Obstructive airways disease with air trapping among firefighters exposed to world trade center dust

Michael D. Weiden, Natalia Ferrier, Anna Nolan, William N. Rom, Ashley Comfort, Jackson Gustave, Rachel Zeig-Owens, Shugi Zheng, Roberta M. Goldring, Kenneth I. Berger, Kaitlyn Cosenza, Roy Lee, Mayris P. Webber, Kerry J. Kelly, Thomas K. Aldrich, David J. Prezant

Research output: Contribution to journalArticle

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Abstract

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 FEV1 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 FEV1 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: FEV1 /FVC, bronchodilator responsiveness, hyperreactivity, or elevated RV. After adjusting for age, gender, race, height and weight, and tobacco use, the decline in FEV1 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 FEV1 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.

Original languageEnglish (US)
Pages (from-to)566-574
Number of pages9
JournalChest
Volume137
Issue number3
DOIs
StatePublished - Mar 1 2010

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Firefighters
Dust
Residual Volume
Air
Lung
Bronchodilator Agents
Total Lung Capacity
Functional Residual Capacity
Methacholine Chloride
Spirometry
Respiratory Function Tests
Tobacco Use
Airway Obstruction
Carbon Monoxide
Thorax
Weights and Measures

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Obstructive airways disease with air trapping among firefighters exposed to world trade center dust. / Weiden, Michael D.; Ferrier, Natalia; Nolan, Anna; Rom, William N.; Comfort, Ashley; Gustave, Jackson; Zeig-Owens, Rachel; Zheng, Shugi; Goldring, Roberta M.; Berger, Kenneth I.; Cosenza, Kaitlyn; Lee, Roy; Webber, Mayris P.; Kelly, Kerry J.; Aldrich, Thomas K.; Prezant, David J.

In: Chest, Vol. 137, No. 3, 01.03.2010, p. 566-574.

Research output: Contribution to journalArticle

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 2010, 'Obstructive airways disease with air trapping among firefighters exposed to world trade center dust', Chest, vol. 137, no. 3, pp. 566-574. https://doi.org/10.1378/chest.09-1580
Weiden MD, Ferrier N, Nolan A, Rom WN, Comfort A, Gustave J et al. Obstructive airways disease with air trapping among firefighters exposed to world trade center dust. Chest. 2010 Mar 1;137(3):566-574. https://doi.org/10.1378/chest.09-1580
Weiden, Michael D. ; Ferrier, Natalia ; Nolan, Anna ; Rom, William N. ; Comfort, Ashley ; Gustave, Jackson ; Zeig-Owens, Rachel ; Zheng, Shugi ; Goldring, Roberta M. ; Berger, Kenneth I. ; Cosenza, Kaitlyn ; Lee, Roy ; Webber, Mayris P. ; Kelly, Kerry J. ; Aldrich, Thomas K. ; Prezant, David J. / Obstructive airways disease with air trapping among firefighters exposed to world trade center dust. In: Chest. 2010 ; Vol. 137, No. 3. pp. 566-574.
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AU - Weiden, Michael D.

AU - Ferrier, Natalia

AU - Nolan, Anna

AU - Rom, William N.

AU - Comfort, Ashley

AU - Gustave, Jackson

AU - Zeig-Owens, Rachel

AU - Zheng, Shugi

AU - Goldring, Roberta M.

AU - Berger, Kenneth I.

AU - Cosenza, Kaitlyn

AU - Lee, Roy

AU - Webber, Mayris P.

AU - Kelly, Kerry J.

AU - Aldrich, Thomas K.

AU - Prezant, David J.

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N2 - 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 FEV1 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 FEV1 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: FEV1 /FVC, bronchodilator responsiveness, hyperreactivity, or elevated RV. After adjusting for age, gender, race, height and weight, and tobacco use, the decline in FEV1 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 FEV1 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.

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