Firefighters frequently remove their self-contained breathing apparatus during overhaul (seeking and extinguishing hidden fires) despite potentially injurious smoke exposure. Preliminary work demonstrated decline in diffusing capacity (DLCO) associated with number of fires fought, while spirometry, usually the only test of lung function used in firefighter surveillance, remained stable. These findings suggested possible chronic injury due to smoke exposure. We proposed to validate these findings through evaluation of firefighters with biomarkers of lung injury potentially more sensitive to smoke exposure than spirometry, including serum Clara cell protein, alveolar surfactant-associated protein A, radiological (inhaled 99mTcDTPA), and induced sputum (cell count, TNF-alpha, O2) tests. The specific aims of the study were: (1) Characterize smoke exposure during overhaul. (2) Use biomarkers to measure acute (less than or equal to 2 hours) pulmonary effects in firefighters after overhaul. (3) Explore the use of serum biomarkers as surveillance tools for chromic (greater than or equal to 1 year) pulmonary effects in firefighters. (4) Determine the ability of air purifying respirators to reduce pulmonary effects of smoke exposure during overhaul. A cohort of 105 Phoenix and Tucson firefighters underwent baseline evaluation including exposure questionnaires, spirometry, DLCO, and measurement of serum biomarkers. Within this group, 26 Phoenix and Tucson firefighters were monitored for smoke exposure during overhaul of residential structural fires, and in addition received post-exposure evaluation using the same set of biomarkers. Phoenix firefighters used air-purifying respirators during overhaul, while Tucson firefighters did not wear respiratory protection during overhaul. Acute changes in serum biomarkers and spirometry in Phoenix and Tucson firefighters were compared to determine the efficacy of using air-purifying respirators during overhaul. Serum biomarkers provided sensitive measures of acute pulmonary injury in firefighters, and served as well to evaluate the efficacy of workplace interventions designed to reduce smoke exposure. Air-purifying respirators did not prevent changes in lung
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