Although firefighting is a hazardous occupation, published evidence of long term lung damage in firemen is inconsistent. A group of 96 men from the West Sussex Fire Brigade, which covers a semi-rural, semi-urban area, were followed up for between one and four years. They included 31 non-smokers, 40 smokers, and 25 ex-smokers. After four years 12 firemen had been lost to the study. A control group of 69 volunteers, consisting of non-smoking men from various other occupations, were followed up in parallel. Lung function tests, covering a wider range than has been previously used in similar studies, were repeated six monthly for two years and annually for a further two years. The results were expressed in terms of the rate of change with time of the lung function variables. Many of the variables deteriorated in both firemen and controls, but the rate of deterioration was greater in the controls than the firemen for vital capacity, ratio of residual volume to total lung capacity, FEV,, FVC, peak expiratory flow (PEF), flow at 50% and 25% remaining vital capacity (V,o and V25 respectively), and airways resistance (Raw). With respect to PEF, V50, V25, and Raw the control subjects deteriorated more rapidly even than the smokers and ex-smokers among the firemen. Alveolar mixing efficiency (AME), a measure of small airways function, did not change significantly over the study period in any group. Non-smoking firemen had the highest mean value of AME, decreasing through ex-smokers, controls, and smokers. We conclude that these results show no evidence of chronic lung damage in West Sussex firemen; indeed, the firemen as a group show a lower rate of deterioration of lung function with age than do the control subjects. This is attributed to the selection of fit men for the service, continued All these previous studies have been carried out on city fire brigades and all but the Boston8 have been cross sectional. We report here a four year longitudinal study of the West Sussex Fire Brigade which covers an area half rural and half industrial in character. We used a larger range of lung function tests than have been used previously, including a newer test of gas mixing efficiency, in order to look for more subtle evidence of chronic lung damage. MethodsThe study was carried out with the full and active cooperation of the West Sussex Fire Brigade and their unions with an agreement that the information gained would be confidential.
There are few reports of long term follow up of symptoms in firemen. In a four year study of symptoms in a group of 96 firemen (31 non-smokers, 40 smokers, and 25 ex-smokers) of which 89 remained in the study for its full duration a volunteer control group of 69 male non-smokers from a variety of occupations was also followed up. A history of symptoms and of smoking habits was obtained on entry to the study, then every six months for two years, and annually for a further two years. All those remaining in the study after four years were interviewed and a history of their use of breathing apparatus and of being affected by smoke and fumes was obtained. Symptom frequency was least in control subjects, intermediate in non-smokers and ex-smokers, and most in smokers. Before the study period (history obtained at the first session) smoking increased symptoms 3-9 times and being affected by smoke in the past increased symptoms 2-3 times, compared with non-smokers who had not been affected by smoke. In smokers who had also been affected by smoke symptoms increased by 9 1 times, suggesting a multiplicative effect. During the study period symptom frequency was increased about 4*4 times in smokers and 5 7 times in those who had been affected by smoke at work in the past compared with non-smokers who had not been affected by smoke. In smokers who had also been-affected by smoke symptom frequency increased by 7-4 times, the combined effects of the two types of smoker being less than additive. These results suggest that being affected by smoke and fumes at work may be a cause of long term symptoms in firemen. In firemen who are non-smokers and who had not been affected by smoke symptom frequency was similar to that observed in the control subjects. Ex-smokers had not smoked for at least one month. Never smokers (referred to as non-smokers) had at no time fulfilled the criterion for being a smoker. Eight symptoms relating to pulmonary disease were chosen for study. These were: Do you usually cough first thing in the morning in the winter? 251
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