Original Research: Occupational and Environmental Lung Diseases |

Lessons From the World Trade Center DisasterRestrictive Dysfunction Due to Airway Disease: Airway Disease Presenting as Restrictive Dysfunction

Kenneth I. Berger, MD, FCCP; Joan Reibman, MD; Beno W. Oppenheimer, MD; Ioannis Vlahos, MD; Denise Harrison, MD; Roberta M. Goldring, MD
Author and Funding Information

From the André Cournand Pulmonary Physiology Laboratory (Drs Berger, Oppenheimer, and Goldring); the World Trade Center Environmental Health Center (Drs Berger, Reibman, and Goldring), Bellevue Hospital; the Division of Pulmonary, Critical Care and Sleep Medicine (Drs Berger, Reibman, Oppenheimer, Harrison, and Goldring), New York University School of Medicine; New York University World Trade Center Health Program Clinical Center of Excellence (Dr Harrison), New York, NY; and the Department of Radiology (Dr Vlahos), St. George’s Healthcare National Health Service Trust, London, England.

Correspondence to: Kenneth I. Berger, MD, FCCP, New York University School of Medicine, 240 E 38 St, Room M15, New York, NY 10016; e-mail: kenneth.berger@nyumc.org

Funding/Support: This work was supported by the Centers for Disease Control and Prevention [Grants 200-2011-39413, 200-2011-39391, and 200-2011-39397], the National Institute for Occupational Safety and Health [Grant 5E11OH009630], and the American Red Cross Liberty Disaster Relief Fund, City of New York.

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

Chest. 2013;144(1):249-257. doi:10.1378/chest.12-1411
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Background:  The present study (1) characterizes a physiologic phenotype of restrictive dysfunction due to airway injury and (2) compares this phenotype to the phenotype of interstitial lung disease (ILD).

Methods:  This is a retrospective study of 54 persistently symptomatic subjects following World Trade Center (WTC) dust exposure. Inclusion criteria were reduced vital capacity (VC), FEV1/VC > 77%, and normal chest roentgenogram. Measurements included spirometry, plethysmography, diffusing capacity of lung for carbon monoxide (Dlco), impulse oscillometry (IOS), inspiratory/expiratory CT scan, and lung compliance (n = 16).

Results:  VC was reduced (46% to 83% predicted) because of the reduction of expiratory reserve volume (43% ± 26% predicted) with preservation of inspiratory capacity (IC) (85% ± 16% predicted). Total lung capacity (TLC) was reduced, confirming restriction (73% ± 8% predicted); however, elevated residual volume to TLC ratio (0.35 ± 0.08) suggested air trapping (AT). Dlco was reduced (78% ± 15% predicted) with elevated Dlco/alveolar volume (5.3 ± 0.8 [mL/mm Hg/min]/L). IOS demonstrated abnormalities in resistance and/or reactance in 50 of 54 subjects. CT scan demonstrated bronchial wall thickening and/or AT in 40 of 54 subjects; parenchymal disease was not evident in any subject. Specific compliance at functional residual capacity (FRC) (0.07 ± 0.02 [L/cm H2O]/L) and recoil pressure (Pel) at TLC (27 ± 7 cm H2O) were normal. In contrast to patients with ILD, lung expansion was not limited, since IC, Pel, and inspiratory muscle pressure were normal. Reduced TLC was attributable to reduced FRC, compatible with airway closure in the tidal range.

Conclusions:  This study describes a distinct physiologic phenotype of restriction due to airway dysfunction. This pattern was observed following WTC dust exposure, has been reported in other clinical settings (eg, asthma), and should be incorporated into the definition of restrictive dysfunction.

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