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Original Research: COPD |

Obstructive Airways Disease With Air Trapping Among Firefighters Exposed to World Trade Center Dust

Michael D. Weiden, MD; Natalia Ferrier, MD; Anna Nolan, MD; William N. Rom, MD, FCCP; Ashley Comfort, BA; Jackson Gustave, MSc; Rachel Zeig-Owens, MPH; Shugi Zheng, MD; Roberta M. Goldring, MD; Kenneth I. Berger, MD, FCCP; Kaitlyn Cosenza, BA; Roy Lee, BA; Mayris P. Webber, DrPH; Kerry J. Kelly, MD; Thomas K. Aldrich, MD, FCCP; David J. Prezant, MD, FCCP
Author and Funding Information

From the Division of Pulmonary/Critical Care (Drs Weiden, Nolan, Rom, Zheng, Goldring, and Berger, and Ms Comfort), New York University, New York, NY; the Bureau of Health Services (Drs Ferrier, Webber, Kelly, and Prezant; Messrs Gustave and Lee; Mss Zeig-Owens and Cosenza), New York City Fire Department, Brooklyn, NY; and the Division of Pulmonary Medicine (Drs Aldrich and Prezant), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.

Correspondence to: David J. Prezant, MD, Office of Medical Affairs, New York City Fire Department, 9 Metrotech Center, Room 4W-1, Brooklyn, NY 11201; e-mail: prezand@fdny.nyc.gov


Funding/Support: This study was funded by the Centers for Disease Control and Prevention[U1Q/CCU221158] and the National Institute of Occupational Safety and Health [U10-OH008243, U10-OH008242, and R01-OH07350], NIH [M01 00096, K23HL084191, K24A1080298, and R01HL057879].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(3):566-574. doi:10.1378/chest.09-1580
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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 FEV1/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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