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Original Research: WORLD TRADE CENTER DISASTER |

Longitudinal Assessment of Spirometry in the World Trade Center Medical Monitoring Program

Gwen S. Skloot, MD; Clyde B. Schechter, MD; Robin Herbert, MD; Jacqueline M. Moline, MD; Stephen M. Levin, MD; Laura E. Crowley, MD; Benjamin J. Luft, MD; Iris G. Udasin; Paul L. Enright, MD, FCCP; for the ATS/ERS Task Force
Author and Funding Information

*From Mount Sinai School of Medicine (Drs. Skloot, Herbert, Moline, Levin, and Crowley), New York, NY; Albert Einstein College of Medicine (Dr. Schechter), Bronx, NY; Department of Medicine (Dr. Luft), State University of New York at Stony Brook, Stony Brook, NY; Environmental and Occupational Health Sciences Institute (Dr. Udasin), University of Medicine and Dentistry of New Jersey, Piscataway, NJ; and College of Public Health (Dr. Enright), the University of Arizona, Tucson, AZ.

Correspondence to: Gwen S. Skloot, MD, Division of Pulmonary & Critical Care Medicine, Box 1232, Mount Sinai Medical Center, One Gustave Levy Place, New York, NY 10029; e-mail: gwen.skloot@mssm.edu


This work was supported by the Centers for Disease Control and Prevention and the National Institute for Occupational Safety and Health, under contract 200-2002-0038 and grants 5U1O 0H008232, U10 OH008225, U10 OH008216, U10 OH008223, U10 OH008239, and U10 OH008275. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health.

Dr. Enright during the past 3 years has received approximately $20,000 for conducting pulmonary function quality assurance programs for clinical trials of patients with COPD (Pfizer), pulmonary fibrosis (Intermune), and diabetes (MannKind). The remaining authors have no conflicts of interest to disclose.

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


Chest. 2009;135(2):492-498. doi:10.1378/chest.08-1391
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Background:  Multiple studies have demonstrated an initial high prevalence of spirometric abnormalities following World Trade Center (WTC) disaster exposure. We assessed prevalence of spirometric abnormalities and changes in spirometry between baseline and first follow-up evaluation in participants in the WTC Worker and Volunteer Medical Monitoring Program. We also determined the predictors of spirometric change between the two examinations.

Methods:  Prebronchodilator and postbronchodilator spirometry, demographics, occupational history, smoking status, and respiratory symptoms and exposure onset were obtained at both examinations (about 3 years apart).

Results:  At the second examination, 24.1% of individuals had abnormal spirometry findings. The predominant defect was a low FVC without obstruction (16.1%). Between examinations, the majority of individuals did not have a greater-than-expected decline in lung function. The mean declines in prebronchodilator FEV1 and FVC were 13 mL/yr and 2 mL/yr, respectively (postbronchodilator results were similar and not reported). Significant predictors of greater average decline between examinations were bronchodilator responsiveness at examination 1 and weight gain.

Conclusions:  Elevated rates of spirometric abnormalities were present at both examinations, with reduced FVC most common. Although the majority had a normal decline in lung function, initial bronchodilator response and weight gain were significantly associated with greater-than-normal lung function declines. Due to the presence of spirometric abnormalities > 5 years after the disaster in many exposed individuals, longer-term monitoring of WTC responders is essential.

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