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Correspondence |

Trajectories in World Trade Center Airways Disease: Progression versus Improvement FREE TO VIEW

Albert Miller, MD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

Pulmonary Division, Mount Sinai Beth Israel Medical Center, and the Mount Sinai School of Medicine, New York, NY

CORRESPONDENCE TO: Albert Miller, MD, Mount Sinai Beth Israel Medical Center, Dazian 7, First Ave at 16th St, New York, NY 10003


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


Chest. 2016;150(5):1166-1167. doi:10.1016/j.chest.2016.07.044
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Published online

Physicians who have been involved in the evaluation and care of patients with World Trade Center (WTC) airways disease have appreciated the New York Fire Department investigators for their ongoing publications on the determinants and trajectories of this illness. The latest publication in CHEST (June 2016) extends the period of observation of the 10,641 firefighters to September 2014, 13 years following the insult. As had been observed at lesser intervals following the post–September 11 sharp decline in lung function, FEV1% predicted remained relatively constant through September 10, 2014. As they had previously, the authors reported “average FEV1 trends.”

Much of interest is hidden within these average trends. The authors note that 19.5% of the group experienced “greater-than-expected age-related FEV1 decline” while 15.0% experienced “improved function.” They have elicited part of the reason for these disparate trajectories to intensity of exposure (time of arrival), smoking cessation, and weight gain. Skloot et al noted in their 3,160 responders who underwent repeat studies that “the majority of individuals did not have a greater-than-expected decline” in FEV1 and FVC. In fact, the mean declines of 13 and 2 mL/y, respectively, were less than expected. One hundred and thirty-one responders (4%) lost > 300 mL/y in FVC. Predictors of greater decline included lack of bronchodilator response and weight gain.

Other mechanisms remain to be uncovered. How do the subjects with these different trajectories differ in treatment or response to treatment, in immune or inflammatory indices, in CT imaging findings, and in other measures of lung function, including response to various bronchoprovocational agents? We physicians who care for patients with WTC airways disease have observed that, like patients with other medical conditions, some improve, some progress, and others change little. It is in the reasons for these different trajectories that we will more fully understand this disorder.

References

Aldrich T.K. .Vossbrinck M. .Zeig-Owens R. .et al Lung function trajectories in World Trade Center exposed New York City firefighters over 13 years: the roles of smoking and smoking cessation. Chest. 2016;149:1419-1427 [PubMed]journal. [CrossRef] [PubMed]
 
Skloot G.S. .Schechter C.B. .Herbert R. .et al Longitudinal assessment of spirometry in the World Trade Center Monitoring Program. Chest. 2009;135:492-498 [PubMed]journal. [CrossRef] [PubMed]
 

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References

Aldrich T.K. .Vossbrinck M. .Zeig-Owens R. .et al Lung function trajectories in World Trade Center exposed New York City firefighters over 13 years: the roles of smoking and smoking cessation. Chest. 2016;149:1419-1427 [PubMed]journal. [CrossRef] [PubMed]
 
Skloot G.S. .Schechter C.B. .Herbert R. .et al Longitudinal assessment of spirometry in the World Trade Center Monitoring Program. Chest. 2009;135:492-498 [PubMed]journal. [CrossRef] [PubMed]
 
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