title: Bronchial Reactivity and Lung Function After World Trade Center Exposure.
abstract: BACKGROUND
  World Trade Center (WTC)-exposed rescue/recovery workers endured massive respiratory insult from inhalation of particulate matter and gases, resulting in respiratory symptoms, loss of lung function, and, for many, bronchial hyperreactivity (BHR). The persistence of respiratory symptoms and lung function abnormalities has been well-documented, whereas persistence of BHR has not been investigated.
  
  
  METHODS
  A total of 173 WTC-exposed firefighters with bronchial reactivity measured within 2 years after September 11, 2001 (9/11) (baseline methacholine challenge test), were reevaluated in 2013 and 2014 (follow-up methacholine challenge test). FEV1measurements were obtained from the late pre-9/11, early post-9/11, and late post-9/11 periods. Respiratory symptoms and corticosteroid treatment were recorded.
  
  
  RESULTS
  Bronchial reactivity remained stable (within 1 doubling dilution) for most (n = 101, 58%). Sixteen of 28 (57%) with BHR (provocative concentration of methacholine producing a 20% decline in FEV1<8 mg/mL) at baseline had BHR at follow-up, and an additional 27 of the 145 (19%) without BHR at baseline had BHR at follow-up. In multivariable models, we found that BHR baseline was strongly associated with BHR follow-up (OR, 6.46) and that BHR at follow-up was associated with an estimated 15.4 mL/y greater FEV1decline than experienced by those without BHR at follow-up. Annual FEV1decline was moderated by corticosteroid use.
  
  
  CONCLUSIONS
  Persistent BHR and its deleterious influence on lung function suggest a role for airway inflammation in perpetuation of WTC-associated airway disease. In future massive occupational exposure to inorganic dust/gases, we recommend early and serial pulmonary function testing, including measurements of bronchial reactivity, when possible, and inhaled corticosteroid therapy for those with symptoms or pulmonary function tests consistent with airway disease.
authors.affiliation: Department of Medicine, Pulmonary Division, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Aldrich
authors.affiliation: Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY.
authors.forename: Jessica
authors.initials: J
authors.lastname: Weakley
authors.affiliation: Department of Medicine, Pulmonary Division, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Sean
authors.initials: S
authors.lastname: Dhar
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: Department of Medicine, Pulmonary Division, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Tesha
authors.initials: T
authors.lastname: Crosse
authors.affiliation: Pulmonary and Critical Care Medicine Division, University of Massachusetts Medical Center, Worcester, MA.
authors.forename: Gisela I
authors.initials: GI
authors.lastname: Banauch
authors.affiliation: Bureau of Health Services, Fire Department of the City of New York, 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: Shaare Zedek Medical Center and the Hebrew University Hadassah Medical School, Jerusalem, Pulmonary Institute, Jerusalem, Israel.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Izbicki
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: Department of Medicine, Pulmonary Division, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Aanchal
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Medicine, Pulmonary Division, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Camille
authors.initials: C
authors.lastname: King
authors.affiliation: Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Christodoulou
authors.affiliation: Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY. Electronic address: Mayris.Webber@fdny.nyc.gov.
authors.forename: Mayris P
authors.initials: MP
authors.lastname: Webber
authors.affiliation: Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY.
authors.forename: Rachel
authors.initials: R
authors.lastname: Zeig-Owens
authors.affiliation: Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY.
authors.forename: William
authors.initials: W
authors.lastname: Moir
authors.affiliation: Bureau of Health Services, Fire Department of the City of New York, 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: Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY.
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Kelly
authors.affiliation: Department of Medicine, Pulmonary Division, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY.
authors.forename: David J
authors.initials: DJ
authors.lastname: Prezant
mesh_terms: D000328:Adult; D016535:Bronchial Hyperreactivity / Q000453:epidemiology* / Q000503:physiopathology*; D001985:Bronchial Provocation Tests; D005260:Female; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects*; D008297:Male; D016210:Methacholine Chloride; D009784:Occupational Diseases / Q000453:epidemiology* / Q000503:physiopathology*; D016273:Occupational Exposure / Q000009:adverse effects*; D015995:Prevalence; D012129:Respiratory Function Tests; D047851:September 11 Terrorist Attacks; D011795:Surveys and Questionnaires
chemical_list: D016210:Methacholine Chloride
keywords: airway disease; asthma; epidemiology; firefighting; occupational diseases