Blood Leukocyte Concentrations, FEV1 Decline, and Airflow Limitation: A 15-Year Longitudinal Study of World Trade Center-Exposed Firefighters

Details

• Personal Author:
  Aldrich TK ; Cohen HW ; Hall CB ; Kelly KJ ; Nolan A ; Prezant DJ ; Schwartz T ; Singh A ; Webber MP ; Weiden MD ; Zeig-Owens R
• Description:
  RATIONALE: Rescue/recovery work at the World Trade Center (WTC) disaster site caused a proximate decline in lung function in Fire Department of the City of New York (FDNY) firefighters. A subset of this cohort experienced an accelerated rate of lung function decline over 15 years of post-9/11 follow-up. OBJECTIVES: To determine if post-exposure inflammatory cell concentrations are biomarkers for subsequent forced expiratory volume (FEV1) decline and incident airflow limitation. METHODS: Individual rates of FEV1 change were calculated for 9,434 firefighters using 88,709 spirometric measurements taken between 9/11/2001 (9/11) and 9/10/2016. We categorized FEV1 change rates into three trajectories: accelerated FEV1 decline (FEV1 loss >64 ml/year), expected FEV1 decline (FEV1 loss between 0-64 ml/year), and improved FEV1 (positive rate of change >0 ml/year). Occurrence of FEV1/FVC<0.70 after 9/11 defined incident airflow limitation. Regression models assessed associations of post-9/11 blood eosinophil and neutrophil concentrations with subsequent FEV1 decline and airflow limitation, adjusted for age, race, smoking, height, WTC exposure level, weight change and baseline lung function. RESULTS: Accelerated FEV1 decline occurred in 12.7% of participants (1,199/9,434), while post-9/11 FEV1 improvement occurred in 8.3% (780/9,434). Eosinophil and neutrophil concentrations were both associated with accelerated vs. expected FEV1 decline after adjustment for covariates (OR: 1.10 per 100 eosinophils/µl, 95% CI: 1.05-1.15 and OR: 1.10 per 1,000 neutrophils/µl, 95% CI: 1.05-1.15). Multivariable-adjusted linear regression models showed that neutrophil concentration was associated with FEV1 decline rate (1.14 ml/year decline per 1000 neutrophils/µl, 95% CI: 0.69-1.60 ml/year, p<0.001), while eosinophil concentration was associated with FEV1 decline rate in ever-smokers (1.46 ml/year decline per 100 eosinophils/µl, 95% CI: 0.65-2.26 ml/year, p<0.001) but not in never-smokers (p for interaction=0.004). Eosinophil concentration was also associated with incident airflow limitation (adjusted HR: 1.10 per 100 eosinophils/µl, 95% CI: 1.04-1.15). Compared with the expected FEV1 decline group, individuals experiencing accelerated FEV1 decline were more likely to have incident airflow limitation (adjusted OR: 4.12, 95% CI: 3.30-5.14). CONCLUSIONS: Elevated post-9/11 blood inflammatory cell concentrations were risk factors for subsequent accelerated FEV1 decline in WTC-exposed firefighters. Accelerated FEV1 decline was associated with incident airflow limitation, suggesting progressive airway injury in this subgroup. [Description provided by NIOSH]
• Subjects:
  Biomarkers Blood Firefighters Lung Occupational Health Respiratory Function Tests Respiratory System Safety September 11 Terrorist Attacks
• Keywords:
  Airflow Author Keywords: Spirometry Blood Cells Eosinophils Fire Fighters Leukocytes Longitudinal Studies Longitudinal Study Lung Function Lung Injury Neutrophils Spirometry World Trade Center WTC

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• ISSN:
  2329-6933
• Document Type:
  Text
• Funding:
  Contract ; 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:
  173-183
• Volume:
  15
• Issue:
  2
• NIOSHTIC Number:
  nn:20050696
• Citation:
  Ann Am Thorac Soc 2018 Feb; 15(2):173-183
• Contact Point Address:
  Dr. Weiden, New York University School of Medicine, New Bellevue Hospital 7N24, 550 First Ave, New York, NY 10016
• Email:
  michael.weiden@nyumc.org
• Federal Fiscal Year:
  2018
• Performing Organization:
  New York City Fire Department
• Peer Reviewed:
  True
• Start Date:
  20140701
• Source Full Name:
  Annals of the American Thoracic Society
• End Date:
  20170630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:f777dca622e2afcb0b8b1d99b94756146f159a1154e9ae0b5096441d2d8747e70668f500b300677857c182307c310c8e6e6acf4a556876609d9696507a5794fa
• Download URL:
  https://stacks.cdc.gov/view/cdc/210939/cdc_210939_DS1.pdf
• File Type:
  [PDF - 1.04 MB ]