Treatment Response of WTC Related Airway Injury

Details

• Personal Author:
  Weiden MD
• Description:
  Rescue/recovery work at the World Trade Center (WTC) disaster site caused a decline in lung function in Fire Department of the City of New York (FDNY) firefighters. Over 15 years of post-exposure follow-up, 1 in 8 WTC- exposed firefighters experienced accelerated FEV1 decline, a FEV1 loss greater than 64 ml/year. Accelerated FEV1 decline is associated with chronic obstructive pulmonary disease (COPD) and asthma. Despite the high burden of respiratory diseases there are no evidence-based indications for inhaled corticosteroid (ICS) combined with long- acting beta-agonist (LABA) treatment in patients whose only defining characteristic is accelerated FEV1 decline. Only 35% of WTC-exposed FDNY firefighters with accelerated FEV1 decline have been treated with ICS/LABA. If the rapid rate of FEV1 loss in the accelerated FEV1 decline population is not reduced, patients with accelerated FEV1 decline will likely develop COPD, the fourth leading cause of death in the United States. Determining if ICS/LABA treatment is effective in blunting FEV1 decline in these patients would have important implications not only for WTC-exposed cohorts, but also for other workplace respiratory disease surveillance. In preliminary analyses, we found that ICS/ LABA use is associated with worse lung function and reduced quality of life. This observation is consistent with selection by indication bias, whereby sicker individuals are the ones who are treated. To mitigate the effects of this bias, we used treated patients as their own controls, examining FEV1 trajectory prior to and after initiation of ICS/LABA therapy. After ICS/LABA initiation, FEV1 trajectory improved by 9.9+/-1.1 ml/year (mean+/-SEM). This grant will explore heterogeneity in ICS/LABA response. The current multi- center collaboration aims to estimate how many in the untreated accelerated decline group have a pretreatment phenotype predictive of significant ICS/LABA benefit. This proposal tests the overall hypothesis that ICS/LABA treatment improves FEV1 trajectory in accelerated FEV1 decline patients, and that specific patient characteristics, including elevated blood eosinophils, will be associated with a favorable response to ICS/LABA treatment. Specific Aim 1 demonstrated ICS/LABA-treatment did not improve FEV1 slope patients as their own controls, Specific Aim 2 found Th2 cytokines and IgA measured soon after WTC exposure predicted poor outcomes. Further accelerated FEV1 decline is a significant risk factor for all cause and cancer caused mortality. Since FEV1 is not a modifiable risk factor for death, we will focus on the effect of poorly controlled CVD risk factors on survival in the accelerated-FEV1-decline subgroup to set the stage for future efforts to improve CVD risk factor control at a stage were lung function remains normal. Our long-range goal is to identify cohort members at greatest risk of death because of lung function decline, so that focused case management can effectively treat hypertension, hyperglycemia, and dyslipidemia thereby improving survival. [Description provided by NIOSH]
• Subjects:
  Cohort Studies Emergency Responders Firefighters Lung Occupational Health Respiratory System Safety September 11 Terrorist Attacks
• Keywords:
  Cohort Studies Disaster Recovery Fire Fighters Lung Function Medical Treatment Rescue Workers World Trade Center WTC
• 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:
  New York ; OSHA Region 2
• 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:
  1-25
• NIOSHTIC Number:
  nn:20069631
• 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-011682, 2023 Dec; :1-25
• Contact Point Address:
  Michael D. Weiden, MD, New York University School of Medicine, One Park Avenue 6th Floor, New York, NY, 10016
• Email:
  michael.weiden@med.nyu.edu
• Federal Fiscal Year:
  2024
• Performing Organization:
  New York University School of Medicine
• Peer Reviewed:
  False
• Start Date:
  20190701
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20210630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:5903656ead1836a865d1ee1421ce517b9aac4bc77958685f7d5a76b4d357ca9ead756ab1c3593005d38cc0f946637b26026f570acb161cc5b5305ea7d218f936
• Download URL:
  https://stacks.cdc.gov/view/cdc/219250/cdc_219250_DS1.pdf
• File Type:
  [PDF - 2.58 MB ]