title: Obstructive airways disease with air trapping among firefighters exposed to World Trade Center dust.
abstract: 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.
authors.affiliation: Division of Pulmonary/Critical Care, New York University, New York, NY, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Weiden
authors.forename: Natalia
authors.initials: N
authors.lastname: Ferrier
authors.forename: Anna
authors.initials: A
authors.lastname: Nolan
authors.forename: William N
authors.initials: WN
authors.lastname: Rom
authors.forename: Ashley
authors.initials: A
authors.lastname: Comfort
authors.forename: Jackson
authors.initials: J
authors.lastname: Gustave
authors.forename: Rachel
authors.initials: R
authors.lastname: Zeig-Owens
authors.forename: Shugi
authors.initials: S
authors.lastname: Zheng
authors.forename: Roberta M
authors.initials: RM
authors.lastname: Goldring
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Berger
authors.forename: Kaitlyn
authors.initials: K
authors.lastname: Cosenza
authors.forename: Roy
authors.initials: R
authors.lastname: Lee
authors.forename: Mayris P
authors.initials: MP
authors.lastname: Webber
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Kelly
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Aldrich
authors.forename: David J
authors.initials: DJ
authors.lastname: Prezant
mesh_terms: 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