Factors predicting treatment of world trade center-related lung injury: A longitudinal cohort study

Barbara Putman, Lies Lahousse, David G. Goldfarb, Rachel Zeig-Owens, Theresa Schwartz, Ankura Singh, Brandon Vaeth, Charles B. Hall, Elizabeth A. Lancet, Mayris P. Webber, Hillel W. Cohen, David J. Prezant, Michael D. Weiden

Research output: Contribution to journalArticlepeer-review


The factors that predict treatment of lung injury in occupational cohorts are poorly defined. We aimed to identify patient characteristics associated with initiation of treatment with inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) >2 years among World Trade Center (WTC)-exposed firefighters. The study population included 8530 WTC-exposed firefighters. Multivariable logistic regression assessed the association of patient characteristics with ICS/LABA treatment for >2 years over two-year intervals from 11 September 2001–10 September 2017. Cox proportional hazards models measured the association of high probability of ICS/LABA initiation with actual ICS/LABA initiation in subsequent intervals. Between 11 September 2001–1 July 2018, 1629/8530 (19.1%) firefighters initiated ICS/LABA treatment for >2 years. Forced Expiratory Volume in 1 s (FEV1), wheeze, and dyspnea were consistently and independently associated with ICS/LABA treatment. High-intensity WTC exposure was associated with ICS/LABA between 11 September 2001– 10 September 2003. The 10th percentile of risk for ICS/LABA between 11 September 2005–10 Septmeber 2007 was associated with a 3.32-fold increased hazard of actual ICS/LABA initiation in the subsequent 4 years. In firefighters with WTC exposure, FEV1, wheeze, and dyspnea were independently associated with prolonged ICS/LABA treatment. A high risk for treatment was identifiable from routine monitoring exam results years before treatment initiation.

Original languageEnglish (US)
Article number9056
Pages (from-to)1-11
Number of pages11
JournalInternational journal of environmental research and public health
Issue number23
StatePublished - Dec 1 2020


  • Epidemiological studies
  • Inhalation therapy
  • Lung injury
  • Occupational exposure
  • Pulmonary function tests

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis

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