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• W2510109114 abstract "We thank Drs Miller and Mann for their letter regarding our article1Berger KI Reibman J Oppenheimer BW Vlahos I Harrison D Goldring RM Lessons from the World Trade Center disaster: airway disease presenting as restrictive dysfunction.Chest. 2013; 144: 249-257Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar and agree with their perspective. Our findings1Berger KI Reibman J Oppenheimer BW Vlahos I Harrison D Goldring RM Lessons from the World Trade Center disaster: airway disease presenting as restrictive dysfunction.Chest. 2013; 144: 249-257Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar expand on a prior report by Miller and Palecki2Miller A Palecki A Restrictive impairment in patients with asthma.Respir Med. 2007; 101: 272-276Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar in a population of patients with asthma and isolated case reports by other authors as cited in our article. These studies indicate that a restrictive pattern on plethysmography with normal FEV1/vital capacity may be found in patients with airway disease more often than previously appreciated. Our study and prior lung biopsy findings3Caplan-Shaw CE Yee H Rogers L et al.Lung pathologic findings in a local residential and working community exposed to World Trade Center dust, gas, and fumes.J Occup Environ Med. 2011; 53: 981-991Crossref PubMed Scopus (57) Google Scholar provide a pathophysiologic mechanism for the restriction related to injury to the distal lung unit. As Drs Miller and Mann indicated, our spirometry and oscillometry findings were minimally responsive to bronchodilator. We believe that this is in accord with the histologic evidhistologic evidence for bronchiolitis, small airway fibrosis, and emphysema noted in subjects exposed to World Trade Center (WTC) dust and fumes.3Caplan-Shaw CE Yee H Rogers L et al.Lung pathologic findings in a local residential and working community exposed to World Trade Center dust, gas, and fumes.J Occup Environ Med. 2011; 53: 981-991Crossref PubMed Scopus (57) Google Scholar In addition, our article provides clues from the standard testing modalities to identify this phenotype: (1) reduction in vital capacity due to reduced expiratory reserve volume with normal inspiratory capacity (ie, restriction from expiratory impairment), (2) relative preservation of diffusing capacity for carbon monoxide suggesting normal alveolar-capillary interface, and (3) reduced alveolar volume to total lung capacity ratio indicating nonuniform airflow distribution. When indicated, confirmation of primary airway disease can be achieved by specific testing of distal lung function and/or by high-resolution CT scanning. We chose to entitle our manuscript “Lessons From the World Trade Center” to highlight the potential application of our findings to a broader clinical population with intrinsic airway disease and inhalational/environmental injury beyond exposure to WTC dust. Recognition of this pattern when FEV1/VC remains normal is an important first step that is required to avoid misdiagnosis and, thus, allow for optimal treatment. Airways Disease Presenting as Restrictive Impairment: A Variant in Asthma, a Defining Feature in World Trade Center Lung DisorderCHESTVol. 144Issue 6PreviewThe recent article by Berger et al1 in CHEST (July 2013) has refocused the interest of readers of CHEST to airway disease presenting as restrictive dysfunction. As cited in the article, this syndrome was noted in individual patients and then by the senior correspondent of this letter in a large series of patients with asthma, in whom it was estimated to characterize at least 8% of patients presenting with asthma. The decrease in expiratory reserve volume was especially notable in the days of precomputerized spirometry, when tracings of tidal breathing were followed by a forced exhalation. Full-Text PDF" @default.
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• W2510109114 date "2013-12-01" @default.
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• W2510109114 title "Airways Disease Presenting as Restrictive Impairment: Response" @default.
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• W2510109114 doi "https://doi.org/10.1378/chest.13-1961" @default.
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