Aerodigestive Disease Risk Factors in Particulate Matter Exposed Firefighters

Details

• Personal Author:
  Crowley G ; Kwon S ; Lam T ; Nolan A ; Phillips O ; Podury S ; Prezant DJ ; Ramprasad M ; Schwartz T ; Zeig-Owens R
• Description:
  RATIONALE: Firefighters exposed to the toxic debris and particulate matter (PM) at the World Trade Center (WTC) site had a higher prevalence of gastroesophageal reflux disease (GERD) and Barrett's Esophagus (BE) often co-existing with obstructive airways disease (OAD). We seek to validate prior findings that short -acting beta agonists (SABA) use was associated with GERD/BE and present preliminary data on a subcohort investigating non-invasive biomarkers of GERD. METHODS: Firefighters (N=4,192) consented for longitudinal monitoring in the WTC-health program. We included exposed subjects that were consented with normal lung function prior. Electronic Medical Record (EMR) was reviewed for pulmonary function testing, medical diagnoses, and medication history. GERD (N=2,539) was defined on EMR diagnosis and/or proton pump inhibitor, H2 blockers, antacid, or surface agent use; BE (N=429) was defined on EMR diagnosis alone. AHR (N=1,434) was identified based on positive methacholine or bronchodilator testing and/or EMR diagnosis. Steroid use was identified by any use of either prednisone or dexamethasone. Logistic regression was used to evaluate associations of respiratory medications and GERD/BE (SPSS28). A subcohort enrolled in a validation observational study on noninvasive markers of GERD had PAGI-SYM, PAGI-QOL, and salivary pepsin levels measured(clinicaltrials.gov#NCT05216133). RESULTS: Demographics. Male firefighters, of which N=3,946(94%) were Caucasian, had a mean age of 39 years at 9/11/01. There were N=1323 ever-smokers, of which N=491 had GERD, N=152 had BE. N=449 GERD were exposed to WTC site in the morning on 9/11, N=1,405 arrived at the site in the afternoon, and N=685 after 9/12. GERD (N=1120) and BE(N= 204) were on SABA while N=612 GERD and N=124 BE were on steroids. SABA and steroid use was associated with increased odds ratio (OR; [95%CI]) of developing 1. GERD by4.08[3.50-4.75] and 4.65[3.74-5.78]; 2. BE by 1.97(1.61-2.41) and 2.27(1.81-2.86), respectively, after adjusting for age and smoking (p<0.001). Pepsin positive patients had lower quality of life(p=0.049 by Chi-Square). CONCLUSIONS: In a population with high PM exposure, treatment of with SABA and steroids can increase risk of GERD. Also, noninvasive biomarkers such as pepsin can potentially identify those with GERD, and are associated with quality of life. Further investigation into overlap of GERD/BE and AHR can help distinguish phenotypes of disease. Future studies will include further assessment of other inhaler use and aerodigestive disease and analysis of serum biomarkers predictive of GERD and BE. [Description provided by NIOSH]
• Subjects:
  Biomarkers Firefighters Occupational Health Particulate Matter Safety September 11 Terrorist Attacks
• Keywords:
  Fire Fighters Gastroesophageal Reflux Disease GERD Particulates World Trade Center WTC
• ISSN:
  1073-449X
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Abstract or Summary
• 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:
  209
• NIOSHTIC Number:
  nn:20070823
• Citation:
  Am J Respir Crit Care Med 2024 May; 209(Abstract Issue):A3927
• Federal Fiscal Year:
  2024
• Performing Organization:
  New York University School of Medicine
• Peer Reviewed:
  False
• Start Date:
  20210701
• Source Full Name:
  American Journal of Respiratory and Critical Care Medicine
• Supplement:
  Abstract Issue
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:31b7dba3408d024912fda3d9d0aec72aacd6595f55bf5601ac46022a0eed8f34939939f474233a7d2f9200e59133654baec7a20a9c413c45e44a66c6a515f0d6
• Download URL:
  https://stacks.cdc.gov/view/cdc/208972/cdc_208972_DS1.pdf
• File Type:
  [PDF - 27.81 KB ]