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Lung function decline before and after treatment of World Trade Center associated obstructive airways disease with inhaled corticosteroids and long-acting beta agonists.

  • Goldfarb, David G1, 2, 3
  • Putman, Barbara4, 5
  • Lahousse, Lies4
  • Zeig-Owens, Rachel1, 3, 6
  • Vaeth, Brandon M1, 3
  • Schwartz, Theresa1, 3
  • Hall, Charles B7
  • Prezant, David J1, 3, 6
  • Weiden, Michael D1, 5
  • 1 Fire Department of the City of New York, The Bureau of Health Services and the FDNY World Trade Center Health Program, Brooklyn, NY, USA.
  • 2 Department of Environmental, Occupational and Geospatial Health Sciences, City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA.
  • 3 Division of Pulmonary Medicine, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.
  • 4 Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium. , (Belgium)
  • 5 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine and Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA.
  • 6 Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
  • 7 Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
Published Article
American Journal of Industrial Medicine
Wiley (John Wiley & Sons)
Publication Date
Oct 01, 2021
DOI: 10.1002/ajim.23272
PMID: 34254700


Greater than average loss of one-second forced expiratory volume (FEV1 ) is a risk factor for asthma, chronic obstructive pulmonary disease (COPD), and asthma/COPD overlap syndrome in World Trade Center (WTC)-exposed firefighters. Inhaled corticosteroids and long-acting beta agonists (ICS/LABA) are used to treat obstructive airways disease but their impact on FEV1 -trajectory in this population is unknown. The study population included WTC-exposed male firefighters who were treated with ICS/LABA for 2 years or longer (with initiation before 2015), had at least two FEV1 measurements before ICS/LABA initiation and two FEV1 measurements posttreatment between September 11, 2001 and September 10, 2019. Linear mixed-effects models were used to estimate FEV1 -slope pre- and post-treatment. During follow-up, 1023 WTC-exposed firefighters were treated with ICS/LABA for 2 years or longer. When comparing intervals 6 years before and 6 years after treatment, participants had an 18.7 ml/year (95% confidence interval [CI]: 11.3-26.1) improvement in FEV1 -slope after adjustment for baseline FEV1 , race, height, WTC exposure, weight change, blood eosinophil concentration, and smoking status. After stratification by median date of ICS/LABA initiation (January 14, 2010), earlier ICS/LABA-initiators had a 32.5 ml/year (95% CI: 19.5-45.5) improvement in slope but later ICS/LABA-initiators had a nonsignificant FEV1 -slope improvement (7.9 ml/year, 95% CI: -0.5 to 17.2). WTC-exposed firefighters treated with ICS/LABA had improved FEV1 slope after initiation, particularly among those who started earlier. Treatment was, however, not associated with FEV1 -slope improvement if started after the median initiation date (1/14/2010), likely because onset of disease began before treatment initiation. Research on alternative treatments is needed for patients with greater than average FEV1 -decline who have not responded to ICS/LABA. © 2021 The Authors. American Journal of Industrial Medicine published by Wiley Periodicals LLC.

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