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• W2556813699 abstract "Physicians who have been involved in the evaluation and care of patients with World Trade Center (WTC) airways disease have appreciated the New York Fire Department investigators for their ongoing publications on the determinants and trajectories of this illness. The latest publication in CHEST (June 2016) extends the period of observation of the 10,641 firefighters to September 2014, 13 years following the insult.1Aldrich T.K. Vossbrinck M. Zeig-Owens R. et al.Lung function trajectories in World Trade Center exposed New York City firefighters over 13 years: the roles of smoking and smoking cessation.Chest. 2016; 149: 1419-1427Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar As had been observed at lesser intervals following the post–September 11 sharp decline in lung function, FEV1% predicted remained relatively constant through September 10, 2014. As they had previously, the authors reported “average FEV1 trends.” Much of interest is hidden within these average trends. The authors note that 19.5% of the group experienced “greater-than-expected age-related FEV1 decline” while 15.0% experienced “improved function.” They have elicited part of the reason for these disparate trajectories to intensity of exposure (time of arrival), smoking cessation, and weight gain. Skloot et al noted in their 3,160 responders who underwent repeat studies that “the majority of individuals did not have a greater-than-expected decline” in FEV1 and FVC.2Skloot G.S. Schechter C.B. Herbert R. et al.Longitudinal assessment of spirometry in the World Trade Center Monitoring Program.Chest. 2009; 135 ([published correction appears in Chest 2009;135(4):1114]): 492-498Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar In fact, the mean declines of 13 and 2 mL/y, respectively, were less than expected. One hundred and thirty-one responders (4%) lost > 300 mL/y in FVC. Predictors of greater decline included lack of bronchodilator response and weight gain.2Skloot G.S. Schechter C.B. Herbert R. et al.Longitudinal assessment of spirometry in the World Trade Center Monitoring Program.Chest. 2009; 135 ([published correction appears in Chest 2009;135(4):1114]): 492-498Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar Other mechanisms remain to be uncovered. How do the subjects with these different trajectories differ in treatment or response to treatment, in immune or inflammatory indices, in CT imaging findings, and in other measures of lung function, including response to various bronchoprovocational agents? We physicians who care for patients with WTC airways disease have observed that, like patients with other medical conditions, some improve, some progress, and others change little. It is in the reasons for these different trajectories that we will more fully understand this disorder. Lung Function Trajectories in World Trade Center-Exposed New York City Firefighters Over 13 Years: The Roles of Smoking and Smoking CessationCHESTVol. 149Issue 6PreviewWorld Trade Center (WTC)-exposed Fire Department of the City of New York firefighters lost, on average, 10% of lung function after September 11, 2011, and >10% developed new obstructive airways disease. There was little recovery (on average) over the first 6 years. Follow-up into the next decade allowed us to determine the longer-term exposure effects and the roles of cigarette smoking and cessation on lung function trajectories. Full-Text PDF ResponseCHESTVol. 150Issue 5PreviewWe appreciate the insightful comments made by Miller1 in his letter about our article on lung function in firefighters after 9/11.2 He is quite right that firefighters and others exposed to the World Trade Center (WTC) collapse have demonstrated a variety of post-9/11 pulmonary function trajectories and that smoking status and body weight changes can account for only part of the observed post-9/11 lung function patterns. Full-Text PDF" @default.
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• W2556813699 date "2016-11-01" @default.
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• W2556813699 title "Trajectories in World Trade Center Airways Disease" @default.
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• W2556813699 doi "https://doi.org/10.1016/j.chest.2016.07.044" @default.
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