Obstructive airways disease with air trapping among firefighters exposed to World Trade Center dust.
The World Trade Center (WTC) collapse produced a massive exposure to respirable particulates in New York City Fire Department (FDNY) rescue workers. This group had spirometry examinations pre-September 11, 2001, and post-September 11, 2001, demonstrating declines in lung function with parallel declines in FEV(1) and FVC. To date, the underlying pathophysiologic cause for this has been open to question.



Of 13,234 participants in the FDNY-WTC Monitoring Program, 1,720 (13%) were referred for pulmonary subspecialty evaluation at a single institution. Evaluation included 919 full pulmonary function tests, 1,219 methacholine challenge tests, and 982 high-resolution chest CT scans.



At pulmonary evaluation (median 34 months post-September 11, 2001), median values were FEV(1) 93% predicted (interquartile range [IQR], 83%-101%), FVC 98% predicted (IQR, 89%-106%), and FEV(1)/FVC 0.78 (IQR, 0.72-0.82). The residual volume (RV) was 123% predicted (IQR, 106%-147%) with nearly all participants having normal total lung capacity, functional residual capacity, and diffusing capacity of carbon monoxide. Also, 1,051/1,720 (59%) had obstructive airways disease based on at least one of the following: FEV(1)/FVC, bronchodilator responsiveness, hyperreactivity, or elevated RV. After adjusting for age, gender, race, height and weight, and tobacco use, the decline in FEV(1) post-September 11, 2001, was significantly correlated with increased RV percent predicted (P < .0001), increased bronchodilator responsiveness (P < .0001), and increased hyperreactivity (P = .0056). CT scans demonstrated bronchial wall thickening that was significantly associated with the decline in FEV(1) post-September 11, 2001 (P = .024), increases in hyperreactivity (P < .0001), and increases in RV (P < .0001). Few had evidence for interstitial disease.



Airways obstruction was the predominant physiologic finding underlying the reduction in lung function post-September 11, 2001, in FDNY WTC rescue workers presenting for pulmonary evaluation.
Weiden
Michael D
MD
Division of Pulmonary/Critical Care, New York University, New York, NY, USA.
Ferrier
Natalia
N
Nolan
Anna
A
Rom
William N
WN
Comfort
Ashley
A
Gustave
Jackson
J
Zeig-Owens
Rachel
R
Zheng
Shugi
S
Goldring
Roberta M
RM
Berger
Kenneth I
KI
Cosenza
Kaitlyn
K
Lee
Roy
R
Webber
Mayris P
MP
Kelly
Kerry J
KJ
Aldrich
Thomas K
TK
Prezant
David J
DJ
D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005390:Fires; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects*; D012189:Retrospective Studies; D047851:September 11 Terrorist Attacks; D015208:Smoke Inhalation Injury / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D013147:Spirometry; D014057:Tomography, X-Ray Computed