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Original Research |

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

All authors participated in analysis of results. The manuscript was prepared by TKA, JW, SD, AG, MDW, RZO, MPW and DJP. TKA and DJP take full responsibility for the entire manuscript. The authors declare no competing interests.

Funding from CDC/NIOSH 1U01OH010411, 200-2011-39383, and 200-2011-39378

1Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, Brooklyn, New York, U.S.A., 11201

2Montefiore Medical Center and Albert Einstein College of Medicine, Pulmonary Medicine Division 951 Prospect Avenue, Bronx, New York, U.S.A., 10459

3Albert Einstein College of Medicine, Department of Epidemiology and Population Health, 1300 Morris Park Avenue, Bronx, New York, U.S.A., 10461

4New York University School of Medicine, Department of Medicine, 550 1st, Avenue, New York, New York, U.S.A., 10016

5University of Massachusetts Medical Center, Pulmonary and Critical Care Medicine Division, 55 North Lake Avenue, Worcester, Massachusetts, U.S.A., 01655

6Shaare Zedek Medical Center, and the Hebrew University Hadassah Medical School, Jerusalem, Pulmonary Institute, Shmu’el Bait St. 12, Jerusalem, 9103102, Israel

Corresponding author: Mayris P. Webber, FDNY Headquarters, 9 Metrotech Center, 5E61K, Brooklyn, NY 11201, USA


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.07.005
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Abstract

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, while persistence of BHR has not been investigated.

Methods  173 WTC-exposed firefighters with bronchial reactivity measured within 2 years after 9/11/2001 (9/11), (baseline methacholine challenge test [MCT]), were re-evaluated in 2013-2014 (follow-up-MCT). 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%). 16 of 28 (57%) with BHR (PC20<8mg/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/year 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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