World Trade Center collapse produced airway injury and air trapping.
Weiden-MD; Ferrier-N; Nolan-A; Rom-WN; Comfort-A; Gustave-J; Zheng-S; Goldring-R; Berger-K; Cosenza-K; Beringer-A; Glass-L; Lee-R; Zeig-Owens-R; Webber-M; Prezant-DJ
Am J Respir Crit Care Med 2009 Apr; 179(Meeting Abstracts):A5852
Background: The collapse of the World Trade Center (WTC) on 9/11/01 produced a massive toxic exposure in a well defined cohort of 12,000 FDNY personnel. This group received intensive post-exposure medical evaluation and had pulmonary function testing pre- and post-WTC. We observed a high incidence of reactive airways disease and an accelerated decline in lung function with parallel decline in FEV1 and VC. Methods: We analyzed the results of lung function testing performed at a single physiology laboratory on 1876 patients who presented for evaluation of persistent respiratory complaints. Results: The mean duration between pre-9/11 and first post-9/11 spirometry was 1.6 years. This subset of patients who sought evaluation had greater annualized decline in FEV1 post-9/11 than the entire cohort (490cc vs. 372cc, p<0.0001). A vast majority of the symptomatic group maintained normal TLC, FRC and DLCO. However, they had an FEV1/FVC of (74 % ±10) and an RV of 131% ±39 predicted. Only 18% (330/1876) had abnormal spirometry. Of these 87% (287/330) had evidence of obstruction as defined by positive methacholine, BD response or FEV1/FVC<0.75. The most common physiologic abnormality was air trapping with an elevated RV which correlated well with reduction in lung function, bronchodilator response and methacholine reactivity. High resolution chest CT demonstrated a high incidence of peribronchial inflammation and air trapping. Physiologic abnormalities only correlated with peribronchial thickening. Conclusion: These data demonstrate that airway injury with air trapping was the predominate cause of the pseudorestrictive pattern seen post-9/11 exposure.
Biological-factors; Bronchial-asthma; Exposure-assessment; Exposure-levels; Exposure-methods; Inhalation-studies; Laboratory-testing; Lung-disorders; Lung-function; Lung-irritants; Mathematical-models; Physiological-effects; Physiological-factors; Physiological-measurements; Pulmonary-disorders; Pulmonary-function-tests; Respiratory-function-tests; Respiratory-hypersensitivity; Respiratory-infections; Respiratory-irritants; Respiratory-system-disorders; Statistical-analysis; Toxic-effects; Toxins; Work-environment; Worker-health; Work-performance
American Journal of Respiratory and Critical Care Medicine