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Original Research: Disaster Medicine |

Bronchial Reactivity and Lung Function After World Trade Center Exposure

Thomas K. Aldrich, MD; Jessica Weakley, MPH; Sean Dhar, MD; Charles B. Hall, PhD; Tesha Crosse, MS; Gisela I. Banauch, MD; Michael D. Weiden, MD; Gabriel Izbicki, MD; Hillel W. Cohen, DrPH; Aanchal Gupta, MD; Camille King, RRT; Vasilios Christodoulou, BA; Mayris P. Webber, DrPH; Rachel Zeig-Owens, DrPH; William Moir, MPH; Anna Nolan, MD; Kerry J. Kelly, MD; David J. Prezant, MD
Author and Funding Information

FUNDING/SUPPORT: This study was funded by the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health [Grants 1U01OH010411, 200-2011-39383, and 200-2011-39378].

aDepartment of Medicine, Pulmonary Division, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY

bBureau of Health Services, Fire Department of the City of New York, Brooklyn, NY

cDepartment of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY

dDepartment of Medicine, New York University School of Medicine, New York, NY

ePulmonary and Critical Care Medicine Division, University of Massachusetts Medical Center, Worcester, MA

fShaare Zedek Medical Center and the Hebrew University Hadassah Medical School, Jerusalem, Pulmonary Institute, Jerusalem, Israel

CORRESPONDENCE TO: Mayris P. Webber, DrPH, FDNY Headquarters, 9 Metrotech Center, 5E61K, Brooklyn, NY 11201


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(6):1333-1340. doi:10.1016/j.chest.2016.07.005
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Background  World Trade Center (WTC)-exposed rescue/recovery workers endured massive respiratory insult from inhalation of particulate matter and gases, resulting in respiratory symptoms, loss of lung function, and, for many, bronchial hyperreactivity (BHR). The persistence of respiratory symptoms and lung function abnormalities has been well-documented, whereas persistence of BHR has not been investigated.

Methods  A total of 173 WTC-exposed firefighters with bronchial reactivity measured within 2 years after September 11, 2001 (9/11) (baseline methacholine challenge test), were reevaluated in 2013 and 2014 (follow-up methacholine challenge test). FEV1 measurements were obtained from the late pre-9/11, early post-9/11, and late post-9/11 periods. Respiratory symptoms and corticosteroid treatment were recorded.

Results  Bronchial reactivity remained stable (within 1 doubling dilution) for most (n = 101, 58%). Sixteen of 28 (57%) with BHR (provocative concentration of methacholine producing a 20% decline in FEV1 <8 mg/mL) at baseline had BHR at follow-up, and an additional 27 of the 145 (19%) without BHR at baseline had BHR at follow-up. In multivariable models, we found that BHR baseline was strongly associated with BHR follow-up (OR, 6.46) and that BHR at follow-up was associated with an estimated 15.4 mL/y greater FEV1 decline than experienced by those without BHR at follow-up. Annual FEV1 decline was moderated by corticosteroid use.

Conclusions  Persistent BHR and its deleterious influence on lung function suggest a role for airway inflammation in perpetuation of WTC-associated airway disease. In future massive occupational exposure to inorganic dust/gases, we recommend early and serial pulmonary function testing, including measurements of bronchial reactivity, when possible, and inhaled corticosteroid therapy for those with symptoms or pulmonary function tests consistent with airway disease.

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