Dyspnea and Inhaled Corticosteroid and Long-Acting Beta Agonist Therapy in an Occupational Cohort: A Longitudinal Study

Details

• Personal Author:
  Cohen HW ; Fazzari MJ ; Hall CB ; Lahousse L ; Prezant DJ ; Putman B ; Schwartz T ; Singh A ; Webber MP ; Weiden MD ; Zeig-Owens R
• Description:
  This study presented longitudinal, patient-reported data on dyspnea from 1,073 previously healthy WTC-exposed firefighters who received >2 years of ICS/LABA treatment. The risk factors for treatment were similar to risk factors for obstructive airway disease in this cohort. We observed heterogeneity in dyspnea response, with only 53% of treated individuals responding to treatment. We found that responders had rapidly increasing dyspnea, as defined by mMRC score, in the three years prior to treatment initiation. Notably, in responders, dyspnea improved for five years post-treatment initiation, returning to a level similar to baseline. Non- responders had gradually increasing dyspnea in the three years prior to treatment, which continued to increase during the first five years post-treatment initiation. This finding suggests that clinical trials with patient-reported outcomes may benefit from longer follow-up than used in most randomized clinical trials. Our study revealed pronounced differences in the trajectory of dyspnea in responders and non-responders to ICS/LABA treatment. Responders presented earlier after WTC exposure, and higher pre-treatment mMRC score predicting favorable treatment response, while non- responders had longer time between WTC exposure and symptom onset or treatment initiation. This difference in onset of symptoms suggests non-responders might have a different endotype of obstructive airway disease that is less responsive to ICS/LABA therapy. The lack of response to ICS/LABA in those with later onset dyspnea might be indicative of a less inflammatory type of disease. One limitation of this study may include generalizability to other affected individuals, as this single-center study of a massively dust-exposed cohort included only previously healthy males. We also acknowledge that there may be unmeasured confounding, as is possible in all observational studies. Additionally, while regression to the mean might also contribute to the difference in symptom score trajectories between responders and non-responders, the greater symptom burden of non-responders at the end of follow-up suggests that regression to the mean is unlikely to be the sole or even main explanation for the observed effect. This longitudinal study showed that almost half of irritant-exposed patients had worsening dyspnea following ICS/LABA initiation. Treatment benefitted more symptomatic individuals who initiated ICS/LABA treatment sooner after WTC exposure. [Description provided by NIOSH]
• Subjects:
  Cohort Studies Occupational Health Respiratory System Safety September 11 Terrorist Attacks
• Keywords:
  Breathing Cohort Studies Corticosteroids Longitudinal Study Respiratory Function World Trade Center WTC
• 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
• Volume:
  17
• Issue:
  6
• NIOSHTIC Number:
  nn:20058793
• Citation:
  Ann Am Thorac Soc 2020 Jun; 17(6):770-773
• Contact Point Address:
  Michael D. Weiden, MS, MD, New York University Shool of Medicine, New Bellevue Hospital 7N24, 550 First Ave, New York, NY 10016
• Email:
  michael.weiden@nyumc.org
• Federal Fiscal Year:
  2020
• 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-512:132c8542521bf7d05b6bb715f5a7acffc28b3dd049240ffd1fd2d677705780b4c569c3f807ae63d88691a26e7140b88abf87c22442764fb2a589caaaebe7ad32
• Download URL:
  https://stacks.cdc.gov/view/cdc/223189/cdc_223189_DS1.pdf
• File Type:
  [PDF - 584.38 KB ]