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Original Research: Occupational and Environmental Lung Diseases |

Longitudinal Pulmonary Function in Newly Hired, Non-World Trade Center-Exposed Fire Department City of New York FirefightersLongitudinal Pulmonary Function in Firefighters: The First 5 Years

Thomas K. Aldrich, MD, FCCP; Fen Ye, MS; Charles B. Hall, PhD; Mayris P. Webber, DrPH; Hillel W. Cohen, DrPH; Michael Dinkels, MD; Kaitlyn Cosenza, BA; Michael D. Weiden, MD; Anna Nolan, MD; Vasilios Christodoulou, BA; Kerry J. Kelly, MD; David J. Prezant, MD, FCCP
Author and Funding Information

From the Pulmonary Medicine Division (Drs Aldrich, Dinkels, and Prezant), Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; the Bureau of Health Services and Office of Medical Affairs (Mss Ye and Cosenza; Mr Christodoulou; and Drs Webber, Weiden, Nolan, Kelly, and Prezant), Fire Department of the City of New York, Brooklyn, NY; the Biostatistics Division (Drs Hall and Cohen), and the Epidemiology Division (Drs Webber and Cohen), Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY; and the Pulmonary Medicine Division (Drs Weiden and Nolan), Department of Medicine, NYU School of Medicine, New York, NY.

Correspondence to: Thomas K. Aldrich, MD, FCCP, Pulmonary Medicine Division, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467; e-mail: taldrich@montefiore.org


Funding/Support: This work was supported by the National Institutes of Health [Grants K23HL084191, K24A1080298, RO1HL057879, HL090316, U01CA008617, U10-OH008243, and U10-OH008242].

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


Chest. 2013;143(3):791-797. doi:10.1378/chest.12-0675
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Background:  Few longitudinal studies characterize firefighters’ pulmonary function. We sought to determine whether firefighters have excessive FEV1 decline rates compared with control subjects.

Methods:  We examined serial measurements of FEV1 from about 6 months prehire to about 5 years posthire in newly hired male, never smoking, non-Hispanic black and white firefighters, hired between 2003 and 2006, without prior respiratory disease or World Trade Center exposure. Similarly defined Emergency Medical Service (EMS) workers served as control subjects.

Results:  Through June 30, 2011, 940 firefighters (82%) and 97 EMS workers (72%) who met study criteria had four or more acceptable posthire spirometries. Prehire FEV1% averaged higher for firefighters than EMS workers (99% vs 95%), reflecting more stringent job entry criteria. FEV1 (adjusted for baseline age and height) declined by an average of 45 mL/y both for firefighters and EMS workers, with Fire − EMS decline rate differences averaging 0.2 mL/y (CI, −9.2 to 9.6). Four percent of each group had FEV1 less than the lower limit of normal before hire, increasing to 7% for firefighters and 17.5% for EMS workers, but similar percentages of both groups had adjusted FEV1 decline rates ≥ 10%. Mixed effects modeling showed a significant influence of weight gain but not baseline weight: FEV1 declined by about 8 mL/kg gained for both groups. Adjusting for weight change, FEV1 decline averaged 38 mL/y for firefighters and 34 mL/y for EMS workers.

Conclusions:  During the first 5 years of duty, firefighters do not show greater longitudinal FEV1 decline than EMS control subjects, and fewer of them develop abnormal lung function. Weight gain is associated with a small loss of lung function, of questionable clinical relevance in this fit and active population.

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