The respiratory pyramid

From symptoms to disease in world trade center exposed firefighters

Justin K. Niles, Mayris P. Webber, Hillel W. Cohen, Charles B. Hall, Rachel Zeig-Owens, Fen Ye, Michelle S. Glaser, Jessica Weakley, Michael D. Weiden, Thomas K. Aldrich, Anna Nolan, Lara Glass, Kerry J. Kelly, David J. Prezant

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

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. Am. J. Ind. Med. 56:870-880, 2013.

Original languageEnglish (US)
Pages (from-to)870-880
Number of pages11
JournalAmerican Journal of Industrial Medicine
Volume56
Issue number8
DOIs
StatePublished - Aug 2013

Fingerprint

Firefighters
Asthma
Bronchitis
Emphysema
Delivery of Health Care
Chronic Obstructive Pulmonary Disease
Spirometry
Administrative Personnel
Inhalation
Therapeutics
Lung

Keywords

  • Asthma
  • Pulmonary function
  • Treatment outcomes
  • World Trade Center

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

The respiratory pyramid : From symptoms to disease in world trade center exposed firefighters. / Niles, Justin K.; Webber, Mayris P.; Cohen, Hillel W.; Hall, Charles B.; Zeig-Owens, Rachel; Ye, Fen; Glaser, Michelle S.; Weakley, Jessica; Weiden, Michael D.; Aldrich, Thomas K.; Nolan, Anna; Glass, Lara; Kelly, Kerry J.; Prezant, David J.

In: American Journal of Industrial Medicine, Vol. 56, No. 8, 08.2013, p. 870-880.

Research output: Contribution to journalArticle

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 2013, 'The respiratory pyramid: From symptoms to disease in world trade center exposed firefighters', American Journal of Industrial Medicine, vol. 56, no. 8, pp. 870-880. https://doi.org/10.1002/ajim.22171
Niles, Justin K. ; Webber, Mayris P. ; Cohen, Hillel W. ; Hall, Charles B. ; Zeig-Owens, Rachel ; Ye, Fen ; Glaser, Michelle S. ; Weakley, Jessica ; Weiden, Michael D. ; Aldrich, Thomas K. ; Nolan, Anna ; Glass, Lara ; Kelly, Kerry J. ; Prezant, David J. / The respiratory pyramid : From symptoms to disease in world trade center exposed firefighters. In: American Journal of Industrial Medicine. 2013 ; Vol. 56, No. 8. pp. 870-880.
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abstract = "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. Am. J. Ind. Med. 56:870-880, 2013.",
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AB - 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. Am. J. Ind. Med. 56:870-880, 2013.

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