Factors Predicting Treatment of World Trade Center-Related Lung Injury: A Longitudinal Cohort Study

Putman, Barbara; Lahousse, Lies; Goldfarb, David G.; Schwartz, Theresa; Singh, Ankura; Vaeth, Brandon M.; Hall, Charles B.; Lancet, Elizabeth A.; Webber, Mayris P.; Cohen, Hillel W.; Prezant, David J.; Weiden, Michael D.

doi:10.3390/ijerph17239056

Cited by 3 publications

(12 citation statements)

References 19 publications

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“…Our stratified analysis revealed that FEV 1 ‐slope improved over 34.5 ml/year if ICS/LABA treatment was started soon after exposure while FEV 1 ‐slope did not change significantly among participants that initiated ICS/LABA treatment after January 14, 2010. The results for FEV 1 ‐slope are consistent with failure to resolve respiratory symptoms if ICS/LABA treatment is started long after exposure 10 . ICS/LABA was initiated at the time patients presented to pulmonologists for evaluation of respiratory symptoms but it is likely that the onset of disease began before presentation for treatment.…”

Section: Discussionsupporting

confidence: 58%

“…The dust and smoke exposure produced by the collapse of the WTC towers on September 11, 2001 resulted in obstructive airways diseases which are frequently treated with ICS/LABA 2,3,7,10 . After the original insult, WTC‐exposed cohorts have been followed longitudinally for almost two decades.…”

Section: Discussionmentioning

confidence: 99%

“…An alternate hypothesis consistent with the data is that distinct lung injury endotypes with different latencies occurred after WTC exposure. The short‐latency endotype(s) have greater FEV 1 ‐decline postinjury but are effectively treated with ICS/LABA improving the FEV 1 trajectory and respiratory symptoms 10 . The long latency endotype(s) have intrinsic risks for FEV 1 decline and are ICS/LABA unresponsive.…”

Section: Discussionmentioning

confidence: 99%

“…WTC‐exposed cohorts had an increased incidence of obstructive airways disease (OAD) with air‐trapping and airway reactivity 3–7 . Specifically, high‐intensity WTC exposure and respiratory symptoms such as cough, shortness of breath, and wheeze that developed in this population shortly after 9/11 were associated with accelerated decline in lung function and early diagnoses of OAD 8–10 …”

Section: Introductionmentioning

confidence: 99%

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

Goldfarb

Putman

Lahousse

et al. 2021

American J Industrial Med

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Background Greater than average loss of one‐second forced expiratory volume (FEV1) is a risk factor for asthma, chronic obstructive pulmonary disease (COPD), and asthma/COPD overlap syndrome in World Trade Center (WTC)‐exposed firefighters. Inhaled corticosteroids and long‐acting beta agonists (ICS/LABA) are used to treat obstructive airways disease but their impact on FEV1‐trajectory in this population is unknown. Methods The study population included WTC‐exposed male firefighters who were treated with ICS/LABA for 2 years or longer (with initiation before 2015), had at least two FEV1 measurements before ICS/LABA initiation and two FEV1 measurements posttreatment between September 11, 2001 and September 10, 2019. Linear mixed‐effects models were used to estimate FEV1‐slope pre‐ and post‐treatment. Results During follow‐up, 1023 WTC‐exposed firefighters were treated with ICS/LABA for 2 years or longer. When comparing intervals 6 years before and 6 years after treatment, participants had an 18.7 ml/year (95% confidence interval [CI]: 11.3–26.1) improvement in FEV1‐slope after adjustment for baseline FEV1, race, height, WTC exposure, weight change, blood eosinophil concentration, and smoking status. After stratification by median date of ICS/LABA initiation (January 14, 2010), earlier ICS/LABA‐initiators had a 32.5 ml/year (95% CI: 19.5–45.5) improvement in slope but later ICS/LABA‐initiators had a nonsignificant FEV1‐slope improvement (7.9 ml/year, 95% CI: −0.5 to 17.2). Conclusions WTC‐exposed firefighters treated with ICS/LABA had improved FEV1 slope after initiation, particularly among those who started earlier. Treatment was, however, not associated with FEV1‐slope improvement if started after the median initiation date (1/14/2010), likely because onset of disease began before treatment initiation. Research on alternative treatments is needed for patients with greater than average FEV1‐decline who have not responded to ICS/LABA.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Goldfarb

Putman

Lahousse

et al. 2021

American J Industrial Med

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show abstract

“…A two-year longitudinal assessment was conducted on 8530 WTC-exposed firefighters with lung injury by Putman et al [ 16 ] A total of 1629/8530 (19.1%) firefighters initiated inhaled corticosteroid/long-acting beta-agonist ICS/LABA treatment conducted for >2 years. Forced Expiratory Volume in 1 s (FEV 1 ), wheeze, and dyspnea were independently associated with prolonged ICS/LABA treatment.…”

Section: Lung Diseasementioning

confidence: 99%