Bronchial Reactivity and the Course of Lung Function After WTC Exposure

描述（由申请人提供）：持久性阻塞性气道疾病在接触wtc的消防员中很常见，尽管在2011年9月11日之前这一人群中很少见。有初步证据表明，支气管高反应性与过度的即时（9/11前）肺功能下降率有关，但尚不清楚这是原因还是结果。本提案是为了在10年后对一大批在9/11后早期进行肺功能和支气管反应性测试的消防员进行支气管反应性和肺功能的重新检查。具体目标是(1)量化10年内支气管反应性的变化；(2)确定2002 - 2013年间初始和/或随后的支气管反应性是否与肺功能下降有关；(3)确定抗炎治疗（主要是吸入皮质类固醇[ICS]）是否能改善支气管高反应性和/或肺功能下降。大约350名接触世贸中心的消防员将接受详细的医疗记录审查和面对面访谈，审查医疗和消防历史，特别关注吸入类固醇的使用情况。还将进行详细的肺功能检查，包括支气管反应性的测量。统计分析将是分类的，比较有或没有OAD、支气管反应性高或正常的亚组的平均肺功能下降率，并通过多变量分析。研究结果应明确wtc相关OAD的自然史，确定临床结果是否随支气管反应性而变化，评估抗炎治疗对结果的影响。

DESCRIPTION (provided by applicant): Persistent obstructive airways disease is common among WTC-exposed firefighters, though rare in this population before 9/11/2011. There is preliminary evidence that bronchial hyperreactivity is associated with excessive immediate (pre-post 9/11) pulmonary function decline rates, but it remains unclear if that was cause or effect. This proposal is for a re- examination, ten years later, of bronchial reactivity and lung function for a large group firefighters who had lung function and bronchial reactivity tests in the early post-9/11 period. Specific aims are (1) to quantify the change in bronchial reactivity over 10 years; (2) to determine whether initial and/or subsequent bronchial reactivity is associated with the decline in lung function from 2002 to 2013; and (3) to determine whether anti-inflammatory treatment (mainly inhaled corticosteroids [ICS]) ameliorates bronchial hyperreactivity and/or lung function decline. Approximately 350 WTC-exposed firefighters will have detailed reviews of medical records, and face-to-face interviews, reviewing medical and firefighting histories, with special attention to the use of inhaled steroids. Detailed pulmonary function tests will also be conducted, including measurements of bronchial reactivity. Statistical analysis will be both categorical, comparing average lung function decline rates in subgroups with or without OAD and with high or normal bronchial reactivity, and by multivariate analysis. The results should define the natural history of WTC-associated OAD, determine whether clinical outcomes varied according to bronchial reactivity, assess the influence of anti- inflammatory treatment on outcomes. PUBLIC HEALTH RELEVANCE: Persistent obstructive airways disease (an asthma-like condition) is common among World Trade Center- exposed firefighters, though rare in this population before 9/11/2011, and is often, but not always, accompanied by bronchial hyperreactivity (easily triggered airway narrowing). We propose to re-examine a large number of firefighters who had bronchial reactivity measured soon after 9/11, to determine whether those with bronchial hyperreactivity have faster declines in lung function and whether those treated with anti-asthma medications show less of that effect.