Lung function more than a decade after World Trade Center (WTC) exposure: the influences of bronchial reactivity and corticosteroid therapy

Details

• Personal Author:
  Aldrich TK ; Banauch GI ; Berger KI ; Christodoulou V ; Crosse T ; Dhar S ; Hall CB ; King C ; Prezant DJ ; Weakley J ; Webber MP ; Weiden MD ; Ye F
• Description:
  Rationale: Inhalation of dust and toxins during rescue/recovery work at the WTC site led to an average 439ml decline in FEV1 for FDNY firefighters in the first post-9/11 year. Approximately 15% demonstrated new obstructive airways disease (OAD) and approximately 25% demonstrated bronchial hyperreactivity (BHR). This study assesses the subsequent (2002-2013) course of BHR and lung function among those with and without OAD, BHR, and corticosteroid treatment. Methods: From January to October 2013, 154 firefighters (72% never-smokers) with normal pre-9/11 spirometry, who had received methacholine challenge tests (MCT) within 2 years of 9/11/2001, underwent full lung function testing, including repeat MCT performed off respiratory medications. To adjust for aging, FEV1 was expressed as percent predicted (FEV1%). The difference between the 2013 FEV1% and the 1st post-9/11 FEV1% was used to describe lung function change subsequent to the initial post-9/11 decline. Results: Initially, post-9/11, 23 firefighters (15%) had BHR (PC20<8mg/ml); 6 of them (26%) were negative (PC20>16mg/ml) in 2013. Of 118 firefighters with initially negative MCTs, 17 (14%) were positive in 2013. 117 firefighters (76%) reported using inhaled and/or oral corticosteroids between 2001-2013. The initial pre-9/11 to post-9/11 FEV1% decline averaged 9.8 percentage points. Thereafter, FEV1% tended to decline further, averaging a 2.7 percentage point decrease over the subsequent 11 years. Excluding 2 firefighters with restrictive disease, a multiple regression model with dependent variable "subsequent" (2002-2013) change in FEV1%, showed significant negative contributions from initial change in FEV1% and smoking (p..005), and a positive contribution from approximate steroid dose (p=.03). Contribution of a composite index of BHR to the model approached statistical significance, with more reactive subjects tending to show decreasing FEV1% (p=.08). As shown in the figure, in firefighters without OAD (top two lines), the presence of BHR predicted greater decline in lung function between 2002-2013; in those with OAD (bottom two lines), the presence of BHR predicted absence of response to treatment (p<.04 for influence of OAD and of BHR on the 2002-2013 change in FEV1%, by 2-way ANOVA). Conclusion: Among WTC-exposed firefighters, new-onset OAD is often, but not always, accompanied by BHR, which may persist for a decade or longer. BHR is significantly associated with worsening lung function between 2002-2013, and helps to explain the persistence of OAD among many firefighters. Post-exposure corticosteroid treatment ameliorated some of the excess lung function decline. These findings suggest a substantial role of airway inflammatory disease in WTC-associated OAD. [Description provided by NIOSH]
• Subjects:
  Drug Therapy Dust Emergency Responders Firefighters Hazardous Substances Lung Lung Diseases Occupational Exposure Occupational Health Particulate Matter Respiratory Function Tests Respiratory System Respiratory Tract Diseases Safety

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• Keywords:
  Airway-obstruction Corticosteroids Drug-therapy Dust-inhalation Emergency-responders Employee-exposure Employee-health Fire-fighters Long-term-study Lung-disorders Lung-function Particulate-dust Pulmonary-function Pulmonary-function-tests Pulmonary-system-disorders Respiratory-system-disorders Spirometry Toxins Vital-capacity

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• ISSN:
  1073-449X
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Abstract or Summary
• Place as Subject:
  Massachusetts ; New York ; OSHA Region 1 ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  189
• NIOSHTIC Number:
  nn:20044740
• Citation:
  Am J Respir Crit Care Med 2014 May; 189(Meeting Abstracts):A6495
• Contact Point Address:
  S. Dhar, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
• Email:
  sdhar@montefiore.org
• Federal Fiscal Year:
  2014
• Performing Organization:
  Albert Einstein College of Medicine, New York
• Peer Reviewed:
  False
• Start Date:
  20120901
• Source Full Name:
  American Journal of Respiratory and Critical Care Medicine
• Supplement:
  Meeting Abstracts
• End Date:
  20160228
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:f0e786858bac0fa7af1ba9439d54a71943d9a0d82ddaf9139bffdcc55737bb49b5f0fbff1f9b88586d5f56258469aa719e2237e9478ef76198c17bb5170600eb
• Download URL:
  https://stacks.cdc.gov/view/cdc/200376/cdc_200376_DS1.pdf
• File Type:
  [PDF - 46.48 KB ]