Lung Function Decline Before and After Treatment of World Trade Center Associated Obstructive Airways Disease with Inhaled Corticosteroids and Long-Acting Beta Agonists

Details

• Personal Author:
  Goldfarb DG ; Hall CB ; Lahousse L ; Prezant DJ ; Putman B ; Schwartz T ; Vaeth BM ; Weiden MD ; Zeig-Owens R
• Description:
  Background: Greater than average loss of one-second forced expiratory volume (FEV1 ) is a risk factor for asthma, chronic obstructive pulmonary disease (COPD), and asthma/COPD overlap syndrome in World Trade Center (WTC)-exposed firefighters. Inhaled corticosteroids and long-acting beta agonists (ICS/LABA) are used to treat obstructive airways disease but their impact on FEV1 -trajectory in this population is unknown. Methods: The study population included WTC-exposed male firefighters who were treated with ICS/LABA for 2 years or longer (with initiation before 2015), had at least two FEV1 measurements before ICS/LABA initiation and two FEV1 measurements posttreatment between September 11, 2001 and September 10, 2019. Linear mixed-effects models were used to estimate FEV1 -slope pre- and post-treatment. Results: During follow-up, 1023 WTC-exposed firefighters were treated with ICS/LABA for 2 years or longer. When comparing intervals 6 years before and 6 years after treatment, participants had an 18.7 ml/year (95% confidence interval [CI]: 11.3-26.1) improvement in FEV1 -slope after adjustment for baseline FEV1, race, height, WTC exposure, weight change, blood eosinophil concentration, and smoking status. After stratification by median date of ICS/LABA initiation (January 14, 2010), earlier ICS/LABA-initiators had a 32.5 ml/year (95% CI: 19.5-45.5) improvement in slope but later ICS/LABA-initiators had a nonsignificant FEV1 -slope improvement (7.9 ml/year, 95% CI: -0.5 to 17.2). Conclusions: WTC-exposed firefighters treated with ICS/LABA had improved FEV1 slope after initiation, particularly among those who started earlier. Treatment was, however, not associated with FEV1-slope improvement if started after the median initiation date (1/14/2010), likely because onset of disease began before treatment initiation. Research on alternative treatments is needed for patients with greater than average FEV1-decline who have not responded to ICS/LABA. [Description provided by NIOSH]
• Subjects:
  Asthma Asthma, Occupational Firefighters Lung Occupational Health Respiratory System Safety September 11 Terrorist Attacks
• Keywords:
  Airway Obstruction Author Keywords: FEV1-slope Chronic Obstructive Pulmonary Disease COPD Corticosteroids Fire Fighters ICS/LABA Lung Function Medical Treatment Treatment Effect World Trade Center WTC

  More +
• ISSN:
  0271-3586
• Document Type:
  Text
• Funding:
  Cooperative Agreement ; Contract
• 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:
  64
• Issue:
  10
• NIOSHTIC Number:
  nn:20063079
• Citation:
  Am J Ind Med 2021 Oct; 64(10):853-860
• Contact Point Address:
  Michael D. Weiden, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA
• Email:
  michael.weiden@nyulangone.org
• Federal Fiscal Year:
  2022
• Performing Organization:
  New York University School of Medicine
• Peer Reviewed:
  True
• Start Date:
  20190701
• Source Full Name:
  American Journal of Industrial Medicine
• End Date:
  20210630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:a4460493008929ecedcefeb2d1cf939236fbe6f64f42d4446a4e8ffd4803a7593ec0eefaeb514aed69629c59e769a3efbc843b421cb870d7ec11c46312d3a049
• Download URL:
  https://stacks.cdc.gov/view/cdc/226206/cdc_226206_DS1.pdf
• File Type:
  [PDF - 711.21 KB ]