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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.
World Trade Center; WTC; 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
Publication Date
Document Type
Journal Article
Email Address
Funding Type
Fiscal Year
Identifying No.
Contract-200-2011-39383; Contract-200-2011-39378; B20130805
Issue of Publication
Source Name
American Journal of Industrial Medicine
Performing Organization
New York City Fire Department
Page last reviewed: August 5, 2022
Content source: National Institute for Occupational Safety and Health Education and Information Division