Chronic Obstructive Pulmonary Disease in WTC Workers – Diagnoses and Transitions

Details

• Personal Author:
  Celedón JC ; de la Hoz R ; Doucette JT ; Jeon Y ; San José Estépar R ; Weber J
• Description:
  Background: The overall goal of this project is to characterize the WTC-related lower airway disorders, to investigate newly developed obesity-related imaging markers that may be associated with unfavorable disease expression and functional outcomes and assess their interaction with WTC occupational exposure level. To that end, we will utilize the WTC Pulmonary Evaluation Unit Chest CT Imaging Archive (WTCCTIA), a large database with more than 3000 chest CT images on 1700 WTC workers, all members of the Mount Sinai WTC General Responders' Cohort (MS WTC GRC), that became operational in February 2016 and we established with our previous project. On that subcohort, we have also linked extensive datasets with disease symptoms, both pre-WTC and WTC-related occupational exposures, detailed pulmonary function and longitudinal spirometry measurements and weight trends, visual imaging classification and grading, and quantitative computer assisted method (QCAM) measurements of airway, and pulmonary parenchymal abnormalities. With our research project renewal, we continued to enrich most sources of data with periodic updates, in order to characterize the WTC-related lower airway diseases and their most important adverse prognostic risk factors and evaluate their longitudinal trajectories. Methods: We proposed the following three specific aims (SA): Specific Aim 1: to use cluster analysis to find and delineate the clinical phenotypes of chronic lower airway disease in a subset of WTCCTIA population without a priori criteria. We used demographic characteristics, obesity status, smoking history, pre-WTC and WTC occupational exposure, chest CT imaging and lung function data. Specific Aim 2: to assess the relationship between quantitative chest CT indicators of visceral and parietal adipose tissue accumulation and two well-defined adverse lower respiratory effects, namely physician-diagnosis of incident asthma and accelerated longitudinal FEV1 decline, as well as the clusters identified in SA1. Specific Aim 3: To test whether visceral/parietal adiposity interacts with WTC exposure level on increasing the risks of two well-defined adverse lower respiratory effects, namely physician-diagnosis of incident asthma and accelerated longitudinal FEV1 decline, as well as the clusters identified in SA1. Significant or Key Findings. Cluster analyses initially identified a low FVC and a COPD/emphysema cluster. Further analyses, including sociodemographic variables, smoking status and intensity, baseline weight and weight gain, WTC exposure, dyspnea, spirometric pattern, bronchodilator response, and QCT metrics (WAP, Pi10, LAV% and HAV%) suggested 4 clusters. The first cluster includes mostly COPD patients with evidence of obstruction and higher LAV% and WAP. The second cluster includes the low FVC subjects, with early arrival at the WTC disaster, substantial dyspnea, as well as QCT metric of WAP. The third cluster seems to group the Latino females, who tend to be nonsmokers, and have low LAV%. The fourth cluster seems to group the predominantly male Caucasian weight gainers, with mostly normal spirometries. We are adding more variables to the model, particularly to derive more information on that fourth cluster. We presented an abstract and are preparing a manuscript for submission. Our studies with QCT indicators of visceral (pericardial, visceral) adiposity have not suggested a stronger association with adverse respiratory outcomes when compared to body mass index, so we continue to use the latter in our studies, as our group was one of the first to find a positive association between a QCT marker of airway wall thickening and BMI. We have not detected thus far any interaction between adiposity and WTC exposure level. Translation of Findings. The Centers for Disease Control identifies the prevention and control of chronic diseases as its most pressing motivation to bridge research and practice. This project was motivated by the concern about chronic respiratory disease in a cohort on longitudinal surveillance, that was exposed occupationally to a poorly characterized mixture of inhaled toxicants. Our work has shown that other competing risk factors for adverse respiratory outcomes, besides WTC exposures, likely include tobacco smoking, pre-WTC occupational exposures, the high prevalence of overweight and obesity in these cohorts, and factors such as poor socioeconomic status, and psychiatric comorbidity. All of those aspects are amenable to interventions which could potentially mitigate the development of chronic respiratory diseases, and in fact the WTC Health Program includes services that could address them (except for overweight/obesity). Our studies are framed within the discovery phase of the knowledge to action plan of the CDC. In our studies, we estimated for the first time the cumulative prevalence of spirometrically defined low forced vital capacity (low FVC) and chronic obstructive pulmonary disease (COPD) in the WTC GRC and documented a linearly decreasing cross-sectional prevalence of current tobacco smoking and the high and increasing prevalence of overweight/obesity. We also documented the association of WTC occupational exposure intensity (as suggested by arrival at the disaster site within the first 48 hours of the terrorist attack) for COPD, asthma-COPD overlap, and low FVC, three very important types of chronic respiratory illness in this population, as is the case in the general population of this country. As part as the translation of our approach and experience to practice, we incorporated our methodologies (longitudinal spirometry, quantitative CT imaging) into a book chapter on occupational COPD. Our plan is to refine and further develop those recommendations within the next few years. Research Outcomes/Impact. The findings from this study can inform the implementation of effective longitudinal surveillance of occupational cohorts. The experience of the WTC rescue and recovery workers may demonstrate the adverse impact of a hazardous respiratory exposure, but also the adverse impact of overweight/obesity on respiratory health, considering that active tobacco smoking prevalence demonstrated a steady reduction as a result of multiple interventions that preceded the WTC Health Program. As a result, it suggested the need to incorporate into occupational surveillance preventive services and programs to improve the adoption of healthy habits. This project contributed the first comprehensive analysis of the longitudinal spirometry findings in the largest occupational cohort within the WTC Health Program, the General Responders' Cohort. It provided the first estimation of the prevalence of COPD in the WTC occupational cohorts after close to 20 years of longitudinal follow up, using fairly universally accepted spirometric definitions (those of the Global Initiative for Chronic Obstructive Lung Disease, GOLD). This project was also the first to apply and publish stringent spirometry quality assurance criteria to select suitable data for analyses and deployed quantitative chest CT techniques to the assessment of the lung diseases observed in these workers. We examined the different patterns of spirometric impairment, and the risk factors for transitions between them. [Description provided by NIOSH]
• Subjects:
  Cohort Studies Emergency Responders Health Care Facilities Workforce And Services Occupational Health Respiratory Function Tests Safety September 11 Terrorist Attacks
• Keywords:
  Chronic Obstructive Pulmonary Disease Cohort Studies COPD Disaster Recovery Longitudinal Study Medical Monitoring Obesity Rescue Workers Spirometry Surveillance World Trade Center WTC

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• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Final Cooperative Agreement Report
• Place as Subject:
  Massachusetts ; New York ; OSHA Region 1 ; OSHA Region 2 ; OSHA Region 3 ; Pennsylvania
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-13
• NIOSHTIC Number:
  nn:20068339
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, U01-OH-010401, 2022 Dec; :1-13
• Contact Point Address:
  Rafael E. de la Hoz, MD, MPH, MSc, Icahn School of Medicine at Mount Sinai, Division of Occupational and Environmental Medicine, One Gustave L. Levy Place, Box 1059, New York, NY 10029
• Email:
  Rafael.delaHoz@mssm.edu
• Federal Fiscal Year:
  2023
• Performing Organization:
  Icahn School of Medicine at Mount Sinai, New York
• Peer Reviewed:
  False
• Start Date:
  20120901
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20260831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:e2f89bce3a2700402e832b83da073fae70d2c0daf32f518dbd68257cc24c7ef41dc31db2ad5870c76906f188ebfe4a13907545fa5b6570772f8137b8f79e4d16
• Download URL:
  https://stacks.cdc.gov/view/cdc/219213/cdc_219213_DS1.pdf
• File Type:
  [PDF - 116.34 KB ]