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Original Research: Occupational and Environmental Lung Diseases |

Pulmonary Function Predicting Confirmed Recovery From Lower-Respiratory Symptoms in World Trade Center-Exposed Firefighters, 2001 to 2010Pulmonary Function and Symptom Recovery

Jackie Soo, MPH; Mayris P. Webber, DrPH, MPH; Charles B. Hall, PhD; Hillel W. Cohen, DrPH, MPH; Theresa M. Schwartz, MS; Kerry J. Kelly, MD; David J. Prezant, MD, FCCP
Author and Funding Information

From the Department of Medicine (Mss Soo and Schwartz and Dr Prezant), Montefiore Medical Center, Bronx, NY; Department of Epidemiology and Population Health (Drs Webber, Hall, and Cohen), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; and Bureau of Health Services (Mss Soo and Schwartz and Drs Webber, Kelly, Prezant), Fire Department of the City of New York, Brooklyn, NY.

Correspondence to: Mayris P. Webber, DrPH, MPH, New York City Fire Department, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201; e-mail: webberm@fdny.nyc.gov


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: This work was supported by the National Institute for Occupational Safety and Health [RO1-OH07350].


Chest. 2012;142(5):1244-1250. doi:10.1378/chest.11-2210
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Background:  We examined the relationship between pulmonary function (FEV1) and confirmed recovery from three lower-respiratory symptoms (LRSs) (cough, dyspnea, and wheeze) up to 9 years after symptom onset.

Methods:  The study included white and black male World Trade Center (WTC)-exposed firefighters who reported at least one LRS on a medical monitoring examination during the first year after September 11, 2001. Confirmed recovery was defined as reporting no LRSs on two consecutive and all subsequent examinations. FEV1 was assessed at the first post-September 11, 2001, examination and at each examination where symptom information was ascertained. We used stratified Cox regression models to analyze FEV1, WTC exposure, and other variables in relation to confirmed symptom recovery.

Results:  A total of 4,368 firefighters met inclusion criteria and were symptomatic at year 1, of whom 1,592 (36.4%) experienced confirmed recovery. In univariable models, first post-September 11, 2001, concurrent, and difference between first post-September 11, 2001, and concurrent FEV1 values were all significantly associated with confirmed recovery. In adjusted analyses, both first post-September 11, 2001, FEV1 (hazard ratio [HR], 1.07 per 355-mL difference; 95% CI, 1.04-1.10) and FEV1 % predicted (HR, 1.08 per 10% predicted difference; 95% CI, 1.04-1.12) predicted confirmed recovery. WTC exposure had an inverse association with confirmed recovery in the model with FEV1, with the earliest arrival group less likely to recover than the latest arrival group (HR, 0.73; 95% CI, 0.58-0.92).

Conclusions:  Higher FEV1 and improvement in FEV1 after September 11, 2001, predicted confirmed LRS recovery, supporting a physiologic basis for recovery and highlighting consideration of spirometry as part of any postexposure respiratory health assessment.

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