Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.
Bureau of Health Services and Office of Medical Affairs, Fire Department of the City of New York, Brooklyn, NY.
Chest. 2013 Mar;143(3):791-797. doi: 10.1378/chest.12-0675.
Few longitudinal studies characterize firefighters’ pulmonary function. We sought to determine whether firefighters have excessive FEV(1) decline rates compared with control subjects.
We examined serial measurements of FEV(1) from about 6 months prehire to about 5 years posthire in newly hired male, never smoking, non-Hispanic black and white firefighters, hired between 2003 and 2006, without prior respiratory disease or World Trade Center exposure. Similarly defined Emergency Medical Service (EMS) workers served as control subjects.
Through June 30, 2011, 940 firefighters (82%) and 97 EMS workers (72%) who met study criteria had four or more acceptable posthire spirometries. Prehire FEV(1) % averaged higher for firefighters than EMS workers (99% vs 95%), reflecting more stringent job entry criteria. FEV(1) (adjusted for baseline age and height) declined by an average of 45 mL/y both for firefighters and EMS workers, with Fire 2 EMS decline rate differences averaging 0.2 mL/y (CI, 2 9.2 to 9.6). Four percent of each group had FEV(1) less than the lower limit of normal before hire, increasing to 7% for firefighters and 17.5% for EMS workers, but similar percentages of both groups had adjusted FEV(1) decline rates 10%. Mixed effects modeling showed a significant influence of weight gain but not baseline weight: FEV(1) declined by about 8 mL/kg gained for both groups. Adjusting for weight change, FEV(1) decline averaged 38 mL/y for firefighters and 34 mL/y for EMS workers.
During the first 5 years of duty, firefighters do not show greater longitudinal FEV(1) decline than EMS control subjects, and fewer of them develop abnormal lung function. Weight gain is associated with a small loss of lung function, of questionable clinical relevance in this fit and active population.
很少有纵向研究描述消防员的肺功能。我们旨在确定与对照相比，消防员是否存在更大的 FEV1 下降率。
我们检查了大约 6 个月的入职前至大约 5 年的入职后，新入职的、从未吸烟的、非西班牙裔的黑人或白人消防员的 FEV1 系列测量值，这些消防员在 2003 年至 2006 年间入职，入职前没有呼吸道疾病或世界贸易中心暴露史。同样定义的急诊医疗服务（EMS）工作人员作为对照。
截至 2011 年 6 月 30 日，符合研究标准的 940 名消防员（82%）和 97 名 EMS 工作人员（72%）有 4 次或更多次可接受的入职后肺活量测定。消防员入职前的 FEV1%平均高于 EMS 工作人员（99%比 95%），反映了更严格的入职标准。消防员和 EMS 工作人员的 FEV1（根据基线年龄和身高进行调整）平均每年下降 45mL，消防员和 EMS 之间的 FEV1 下降率差异平均为 0.2mL/y（CI，2 9.2 至 9.6）。入职前，两组各有 4%的人的 FEV1 低于正常值下限，消防员增加到 7%，EMS 工作人员增加到 17.5%，但两组都有相似比例的调整后 FEV1 下降率为 10%。混合效应模型显示体重增加有显著影响，但基线体重没有影响：两组的 FEV1 都因体重增加而下降了约 8mL/kg。调整体重变化后，消防员的 FEV1 下降平均为 38mL/y，EMS 工作人员为 34mL/y。
在服役的头 5 年中，消防员的 FEV1 纵向下降率没有比 EMS 对照组更大，而且他们中较少人出现肺功能异常。体重增加与肺功能的轻微损失有关，在这个健康活跃的人群中，其临床意义值得怀疑。
