Aldrich Thomas K, Weakley Jessica, Dhar Sean, Hall Charles B, Crosse Tesha, Banauch Gisela I, Weiden Michael D, Izbicki Gabriel, Cohen Hillel W, Gupta Aanchal, King Camille, Christodoulou Vasilios, Webber Mayris P, Zeig-Owens Rachel, Moir William, Nolan Anna, Kelly Kerry J, Prezant David J
Department of Medicine, Pulmonary Division, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.
Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY.
Chest. 2016 Dec;150(6):1333-1340. doi: 10.1016/j.chest.2016.07.005. Epub 2016 Jul 19.
World Trade Center (WTC)-exposed rescue/recovery workers endured massive respiratory insult from inhalation of particulate matter and gases, resulting in respiratory symptoms, loss of lung function, and, for many, bronchial hyperreactivity (BHR). The persistence of respiratory symptoms and lung function abnormalities has been well-documented, whereas persistence of BHR has not been investigated.
A total of 173 WTC-exposed firefighters with bronchial reactivity measured within 2 years after September 11, 2001 (9/11) (baseline methacholine challenge test), were reevaluated in 2013 and 2014 (follow-up methacholine challenge test). FEV measurements were obtained from the late pre-9/11, early post-9/11, and late post-9/11 periods. Respiratory symptoms and corticosteroid treatment were recorded.
Bronchial reactivity remained stable (within 1 doubling dilution) for most (n = 101, 58%). Sixteen of 28 (57%) with BHR (provocative concentration of methacholine producing a 20% decline in FEV <8 mg/mL) at baseline had BHR at follow-up, and an additional 27 of the 145 (19%) without BHR at baseline had BHR at follow-up. In multivariable models, we found that BHR baseline was strongly associated with BHR follow-up (OR, 6.46) and that BHR at follow-up was associated with an estimated 15.4 mL/y greater FEV decline than experienced by those without BHR at follow-up. Annual FEV decline was moderated by corticosteroid use.
Persistent BHR and its deleterious influence on lung function suggest a role for airway inflammation in perpetuation of WTC-associated airway disease. In future massive occupational exposure to inorganic dust/gases, we recommend early and serial pulmonary function testing, including measurements of bronchial reactivity, when possible, and inhaled corticosteroid therapy for those with symptoms or pulmonary function tests consistent with airway disease.
世贸中心（WTC）救援/恢复工作人员因吸入颗粒物和气体而遭受严重的呼吸道损伤，导致呼吸道症状、肺功能丧失，许多人还出现支气管高反应性（BHR）。呼吸道症状和肺功能异常的持续存在已有充分记录，而BHR的持续情况尚未得到研究。
共有173名在2001年9月11日（9/11）后2年内测量过支气管反应性的WTC暴露消防员（基线乙酰甲胆碱激发试验），于2013年和2014年进行了重新评估（随访乙酰甲胆碱激发试验）。从9/11事件前后期、9/11事件后早期和9/11事件后后期获取了第一秒用力呼气容积（FEV）测量值。记录了呼吸道症状和皮质类固醇治疗情况。
大多数（n = 101，58%）的支气管反应性保持稳定（在1倍稀释范围内）。基线时28名（57%）有BHR（乙酰甲胆碱激发浓度导致FEV下降20%时的浓度<8 mg/mL）的患者在随访时有BHR，另外145名基线时无BHR的患者中有27名（19%）在随访时有BHR。在多变量模型中，我们发现BHR基线与随访时的BHR密切相关（比值比，6.46），且随访时的BHR与FEV每年下降估计比无BHR的随访者多15.4 mL相关。使用皮质类固醇可减轻FEV的年下降幅度。
持续的BHR及其对肺功能的有害影响表明气道炎症在WTC相关气道疾病的持续存在中起作用。在未来大量职业性接触无机粉尘/气体的情况下，我们建议尽早并定期进行肺功能测试，包括尽可能测量支气管反应性，并对有症状或肺功能测试符合气道疾病的患者进行吸入皮质类固醇治疗。
