relative to other 9/11-exposed populations. Conclusions: These findings are relevant for optimizing care for the population in question, as well as for other survivors of past and future disasters with both psychiatric and medical sequelae.