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Thomas Aldrich, MD
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FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

CORRESPONDENCE TO: David Prezant, MD, Division of Pulmonary Medicine, Montefiore Medical Center, Bronx, NY 10467; e-mail: dprezant@montefiore.org

Division of Pulmonary Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY


Copyright 2016, . All Rights Reserved.


Chest. 2016;150(5):1167. doi:10.1016/j.chest.2016.09.005
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We appreciate the insightful comments made by Miller in his letter about our article on lung function in firefighters after 9/11. He is quite right that firefighters and others exposed to the World Trade Center (WTC) collapse have demonstrated a variety of post-9/11 pulmonary function trajectories and that smoking status and body weight changes can account for only part of the observed post-9/11 lung function patterns.

Although we found that WTC exposure intensity (arrival time) was significantly associated with trans-9/11 (before to first post-9/11) decline in lung function, it was not associated with later post-9/11 changes in lung function. In fact, in a sample of 173 WTC-exposed firefighters that we describe in a forthcoming manuscript in CHEST, and in our larger cohort (unpublished data), we found substantial negative associations between trans-9/11 and subsequent changes in FEV1, indicating that those who lost the most lung function in the immediate aftermath of 9/11 tended to have the most recovery. That finding may help to explain the relatively modest average FEV1 decline rates reported by Skloot et al in a cohort of WTC responders studied only in the post-9/11 period—many of them may have suffered substantial trans-9/11 lung function losses so that their subsequent lung function trajectories were less negative than expected. We had the advantage of access to pre-9/11 data, allowing us to demonstrate the negative association.

In the same manuscript, we report that bronchial hyperreactivity was significantly associated with declining post-9/11 lung function and that corticosteroid therapy, systemic and inhaled, was significantly associated with improving lung function. Our group has also demonstrated associations of serum biomarkers of inflammation, metabolic derangement, protease/antiprotease balance, and vascular injury with development of abnormal lung function (measured as less than the lower limit of normal). We have also demonstrated that IgE is associated with a reduced FEV1/FVC ratio.

It is true that the range of possible lung function responses to the WTC collapse (and other massive toxic exposures) goes well beyond a dichotomy of greater than or less than the expected rate of change in FEV1. As Miller recommended in his comments, we are actively investigating the association of different inflammatory biomarkers, radiographic presentations, comorbid conditions, and treatment patterns with the rate of post-9/11 lung function decline.

References

Miller A. . Trajectories in World Trade Center airways disease: progression versus improvement. Chest. 2016;150:1166-1167 [PubMed]journal. [CrossRef]
 
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]
 
Aldrich TK, Weakley J, Dhar S, et al. Bronchial reactivity and lung function after World Trade Center exposure [published online ahead of print July 19, 2016].Chest.http://dx.doi.org/10.1016/j.chest.2016.07.005.
 
Skloot G.S. .Schechter C.B. .Herbert R. .et al Longitudinal assessment of spirometry in the World Trade Center medical monitoring program. Chest. 2009;135:492-498 [PubMed]journal. [CrossRef] [PubMed]
 
Weiden M.D. .Kwon S. .Caraher E. .et al Biomarkers of World Trade Center particulate matter exposure: physiology of distal airway and blood biomarkers that predict FEV(1) decline. Semin Respir Crit Care Med. 2015;36:323-333 [PubMed]journal. [CrossRef] [PubMed]
 

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References

Miller A. . Trajectories in World Trade Center airways disease: progression versus improvement. Chest. 2016;150:1166-1167 [PubMed]journal. [CrossRef]
 
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]
 
Aldrich TK, Weakley J, Dhar S, et al. Bronchial reactivity and lung function after World Trade Center exposure [published online ahead of print July 19, 2016].Chest.http://dx.doi.org/10.1016/j.chest.2016.07.005.
 
Skloot G.S. .Schechter C.B. .Herbert R. .et al Longitudinal assessment of spirometry in the World Trade Center medical monitoring program. Chest. 2009;135:492-498 [PubMed]journal. [CrossRef] [PubMed]
 
Weiden M.D. .Kwon S. .Caraher E. .et al Biomarkers of World Trade Center particulate matter exposure: physiology of distal airway and blood biomarkers that predict FEV(1) decline. Semin Respir Crit Care Med. 2015;36:323-333 [PubMed]journal. [CrossRef] [PubMed]
 
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