title: Distal airway function in symptomatic subjects with normal spirometry following World Trade Center dust exposure.
abstract: BACKGROUND
  Following collapse of the World Trade Center (WTC), individuals reported new-onset respiratory symptoms. Despite symptoms, spirometry often revealed normal airway function. However, bronchial wall thickening and air trapping were seen radiographically in some subjects. We hypothesized that symptomatic individuals following exposure to WTC dust may have functional abnormalities in distal airways not detectable with routine spirometry.
  
  
  METHODS
  One hundred seventy-four subjects with respiratory symptoms and normal spirometry results were evaluated. Impedance oscillometry (IOS) was performed to determine resistance at 5 Hz, 5 to 20 Hz, and reactance area. Forty-three subjects were also tested for frequency dependence of compliance (FDC). Testing was repeated after bronchodilation.
  
  
  RESULTS
  Predominant symptoms included cough (67%) and dyspnea (65%). Despite normal spirometry results, mean resistance at 5 Hz, 5 to 20 Hz, and reactance area were elevated (4.36 +/- 0.12 cm H(2)O/L/s, 0.86 +/- 0.05 cm H(2)O/L/s, and 6.12 +/- 0.50 cm H(2)O/L, respectively) [mean +/- SE]. Resistance and reactance normalized after bronchodilation. FDC was present in 37 of 43 individuals with improvement after bronchodilation.
  
  
  CONCLUSIONS
  Symptomatic individuals with presumed WTC dust/fume exposure and normal spirometry results displayed airway dysfunction based on the following: (1) elevated airway resistance and frequency dependence of resistance determined by IOS; (2) heterogeneity of distal airway function demonstrated by elevated reactance area on oscillometry and FDC; and (3) reversibility of these functional abnormalities to or toward normal following administration of a bronchodilator. Since spirometry results were normal in all subjects, these abnormalities likely reflect dysfunction in airways more distal to those evaluated by spirometry. Examination of distal airway function when spirometry results are normal may be important in the evaluation of subjects exposed to occupational and environmental hazards.
authors: Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA.
authors: Beno W
authors: BW
authors: Oppenheimer
authors: Roberta M
authors: RM
authors: Goldring
authors: Matthew E
authors: ME
authors: Herberg
authors: Ira S
authors: IS
authors: Hofer
authors: Paul A
authors: PA
authors: Reyfman
authors: Sybille
authors: S
authors: Liautaud
authors: William N
authors: WN
authors: Rom
authors: Joan
authors: J
authors: Reibman
authors: Kenneth I
authors: KI
authors: Berger
mesh_terms: D000328:Adult; D001980:Bronchi / Q000503:physiopathology*; D004391:Dust; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009991:Oscillometry; D012129:Respiratory Function Tests; D047851:September 11 Terrorist Attacks; D013147:Spirometry
chemical_list: D004391:Dust