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Obstructive airways disease with air trapping among firefighters exposed to World Trade Center dust.
Weiden MD; Ferrier N; Nolan A; Rom WN; Comfort A; Gustave J; Zeig-Owens R; Zheng S; Goldring RM; Berger KI; Cosenza K; Lee R; Webber MP; Kelly KJ; Aldrich TK; Prezant DJ
Chest 2010 Mar; 137(3):566-574
BACKGROUND: The World Trade Center (WTC) collapse produced a massive exposure to respirable particulates in New York City Fire Department (FDNY) rescue workers. This group had spirometry examinations pre-September 11, 2001, and post-September 11, 2001, demonstrating declines in lung function with parallel declines in FEV(1) and FVC. To date, the underlying pathophysiologic cause for this has been open to question. METHODS: Of 13,234 participants in the FDNY-WTC Monitoring Program, 1,720 (13%) were referred for pulmonary subspecialty evaluation at a single institution. Evaluation included 919 full pulmonary function tests, 1,219 methacholine challenge tests, and 982 high-resolution chest CT scans. RESULTS: At pulmonary evaluation (median 34 months post-September 11, 2001), median values were FEV(1) 93% predicted (interquartile range [IQR], 83%-101%), FVC 98% predicted (IQR, 89%-106%), and FEV(1)/FVC 0.78 (IQR, 0.72-0.82). The residual volume (RV) was 123% predicted (IQR, 106%-147%) with nearly all participants having normal total lung capacity, functional residual capacity, and diffusing capacity of carbon monoxide. Also, 1,051/1,720 (59%) had obstructive airways disease based on at least one of the following: FEV(1)/FVC, bronchodilator responsiveness, hyperreactivity, or elevated RV. After adjusting for age, gender, race, height and weight, and tobacco use, the decline in FEV(1) post-September 11, 2001, was significantly correlated with increased RV percent predicted (P < .0001), increased bronchodilator responsiveness (P < .0001), and increased hyperreactivity (P = .0056). CT scans demonstrated bronchial wall thickening that was significantly associated with the decline in FEV(1) post-September 11, 2001 (P = .024), increases in hyperreactivity (P < .0001), and increases in RV (P < .0001). Few had evidence for interstitial disease. CONCLUSIONS: Airways obstruction was the predominant physiologic finding underlying the reduction in lung function post-September 11, 2001, in FDNY WTC rescue workers presenting for pulmonary evaluation.
Biological-factors; Breathing; Dust-exposure; Exposure-assessment; Exposure-levels; Exposure-methods; Fire-fighters; Health-care-personnel; Inhalation-studies; Lung-disorders; Lung-function; Lung-irritants; Medical-rescue-services; Particle-aerodynamics; Particulate-dust; Particulates; Pathogenicity; Physiological-effects; Pulmonary-disorders; Pulmonary-system-disorders; Rescue-workers; Respiratory-hypersensitivity; Respiratory-irritants; Respiratory-system-disorders; Statistical-analysis; Toxic-effects; Work-environment; Worker-health; Work-performance
David J. Prezant, MD, Office of Medical Affairs, New York City Fire Department, 9 Metrotech Center, Room 4W-1, Brooklyn, NY 11201
Cooperative Agreement; Grant
Cooperative-Agreement-Number-U10-OH-008243; Cooperative-Agreement-Number-U10-OH-008242; Grant-Number-R01-OH-007350
Issue of Publication
New York City Fire Department
Page last reviewed: June 15, 2021
Content source: National Institute for Occupational Safety and Health Education and Information Division