0
Abstract: Poster Presentations |

THE USE OF PROPHYLACTIC INHALED STEROIDS (BUDESONIDE) TO PREVENT OR REDUCE PULMONARY SYMPTOMS, AIRWAY HYPERREACTIVITY, AND PULMONARY FUNCTION DECLINES AFTER EXPOSURE TO WORLD TRADE CENTER DUST FREE TO VIEW

Gisela I. Banauch, MD; Gabriel Izbicki, MD; Vasilios Christodoulou; Michael Weiden, MD; Robert Chavko, MD; Thomas K. Aldrich, MD; Kerry J. Kelly, MD; David J. Prezant, MD*
Author and Funding Information

Fire Department City of New York, Brooklyn, NY


Chest


Chest. 2007;132(4_MeetingAbstracts):598b-599. doi:10.1378/chest.132.4_MeetingAbstracts.598b
Text Size: A A A
Published online

Abstract

PURPOSE: Inhaled corticosteroids (ICS) are the safest, most effective anti-inflammatory treatment for asthmatics. Yet, we could find no studies on prophylactic ICS use to prevent asthma and other respiratory diseases after inhalation exposures. We hypothesized that ICS, started shortly after exposure to World Trade Center (WTC) dust and combustion by-products would prevent or reduce persistent respiratory symptoms, airway hyperreactivity (AHR) and lung function decline.

METHODS: One week post-attack, budesonide by turbuhaler, was offered to NYC firefighters. Proper use was demonstrated and instructions given as to safety profile, off-label use for this IRB approved study and dose (2 puffs daily for 4 weeks). 2 years post-WTC, the treated group was evaluated for persistent respiratory symptoms (St. Georges Respiratory Questionnaire), AHR (PC20 <8mg methacholine) and lung function decline (FEV1) as compared to case controls (matched for WTC arrival time as an exposure severity surrogate, pre-WTC FVC and FEV1, age, work years and tobacco status) who did not receive ICS.

RESULTS: 2,991 of ∼11,000 (27%) firefighters agreed to enroll, but only 220 (7%)completed 4 weeks of treatment. The most common reason for not enrolling was “steroid fear” and for not completing was “no immediate effect”. No side effects were reported. Although matched for WTC arrival time, the treated group reported greater number of unprotected hours without a respirator between 9/11-9/17/01 (prior to enrollment). Pulmonary function was normal. Two years post-WTC, the treated group reported significantly greater declines in respiratory symptom severity scores, but without significant differences FEV1 decline rates or AHR when compared to controls (table).

CONCLUSION: Prophylactic ICS use reduced respiratory symptoms and improved quality of life but did not affect pulmonary functions (decline rate or AHR). Improvement occurred despite greater respiratory exposure in the treated group.

CLINICAL IMPLICATIONS: Respiratory protection is the primary means for preventing lung injury but prophylactic ICS should be considered after high-risk exposures given ease of use, safety profile and improvement in respiratory symptoms. Pre-treatment education must focus on proper use and correcting misperceptions interfering with enrollment/treatment.

DISCLOSURE: David Prezant, Grant monies (from industry related sources) This research was conducted with support from the Investigator-Sponsored Study Program of AstraZeneca; Product/procedure/technique that is considered research and is NOT yet approved for any purpose. The use of an inhaled corticosteroid for prophylactic purposes may be considered off-label use.

Wednesday, October 24, 2007

12:30 PM - 2:00 PM


Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
Guidelines
Asthma in pregnancy.
American College of Obstetricians and Gynecologists | 9/19/2008
Inhaled corticosteroids for the treatment of chronic asthma in children under the age of 12 years.
National Institute for Health and Clinical Excellence (NICE) | 1/31/2008
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543