The respiratory pyramid: from symptoms to disease in World Trade Center exposed firefighters

Details

• Personal Author:
  Aldrich TK ; Cohen HW ; Glaser MS ; Glass L ; Hall CB ; Kelly KJ ; Niles JK ; Nolan A ; Prezant DJ ; Weakley J ; Webber MP ; Weiden MD ; Ye F ; Zeig-Owens R
• Description:
  Background: This study utilizes a four-level pyramid framework to understand the relationship between symptom reports and/or abnormal pulmonary function and diagnoses of airway diseases (AD), including asthma, recurrent bronchitis and COPD/emphysema in WTC-exposed firefighters. We compare the distribution of pyramid levels at two time-points: by 9/11/2005 and by 9/11/2010. Methods: We studied 6,931 WTC-exposed FDNY firefighters who completed a monitoring exam during the early period and at least two additional follow-up exams 9/11/2005-9/11/2010. Results: By 9/11/2005, the pyramid structure was as follows: 4,039 (58.3%) in Level 1, no respiratory evaluation or treatment; 1,608 (23.2%) in Level 2, evaluation or treatment without AD diagnosis; 1,005 (14.5%) in Level 3, a single AD diagnosis (asthma, emphysema/COPD, or recurrent bronchitis); 279 (4.0%) in Level 4, asthma and another AD. By 9/11/2010, the pyramid distribution changed considerably, with Level 1 decreasing to 2,612 (37.7% of the cohort), and Levels 3 (N = 1,530) and 4 (N = 796) increasing to 22.1% and 11.5% of the cohort, respectively. Symptoms, spirometry measurements and healthcare utilization were associated with higher pyramid levels. Conclusions: Respiratory diagnoses, even four years after a major inhalation event, are not the only drivers of future healthcare utilization. Symptoms and abnormal FEV- 1 values must also be considered if clinicians and healthcare administrators are to accurately anticipate future treatment needs, years after initial exposure. [Description provided by NIOSH]
• Subjects:
  Asthma Dust Emergency Responders Firefighters Hazardous Substances Health Care Facilities Workforce And Services Health Promotion Lung Lung Diseases Occupational Exposure Occupational Health Particulate Matter Respiratory Function Tests Respiratory System Respiratory Tract Diseases Safety September 11 Terrorist Attacks

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• Keywords:
  Airway Obstruction Asthma Author Keywords: World Trade Center Bronchial Asthma Clinical Symptoms Disease Incidence Dose Response Dust Exposure Dust Particles Dusts Emergency Responders Employee Exposure Fire Fighters Hazardous Materials Health Care Health Programs Lung Disorders Lung Function Medical Monitoring Medical Screening Medical Treatment Pulmonary Function Pulmonary System Disorders Respiratory Function Tests Respiratory System Disorders Spirometry Treatment Outcomes World Trade Center WTC

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• ISSN:
  0271-3586
• Document Type:
  Text
• Funding:
  Contract
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  56
• Issue:
  8
• NIOSHTIC Number:
  nn:20042966
• Citation:
  Am J Ind Med 2013 Aug; 56(8):870-880
• Contact Point Address:
  Mayris P. Webber, Department of Epidemiology and Population Health, Montefiore Medical Center/Albert Einstein College of Medicine and Director of WTC Epidemiology, Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY 11201
• Email:
  mwebber@montefiore.org
• Federal Fiscal Year:
  2013
• Performing Organization:
  New York City Fire Department
• Peer Reviewed:
  True
• Start Date:
  20140701
• Source Full Name:
  American Journal of Industrial Medicine
• End Date:
  20170630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:39afb86b2ef71facd7abfe2b7e732bbe779ebea9d4fa19c8d32d7852636bea6ad95c3221fdc51dfd33394870a26ee38f438875adde87cc7ac5a32ee90d931108
• Download URL:
  https://stacks.cdc.gov/view/cdc/195013/cdc_195013_DS1.pdf
• File Type:
  [PDF - 637.09 KB ]