Obstructive Airways Disease With Air Trapping Among Firefighters Exposed to World Trade Center Dust
Obstructive Airways Disease With Air Trapping Among Firefighters Exposed to World Trade Center Dust
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DOI：
10.1378/chest.09-1580
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发表时间：
2010-03-01
期刊：
影响因子：
9.6
通讯作者：
Prezant, David J.
中科院分区：
文献类型：
--
作者：
Weiden, Michael D.;Ferrier, Natalia;Prezant, David J.
背景资料：世界贸易中心（WTC）倒塌导致纽约市消防局（FDNY）救援人员大量暴露于可吸入颗粒物中。该组在2001年9月11日之前和2001年9月11日之后进行了肺功能测定，显示肺功能下降，FEVI和FVC平行下降。到目前为止，潜在的病理生理原因，这一直是开放的question.Methods：在FDNY-WTC监测程序的13,234名参与者，1,720（13%）被称为肺亚专科评价在一个单一的机构。评估包括919次完整的肺功能测试，1，219次乙酰甲胆碱激发测试和982次高分辨率胸部CT扫描。肺部评价时（2001年9月11日之后的中位数34个月），中位数值为FEVI 93%预测值（四分位距[IQR]，83%-101%），FVC 98%预测值（IQR，89%-106%）和FEVI/FVC 0.78（IQR，0.72-0.82）。残气量（RV）为123%预测值（IQR，106%-147%），几乎所有参与者的总肺容量、功能残气量和一氧化碳弥散量均正常。此外，1，051/1，720例（59%）患有阻塞性气道疾病，基于以下至少一项：FEVI/FVC、支气管扩张剂反应性、高反应性或RV升高。在校正年龄、性别、种族、身高、体重和烟草使用后，2001年9月11日后FEVI的下降与RV预测百分比的增加（P <0.0001）、支气管扩张剂反应性的增加（P <0.0001）和高反应性的增加（P = 0.0056）显著相关。CT扫描显示支气管壁增厚与2001年9月11日后FEVI下降（P = 0.024）、高反应性增加（P <0.0001）和RV增加（P <0.0001）显著相关。很少有证据表明间质性diseases.Conclusions：气道阻塞是主要的生理发现，肺功能下降后，2001年9月11日，在纽约消防局世贸中心救援人员提出肺评估。胸部2010，137（3）：566-574
Background: The World Trade Center (WTC) collapse produced a massive exposure to respirable particulates in New York City Fire Department (FDNY) rescue workers. This group had spirometry examinations pre-September 11, 2001, and post-September 11, 2001, demonstrating declines in lung function with parallel declines in FEVI and FVC. To date, the underlying pathophysiologic cause for this has been open to question.Methods: Of 13,234 participants in the FDNY-WTC Monitoring Program, 1,720 (13%) were referred for pulmonary subspecialty evaluation at a single institution. Evaluation included 919 full pulmonary function tests, 1,219 methacholine challenge tests, and 982 high-resolution chest CT scans.Results: At pulmonary evaluation (median 34 months post-September 11, 2001), median values were FEVI 93% predicted (interquartile range [IQR], 83%-101%), FVC 98% predicted (IQR, 89%-106%), and FEVI/FVC 0.78 (IQR, 0.72-0.82). The residual volume (RV) was 123% predicted (IQR, 106%-147%) with nearly all participants having normal total lung capacity, functional residual capacity, and diffusing capacity of carbon monoxide. Also, 1,051/1,720 (59%) had obstructive airways disease based on at least one of the following: FEVI/FVC, bronchodilator responsiveness, hyperreactivity, or elevated RV. After adjusting for age, gender, race, height and weight, and tobacco use, the decline in FEVI post-September 11, 2001, was significantly correlated with increased RV percent predicted (P < .0001), increased bronchodilator responsiveness (P < .0001), and increased hyperreactivity (P = .0056). CT scans demonstrated bronchial wall thickening that was significantly associated with the decline in FEVI post-September 11, 2001 (P = .024), increases in hyperreactivity (P < .0001), and increases in RV (P < .0001). Few had evidence for interstitial disease.Conclusions: Airways obstruction was the predominant physiologic finding underlying the reduction in lung function post-September 11, 2001, in FDNY WTC rescue workers presenting for pulmonary evaluation. CHEST 2010,137(3):566-574