Characterization of Persistent Uncontrolled Asthma Symptoms in Community Members Exposed to World Trade Center Dust and Fumes

Abstract

The destruction of the World Trade Center (WTC) towers on the 11th of September, 2001 released a vast amount of aerosolized dust and smoke resulting in acute and chronic exposures to community members as well as responders. The WTC Environmental Health Center (WTC EHC) is a surveillance and treatment program for a diverse population of community members, including local residents and local workers with WTC dust exposure. Many of these patients have reported persistent lower respiratory symptoms (LRS) despite treatment for presumed asthma. Our goal was to identify conditions associated with persistent uncontrolled LRS despite standard asthma management. We recruited 60 patients who were uncontrolled at enrollment and, after a three-month run-in period on high-dose inhaled corticosteroid and long acting bronchodilator, reassessed their status as Uncontrolled or Controlled based on a score from the Asthma Control Test (ACT). Despite this treatment, only 11 participants (18%) gained Controlled status as defined by the ACT. We compared conditions associated with Uncontrolled and Controlled status. Those with Uncontrolled symptoms had higher rates of upper airway symptoms. Many patients had persistent bronchial hyper-reactivity (BHR) and upper airway hyper-reactivity as measured by paradoxical vocal fold movement (PVFM). We found a significant increasing trend in the percentage of Controlled with respect to the presence of BHR and PVFM. We were unable to identify significant differences in lung function or inflammatory markers in this small group. Our findings suggest persistent upper and lower airway hyper-reactivity that may respond to standard asthma treatment, whereas others with persistent LRS necessitate additional diagnostic evaluation, including a focus on the upper airway.

Serum Th‐2 cytokines and FEV1 decline in WTC‐exposed firefighters: A 19‐year longitudinal study

“…Despite these limitations, the FDNY WTC Health Program is a valuable resource for understanding irritant‐induced conditions such as accelerated‐FEV 1 ‐decline in an occupational setting where there is otherwise little available data. Even with the unique aspects of the FDNY WTC‐exposed cohort, findings in this population have been replicated in other WTC‐exposed cohorts 30–34 …”

Lung function decline before and after treatment of World Trade Center associated obstructive airways disease with inhaled corticosteroids and long‐acting beta agonists

“…This study includes a predominately male cohort of previously healthy firefighters which may limit the generalizability of our findings. Nevertheless, many discoveries in the FDNY cohort have been replicated in other WTC exposed populations 5,6,24–26 . Another limitation was that we could not fully determine the degree to which regression to the mean or selection by indication biases, which were produced by the different endotypes, may have accounted for the diminished effect between ICS/LABA initiation and change in FEV 1 ‐slope.…”

9/11 Health Update

“…Another study on the WTC Survivors examined the persistence of lower respiratory symptoms (LRS) of uncontrolled asthma affecting individuals residing in lower Manhattan with previous WTC exposure to airborne particles. Reibman et al [ 15 ] reported that out of 60 patients seen at the EHC, who were uncontrolled at baseline, only 11 participants (18%) gained controlled status as defined by the Asthma Control Test after a three-month run-in period on high-dose inhaled corticosteroid and long-acting bronchodilator. After the treatment, uncontrolled subjects showed higher rates of upper airway symptoms, whereas controlled subjects showed persistent bronchial hyper-reactivity (BHR) and upper airway hyper-reactivity as measured by paradoxical vocal fold movement (PVFM).…”