Bronchial reactivity and lung function after World Trade Center exposure

Details

• Personal Author:
  Aldrich TK ; Banauch GI ; Christodoulou V ; Cohen HW ; Crosse T ; Dhar S ; Gupta A ; Hall CB ; Izbicki G ; Kelly KJ ; King C ; Moir W ; Nolan A ; Prezant DJ ; Weakley J ; Webber MP ; Weiden MD ; Zeig-Owens R
• Description:
  BACKGROUND: World Trade Center (WTC)-exposed rescue/recovery workers endured massive respiratory insult from inhalation of particulate matter and gases, resulting in respiratory symptoms, loss of lung function, and, for many, bronchial hyperreactivity (BHR). The persistence of respiratory symptoms and lung function abnormalities has been well-documented, whereas persistence of BHR has not been investigated. METHODS: A total of 173 WTC-exposed firefighters with bronchial reactivity measured within 2 years after September 11, 2001 (9/11) (baseline methacholine challenge test), were reevaluated in 2013 and 2014 (follow-up methacholine challenge test). FEV1 measurements were obtained from the late pre-9/11, early post-9/11, and late post-9/11 periods. Respiratory symptoms and corticosteroid treatment were recorded. RESULTS: Bronchial reactivity remained stable (within 1 doubling dilution) for most (n = 101, 58%). Sixteen of 28 (57%) with BHR (provocative concentration of methacholine producing a 20% decline in FEV1 <8 mg/mL) at baseline had BHR at follow-up, and an additional 27 of the 145 (19%) without BHR at baseline had BHR at follow-up. In multivariable models, we found that BHR baseline was strongly associated with BHR follow-up (OR, 6.46) and that BHR at follow-up was associated with an estimated 15.4 mL/y greater FEV1 decline than experienced by those without BHR at follow-up. Annual FEV1 decline was moderated by corticosteroid use. CONCLUSIONS: Persistent BHR and its deleterious influence on lung function suggest a role for airway inflammation in perpetuation of WTC-associated airway disease. In future massive occupational exposure to inorganic dust/gases, we recommend early and serial pulmonary function testing, including measurements of bronchial reactivity, when possible, and inhaled corticosteroid therapy for those with symptoms or pulmonary function tests consistent with airway disease. [Description provided by NIOSH]
• Subjects:
  Dust Emergency Responders Firefighters Lung Occupational Health Particulate Matter Respiratory Function Tests Respiratory System Respiratory Tract Diseases Safety September 11 Terrorist Attacks

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• Keywords:
  Asthma Author Keywords: Airway Disease Dust Inhalation Emergency Responders Epidemiology Fire Fighters Firefighting Lung Function Occupational Diseases Particulate Dust Pulmonary Function Tests Respiratory System Disorders Spirometry World Trade Center WTC

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• ISSN:
  0012-3692
• Document Type:
  Text
• Funding:
  Cooperative Agreement ; Contract
• Genre:
  Journal Article
• 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:
  150
• Issue:
  6
• NIOSHTIC Number:
  nn:20048996
• Citation:
  Chest 2016 Dec; 150(6):1333-1340
• Contact Point Address:
  Mayris P. Webber, DrPH, FDNY Headquarters, 9 Metrotech Center, 5E61K, Brooklyn, NY 11201
• Email:
  Mayris.Webber@fdny.nyc.gov
• Federal Fiscal Year:
  2017
• Performing Organization:
  Albert Einstein College of Medicine, New York
• Peer Reviewed:
  True
• Start Date:
  20120901
• Source Full Name:
  Chest
• End Date:
  20160228
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:23a9cf6b56ad8a625daae7ee92a4e3d7d61ab956da012e093509443ffe17d68253f175d75a4846a7af5fc521237cc2550330f461bc35111391672480b18c6ff6
• Download URL:
  https://stacks.cdc.gov/view/cdc/203599/cdc_203599_DS1.pdf
• File Type:
  [PDF - 322.33 KB ]