title: Lung Function Trajectories in World Trade Center-Exposed New York City Firefighters Over 13 Years: The Roles of Smoking and Smoking Cessation.
abstract: World Trade Center (WTC)-exposed Fire Department of the City of New York firefighters lost, on average, 10% of lung function after September 11, 2011, and >10% developed new obstructive airways disease. There was little recovery (on average) over the first 6 years. Follow-up into the next decade allowed us to determine the longer-term exposure effects and the roles of cigarette smoking and cessation on lung function trajectories.
  
  
  
  We examined serial measurements of FEV1 from March 11, 2000, to September 10, 2014, among 10,641 WTC-exposed Fire Department of the City of New York firefighters with known smoking and body weight histories.
  
  
  
  The median number of FEV1 measurements during follow-up was 9; 15% of firefighters arrived at the WTC during the morning of September 11, 2001; and 65% never smoked. Firefighters arriving the morning of September 11, 2001 averaged lower lung function than did lesser exposed firefighters; this difference remained significant during most of follow-up (P < .05). Never smokers had significantly better lung function than current smokers; former smokers fell in between, depending upon their cessation date. Those arriving the morning of September 11, 2001 were more likely to have an FEV1 < lower limits of normal compared with those arriving between September 13, 2001, and September 24, 2001 (OR = 1.70, P < .01). Current smokers were more likely to have an FEV1 < lower limits of normal compared with never smokers (OR = 2.06, P < .01), former smokers who quit before September 11, 2001 (OR = 1.96, P < .01), or those who quit between September 11, 2001 and March 10, 2008 (OR = 1.49, P < .01).
  
  
  
  Thirteen years after September 11, 2001, most firefighters continued to show a lack of lung function recovery, with the trajectory of decline differing by WTC exposure and smoking status. Unlike the immutable effect of WTC exposure, we demonstrated the benefit on lung function of smoking cessation in this unique occupational/environmental cohort.
authors.affiliation: Pulmonary Medicine Division, Montefiore Medical Center, Bronx, NY; Department of Medicine, Pulmonary Division, Albert Einstein College of Medicine, Bronx, NY. Electronic address: taldrich@montefiore.org.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Aldrich
authors.affiliation: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY; Department of Medicine, Montefiore Medical Center, Bronx, NY.
authors.forename: Madeline
authors.initials: M
authors.lastname: Vossbrinck
authors.affiliation: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY; Department of Medicine, Montefiore Medical Center, Bronx, NY.
authors.forename: Rachel
authors.initials: R
authors.lastname: Zeig-Owens
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Hall
authors.affiliation: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY; Department of Medicine, Montefiore Medical Center, Bronx, NY.
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Schwartz
authors.affiliation: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY; Department of Medicine, Montefiore Medical Center, Bronx, NY.
authors.forename: William
authors.initials: W
authors.lastname: Moir
authors.affiliation: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY; Department of Epidemiology and Population Health, Montefiore Medical Center, Bronx, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Mayris P
authors.initials: MP
authors.lastname: Webber
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Hillel W
authors.initials: HW
authors.lastname: Cohen
authors.affiliation: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY; Department of Medicine, New York University School of Medicine, New York, NY.
authors.forename: Anna
authors.initials: A
authors.lastname: Nolan
authors.affiliation: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY; Department of Medicine, New York University School of Medicine, New York, NY.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Weiden
authors.affiliation: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Christodoulou
authors.affiliation: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY.
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Kelly
authors.affiliation: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, NY; Pulmonary Medicine Division, Montefiore Medical Center, Bronx, NY; Department of Medicine, Pulmonary Division, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: David J
authors.initials: DJ
authors.lastname: Prezant
mesh_terms: D000328:Adult; D005260:Female; D061388:Firefighters; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D020127:Recovery of Function; D012129:Respiratory Function Tests / Q000379:methods; D047851:September 11 Terrorist Attacks; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data; D013223:Statistics as Topic; D013997:Time Factors; D014481:United States
keywords: World Trade Center; firefighting; occupational lung disease; pulmonary function test; smoking
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