Predictors of Asthma/COPD Overlap in FDNY Firefighters with World Trade Center Dust Exposure: A Longitudinal Study

Details

• Personal Author:
  Berger KI ; Cohen HW ; Hall CB ; Liu C ; Nolan A ; Prezant DJ ; Putman B ; Schwartz T ; Singh A ; Webber MP ; Weiden MD ; Zeig-Owens R
• Description:
  Background: Previously healthy firefighters with World Trade Center (WTC) dust exposure developed airway disease. Risk factors for irritant-associated asthma/COPD overlap are poorly defined. Methods: The study included 2,137 WTC-exposed firefighters who received a clinically-indicated bronchodilator pulmonary function test (BD-PFT) between 9/11/2001-9/10/2017. A post-BD FEV1 increase of >12% and 200 ml from baseline defined asthma, and post-BD FEV1/FVC ratio<0.7 identified COPD cases. Participants who met both criteria had asthma/COPD overlap. Eosinophil levels were measured on screening blood tests performed shortly after 9/11/2001 and prior to BD-PFT; a subgroup of participants also had serum IgE and 21 cytokines measured (N=215). Marginal Cox regression models for multiple events assessed the associations of eosinophil levels or serum biomarkers with subsequent diagnosis, with age, race, smoking, WTC-exposure, first post-9/11 FEV1/FVC ratio, and BMI included as covariates. Results: BD-PFT diagnosed asthma/COPD overlap in 99 individuals (4.6%), isolated-asthma in 202 (9.5%), and isolated-COPD in 215 (10.1%). Eosinophil concentration?300 cells/ l was associated with increased risk of asthma/COPD overlap (HR: 1.85, 95% CI: 1.16-2.95), but not with isolated-asthma or isolated-COPD. Serum IL-4 also predicted asthma/COPD overlap (HR: 1.51 per doubling of cytokine concentration, 95% CI: 1.17-1.95). Greater IL-21 concentration was associated with both isolated-asthma and isolated-COPD (HR: 1.73, 95% CI: 1.27-2.35 and HR: 2.06, 95% CI: 1.31-3.23, respectively). Conclusions: In WTC-exposed firefighters, elevated blood eosinophils and IL-4 levels are associated with subsequent asthma/COPD overlap. Disease-specific Th-2 biomarkers present years before diagnosis suggest patient-intrinsic predisposition to irritant-associated asthma/COPD overlap. [Description provided by NIOSH]
• Subjects:
  Aging Asthma Biomarkers Blood Dust Environmental Exposure Firefighters Hematologic Tests Lung Diseases Men Occupational Health Race Factors Respiratory System Respiratory Tract Diseases Risk Assessment Risk Factors Safety September 11 Terrorist Attacks Smokers Women

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• Keywords:
  Age Groups Airway Obstruction Author Keywords: Asthma Blood Tests BMI Body Mass Index Bronchial Asthma Chronic Obstructive Pulmonary Disease COPD Cytokines Dust Exposure Dusts Eosinophils Exposure Levels Fire Fighters Humans Models Pulmonary System Disorders Racial Factors Respiratory System Disorders Risk Factors Smoking Statistical Analysis World Trade Center WTC

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• ISSN:
  0012-3692
• 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
• Volume:
  154
• Issue:
  6
• NIOSHTIC Number:
  nn:20052081
• Citation:
  Chest 2018 Dec; 154(6):1301-1310
• Contact Point Address:
  Michael D. Weiden, MD, 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:
  2019
• Performing Organization:
  New York University School of Medicine
• Peer Reviewed:
  True
• Start Date:
  20160901
• Source Full Name:
  Chest
• End Date:
  20190831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:8fea3600ca007677e90591b46e1264a00744b550dee598cc2544fd08c42f858bddbeafda3e1e1cfb1fc7ab99c307c10ed0615e0006eac65279b7a7fef82eb1b4
• Download URL:
  https://stacks.cdc.gov/view/cdc/211681/cdc_211681_DS1.pdf
• File Type:
  [PDF - 465.59 KB ]