Long-term outcomes of acute irritant-induced asthma and World Trade Center-related lower airway disease

Details

• Personal Author:
  de la Hoz RE
• Description:
  As a pulmonologist dedicated exclusively for almost 7 years to the diagnosis and treatment of presumed World Trade Center (WTC)-related lower airway disease (LAD), I read with interest the recent article by Dr. Malo and colleagues on long-term outcomes of acute irritant-induced asthma (IIA), and have several comments related to the authors' findings and statements. WTC inhalation injury is not the best known outbreak of IIA syndrome (also known as reactive airways disease syndrome [RADS]), as stated by Malo and coworkers. In fact, most of the lower airway disease resulting from the occupational WTC dust exposure did not meet acute IIA criteria, and only a small proportion of cases (22.6%) met criteria for IIA altogether. In the vast majority of workers, lower respiratory symptom onset was relatively delayed and insidious over weeks and months, and in some patients latency between exposure cessation and symptom onset could be up to 6 months after leaving the disaster site. That partially explains why exposure duration could be so prolonged (mean, 18.2 wk; SD, 15.6 wk). Furthermore, only about 27% of the patients with LAD had evidence of nonspecific bronchial reactivity 1 to 2 years after leaving the WTC site, although that may partly reflect the well-known resolution or mitigation of nonspecific bronchial hyperreactivity that, as Malo and coworkers report, happens in some individuals. Other forms of irritant-induced airway disease included aggravation of probably preexistent subclinical or very mild chronic obstructive pulmonary disease, a nonspecific chronic bronchitis picture, and bronchiolitis/small airway disease. With regard to the observation on the role of smoking as a predisposing or additive risk factor, we also found it in our WTC dust-exposed workers. The caveat for the latter is that we found it as a risk factor for all lower airway diseases, including clinical forms other than IIA. Atopic status, the third most frequently investigated risk factor for IIA (together with occupational exposure and tobacco smoking), was not reported by Malo and coworkers. We identified it as a risk factor for upper but not for lower airway disease in WTC workers. It would have also been informative to report on the chronic upper airway disease that frequently accompanies IIA, and contributes substantially to poor symptom control and quality of life. Comments on: Am J Respir Crit Care Med 2009 May; 179(10):923-928. [Description provided by NIOSH]
• Subjects:
  Asthma Asthma, Occupational Diagnosis Dust Emergency Responders Health Personnel Irritants Lung Lung Diseases Occupational Exposure Occupational Health Respiratory System Respiratory Tract Diseases Risk Assessment Risk Factors Safety

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• Keywords:
  Airway-obstruction Airway-resistance Bronchial-asthma Clinical-diagnosis Dust-exposure Emergency-responders Employee-exposure Lung-disorders Lung-irritants Medical-personnel Medical-research Medical-treatment Pulmonary-system-disorders Respiratory-irritants Respiratory-system-disorders Risk-factors

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• ISSN:
  1073-449X
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• 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
• Pages in Document:
  95-96
• Volume:
  181
• Issue:
  1
• NIOSHTIC Number:
  nn:20045789
• Citation:
  Am J Respir Crit Care Med 2010 Jan; 181(1):95-96
• Contact Point Address:
  Rafael E. de la Hoz, MD, MPH, Mount Sinai WTC Medical Monitoring and Treatment Program, One Gustave L. Levy Place, Box 1059, New York, NY 10029
• Email:
  Rafael.delaHoz@mssm.edu
• Federal Fiscal Year:
  2010
• Performing Organization:
  Mount Sinai School of Medicine of New York University
• Peer Reviewed:
  False
• Start Date:
  20040715
• Source Full Name:
  American Journal of Respiratory and Critical Care Medicine
• End Date:
  20090714
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:0d1a15e30582861e67c228c716997140ff934c2c3a70a668b32055c68b8037fdbb820222e3092d4d6c6fafa8c1699f8a839dedf348ae59a2153b11f1e5b8ea19
• Download URL:
  https://stacks.cdc.gov/view/cdc/201077/cdc_201077_DS1.pdf
• File Type:
  [PDF - 46.81 KB ]