Longitudinal assessment of spirometry in the World Trade Center medical monitoring program.
BACKGROUND
Multiple studies have demonstrated an initial high prevalence of spirometric abnormalities following World Trade Center (WTC) disaster exposure. We assessed prevalence of spirometric abnormalities and changes in spirometry between baseline and first follow-up evaluation in participants in the WTC Worker and Volunteer Medical Monitoring Program. We also determined the predictors of spirometric change between the two examinations.


METHODS
Prebronchodilator and postbronchodilator spirometry, demographics, occupational history, smoking status, and respiratory symptoms and exposure onset were obtained at both examinations (about 3 years apart).


RESULTS
At the second examination, 24.1% of individuals had abnormal spirometry findings. The predominant defect was a low FVC without obstruction (16.1%). Between examinations, the majority of individuals did not have a greater-than-expected decline in lung function. The mean declines in prebronchodilator FEV(1) and FVC were 13 mL/yr and 2 mL/yr, respectively (postbronchodilator results were similar and not reported). Significant predictors of greater average decline between examinations were lack of bronchodilator responsiveness at examination 1 and weight gain [corrected].


CONCLUSIONS
Elevated rates of spirometric abnormalities were present at both examinations, with reduced FVC most common. Although the majority had a normal decline in lung function, lack of bronchodilator response at examination 1 and weight gain were significantly associated with greater-than-normal lung function declines [corrected]. Due to the presence of spirometric abnormalities > 5 years after the disaster in many exposed individuals, longer-term monitoring of WTC responders is essential.
Skloot
Gwen S
GS
Mount Sinai School of Medicine, New York, NY. Electronic address: gwen.skloot@mssm.edu.
Schechter
Clyde B
CB
Albert Einstein College of Medicine, Bronx, NY.
Herbert
Robin
R
Mount Sinai School of Medicine, New York, NY.
Moline
Jacqueline M
JM
Mount Sinai School of Medicine, New York, NY.
Levin
Stephen M
SM
Mount Sinai School of Medicine, New York, NY.
Crowley
Laura E
LE
Mount Sinai School of Medicine, New York, NY.
Luft
Benjamin J
BJ
Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY.
Udasin
Iris G
IG
Environmental and Occupational Health Sciences Institute, University of Medicine and Dentistry of New Jersey, Piscataway, NJ.
Enright
Paul L
PL
College of Public Health, the University of Arizona, Tucson, AZ.
D000328:Adult; D000393:Air Pollutants / Q000032:analysis; D000704:Analysis of Variance; D004784:Environmental Monitoring / Q000706:statistics & numerical data*; D062665:Epidemiological Monitoring; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening / Q000458:organization & administration / Q000706:statistics & numerical data*; D008991:Monitoring, Physiologic; D015999:Multivariate Analysis; D009519:New York City; D009784:Occupational Diseases / Q000175:diagnosis / Q000209:etiology; D012016:Reference Values; D012140:Respiratory Tract Diseases / Q000175:diagnosis* / Q000209:etiology; D012307:Risk Factors; D012680:Sensitivity and Specificity; D047851:September 11 Terrorist Attacks; D012907:Smoking / Q000453:epidemiology; D013147:Spirometry; D013997:Time Factors; D014797:Vital Capacity
D000393:Air Pollutants