Lung function decline before and after treatment of World Trade Center associated obstructive airways disease with inhaled corticosteroids and long-acting beta agonists

David G. Goldfarb, Barbara Putman, Lies Lahousse, Rachel Zeig-Owens, Brandon M. Vaeth, Theresa Schwartz, Charles B. Hall, David J. Prezant, Michael D. Weiden

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Greater than average loss of one-second forced expiratory volume (FEV1) is a risk factor for asthma, chronic obstructive pulmonary disease (COPD), and asthma/COPD overlap syndrome in World Trade Center (WTC)-exposed firefighters. Inhaled corticosteroids and long-acting beta agonists (ICS/LABA) are used to treat obstructive airways disease but their impact on FEV1-trajectory in this population is unknown. Methods: The study population included WTC-exposed male firefighters who were treated with ICS/LABA for 2 years or longer (with initiation before 2015), had at least two FEV1 measurements before ICS/LABA initiation and two FEV1 measurements posttreatment between September 11, 2001 and September 10, 2019. Linear mixed-effects models were used to estimate FEV1-slope pre- and post-treatment. Results: During follow-up, 1023 WTC-exposed firefighters were treated with ICS/LABA for 2 years or longer. When comparing intervals 6 years before and 6 years after treatment, participants had an 18.7 ml/year (95% confidence interval [CI]: 11.3–26.1) improvement in FEV1-slope after adjustment for baseline FEV1, race, height, WTC exposure, weight change, blood eosinophil concentration, and smoking status. After stratification by median date of ICS/LABA initiation (January 14, 2010), earlier ICS/LABA-initiators had a 32.5 ml/year (95% CI: 19.5–45.5) improvement in slope but later ICS/LABA-initiators had a nonsignificant FEV1-slope improvement (7.9 ml/year, 95% CI: −0.5 to 17.2). Conclusions: WTC-exposed firefighters treated with ICS/LABA had improved FEV1 slope after initiation, particularly among those who started earlier. Treatment was, however, not associated with FEV1-slope improvement if started after the median initiation date (1/14/2010), likely because onset of disease began before treatment initiation. Research on alternative treatments is needed for patients with greater than average FEV1-decline who have not responded to ICS/LABA.

Original languageEnglish (US)
Pages (from-to)853-860
Number of pages8
JournalAmerican Journal of Industrial Medicine
Volume64
Issue number10
DOIs
StatePublished - Oct 2021

Keywords

  • FEV-slope
  • ICS/LABA
  • treatment effect

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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