title: Elevated peripheral eosinophils are associated with new-onset and persistent wheeze and airflow obstruction in world trade center-exposed individuals.
abstract: BACKGROUND
  Exposure to World Trade Center (WTC) dust and fumes is associated with the onset of asthma-like respiratory symptoms in rescue and recovery workers and exposed community members. Eosinophilic inflammation with increased lung and peripheral eosinophils has been described in subpopulations with asthma. We hypothesized that persistent asthma-like symptoms in WTC-exposed individuals would be associated with systemic inflammation characterized by peripheral eosinophils.
  
  
  METHODS
  The WTC Environmental Health Center (WTC EHC) is a treatment program for local residents, local workers, and cleanup workers with presumed WTC-related symptoms. Patients undergo a standardized evaluation including questionnaires and complete blood count. Between September 2005 and March 2009, 2462 individuals enrolled in the program and were available for analysis. Individuals with preexisting respiratory symptoms or lung disease diagnoses prior to September 2001 and current or significant tobacco use were excluded,
  
  
  RESULTS
  One thousand five hundred and seventeen individuals met the inclusion criteria. Patients had a mean age of 47 years, were mostly female (51%), and had a diverse race/ethnicity. Respiratory symptoms that developed after WTC dust/fume exposure and remained persistent included dyspnea on exertion (68%), cough (57%), chest tightness (47%), and wheeze (33%). A larger percentage of patients with wheeze had elevated peripheral eosinophils compared with those without wheeze (21% vs. 13%, p < .0001). Individuals with elevated peripheral eosinophils were more likely to have airflow obstruction on spirometry (16% vs. 7%, p = .0003).
  
  
  CONCLUSIONS
  Peripheral eosinophils were associated with wheeze and airflow obstruction in a diverse WTC-exposed population. These data suggest that eosinophils may participate in lung inflammation in this population with symptoms consistent with WTC-related asthma.
authors.affiliation: Department of Medicine, Bellevue Hospital, New York University, NY, USA.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Kazeros
authors.forename: Ming-Tyh
authors.initials: MT
authors.lastname: Maa
authors.forename: Paru
authors.initials: P
authors.lastname: Patrawalla
authors.forename: Mengling
authors.initials: M
authors.lastname: Liu
authors.forename: Yongzhao
authors.initials: Y
authors.lastname: Shao
authors.forename: Meng
authors.initials: M
authors.lastname: Qian
authors.forename: Meredith
authors.initials: M
authors.lastname: Turetz
authors.forename: Sam
authors.initials: S
authors.lastname: Parsia
authors.forename: Caralee
authors.initials: C
authors.lastname: Caplan-Shaw
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Berger
authors.forename: Roberta
authors.initials: R
authors.lastname: Goldring
authors.forename: Linda
authors.initials: L
authors.lastname: Rogers
authors.forename: Joan
authors.initials: J
authors.lastname: Reibman
mesh_terms: D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction / Q000097:blood* / Q000209:etiology* / Q000473:pathology; D001772:Blood Cell Count; D004804:Eosinophils / Q000473:pathology*; D005260:Female; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009519:New York City; D011014:Pneumonia / Q000097:blood* / Q000209:etiology* / Q000473:pathology; D047851:September 11 Terrorist Attacks; D013147:Spirometry; D055815:Young Adult