The respiratory pyramid: from symptoms to disease in World Trade Center exposed firefighters.
Niles-JK; Webber-MP; Cohen-HW; Hall-CB; Zeig-Owens-R; Ye-F; Glaser-MS; Weakley-J; Weiden-MD; Aldrich-TK; Nolan-A; Glass-L; Kelly-KJ; Prezant-DJ
Am J Ind Med 2013 Aug; 56(8):870-880
Background: This study utilizes a four-level pyramid framework to understand the relationship between symptom reports and/or abnormal pulmonary function and diagnoses of airway diseases (AD), including asthma, recurrent bronchitis and COPD/emphysema in WTC-exposed firefighters. We compare the distribution of pyramid levels at two time-points: by 9/11/2005 and by 9/11/2010. Methods: We studied 6,931 WTC-exposed FDNY firefighters who completed a monitoring exam during the early period and at least two additional follow-up exams 9/11/2005-9/11/2010. Results: By 9/11/2005, the pyramid structure was as follows: 4,039 (58.3%) in Level 1, no respiratory evaluation or treatment; 1,608 (23.2%) in Level 2, evaluation or treatment without AD diagnosis; 1,005 (14.5%) in Level 3, a single AD diagnosis (asthma, emphysema/COPD, or recurrent bronchitis); 279 (4.0%) in Level 4, asthma and another AD. By 9/11/2010, the pyramid distribution changed considerably, with Level 1 decreasing to 2,612 (37.7% of the cohort), and Levels 3 (N = 1,530) and 4 (N = 796) increasing to 22.1% and 11.5% of the cohort, respectively. Symptoms, spirometry measurements and healthcare utilization were associated with higher pyramid levels. Conclusions: Respiratory diagnoses, even four years after a major inhalation event, are not the only drivers of future healthcare utilization. Symptoms and abnormal FEV- 1 values must also be considered if clinicians and healthcare administrators are to accurately anticipate future treatment needs, years after initial exposure.
Respiratory-system-disorders; Pulmonary-system-disorders; Lung-disorders; Fire-fighters; Hazardous-materials; Dust-exposure; Dust-particles; Dusts; Dose-response; Lung-function; Spirometry; Respiratory-function-tests; Medical-monitoring; Medical-treatment; Medical-screening; Airway-obstruction; Health-care; Health-programs; Employee-exposure; Emergency-responders; Bronchial-asthma; Disease-incidence; Clinical-symptoms;
Author Keywords: World Trade Center; asthma; pulmonary function; treatment outcomes
Mayris P. Webber, Department of Epidemiology and Population Health, Montefiore Medical Center/Albert Einstein College of Medicine and Director of WTC Epidemiology, Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY 11201
Contract; Cooperative Agreement
Contract-200-2011-39383; Contract-200-2011-39378; B20130805
American Journal of Industrial Medicine
New York City Fire Department