Longitudinal Assessment of Spirometry in the World Trade Center Medical Monitoring Program

Division of Pulmonary & Critical Care Medicine, Mount Sinai Medical Center, New York, NY 10029, USA.
Chest (Impact Factor: 7.48). 02/2009; 135(2):492-8. DOI: 10.1378/chest.08-1391
Source: PubMed


Multiple studies have demonstrated an initial high prevalence of spirometric abnormalities following World Trade Center (WTC) disaster exposure. We assessed prevalence of spirometric abnormalities and changes in spirometry between baseline and first follow-up evaluation in participants in the WTC Worker and Volunteer Medical Monitoring Program. We also determined the predictors of spirometric change between the two examinations.
Prebronchodilator and postbronchodilator spirometry, demographics, occupational history, smoking status, and respiratory symptoms and exposure onset were obtained at both examinations (about 3 years apart).
At the second examination, 24.1% of individuals had abnormal spirometry findings. The predominant defect was a low FVC without obstruction (16.1%). Between examinations, the majority of individuals did not have a greater-than-expected decline in lung function. The mean declines in prebronchodilator FEV(1) and FVC were 13 mL/yr and 2 mL/yr, respectively (postbronchodilator results were similar and not reported). Significant predictors of greater average decline between examinations were lack of bronchodilator responsiveness at examination 1 and weight gain [corrected].
Elevated rates of spirometric abnormalities were present at both examinations, with reduced FVC most common. Although the majority had a normal decline in lung function, lack of bronchodilator response at examination 1 and weight gain were significantly associated with greater-than-normal lung function declines [corrected]. Due to the presence of spirometric abnormalities > 5 years after the disaster in many exposed individuals, longer-term monitoring of WTC responders is essential.

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    • "Recent studies have documented the persistence of physical and mental health problems among rescue and recovery workers exposed to the World Trade Center (WTC) sites (Mauer et al. 2010; Skloot et al. 2009; Wisnivesky et al. 2011). A study of 27,449 WTC responders found persistence through 2010 of multiple physical and mental health problems including asthma, sinusitis, gastroesophageal reflux disease, depression, anxiety, and posttraumatic stress disorder (Wisnivesky et al. 2011). "
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    ABSTRACT: Background: World Trade Center rescue and recovery workers were exposed to a complex mix of pollutants and carcinogens. The purpose of this investigation was to evaluate cancer incidence in responders during the first seven years after September 11, 2001. Methods: Cancers among 20,984 consented participants in the WTC Health Program were identified through linkage to state tumor registries in New York, New Jersey, Connecticut, and Pennsylvania. Standardized incidence ratios (SIRs) were calculated to compare cancers diagnosed in responders to predicted numbers for the general population. Multivariate regression models were used to estimate associations with degree of exposure. Results: A total of 575 cancers were diagnosed in 552 individuals. Increases over registry-based expectations were noted for all cancer sites combined (SIR 1.15; 95% CI: 1.06, 1.25), thyroid cancer (SIR 2.39; 95% CI: 1.70, 3.27), prostate cancer (SIR 1.21; 95% CI: 1.01, 1.44), combined hematopoietic and lymphoid cancers (SIR 1.36; 95% CI: 1.07, 1.71) and soft tissue cancers (SIR 2.26; 95% CI: 1.13, 4.05). When restricted to 302 cancers diagnosed six or more months after enrollment, the SIR for all cancers decreased to 1.06 (95% CI: 0.94, 1.18), but thyroid and prostate cancer diagnoses remained greater than expected. All cancers combined were increased in very highly exposed responders and among those exposed to significant amounts of dust compared with responders who reported lower levels of exposure. Conclusion: Estimates should be interpreted with caution given the short follow-up and long latency period for most cancers, the intensive medical surveillance of this cohort, and the small numbers of cancers at specific sites. However, our findings highlight the need for continued follow up and surveillance of WTC responders.
    Environmental Health Perspectives 04/2013; Advance pubblication. DOI:10.1289/ehp.1205894 · 7.98 Impact Factor
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    • "To date, there has been no detailed characterization of the work of the WTC responder population or of the multiple job tasks that they performed, often under harrowing and heroic conditions. Previous studies have reported that some of the health consequences among responders varied depending on the time of arrival at the site, whether they were entrapped in the dust cloud at the collapse, and their duration of work [Banauch et al., 2006; Herbert et al., 2006; Wheeler et al. 2007; Skloot et al., 2009]. "
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    ABSTRACT: To date there have been no comprehensive reports of the work performedby 9/11 World Trade Center responders. 18,969 responders enrolled in the WTC Medical Monitoring and Treatment Program were used to describe workers’ pre-9/11 occupations, WTC work activities and locations from September 11, 2001 to June 2002. The most common pre-9/11 occupation was protective services (47%); other common occupations included construction, telecommunications, transportation, and support services workers. 14% served as volunteers. Almost one-half began work on 9/11 and >80% reported working on or adjacent to the ‘‘pile’’ at Ground Zero. Initially,the most common activity was search and rescue but subsequently, the activities of most responders related to their pre-9/11 occupations. Other major activities included security; personnel support; buildings and grounds cleaning; and telecommunications repair. The spatial, temporal, occupational, and task-related taxonomy reported here will aid the development of a job-exposure matrix, assist in assessment of disease risk, and improve planning and training for responders in future urban disasters.
    American Journal of Industrial Medicine 09/2011; 54(9):681-95. DOI:10.1002/ajim.20997 · 1.74 Impact Factor
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