Increased Airway Wall Thickness is Associated with Adverse Longitudinal First–Second Forced Expiratory Volume Trajectories of Former World Trade Center workers

• Published in: Lung Vol. 196; no. 4; pp. 481 - 489
• Main Authors: de la Hoz, Rafael E., Liu, Xiaoyu, Doucette, John T., Reeves, Anthony P., Bienenfeld, Laura A., Wisnivesky, Juan P., Celedón, Juan C., Lynch, David A., San José Estépar, Raúl
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2018; Springer; Springer Nature B.V
• Subjects: Adult; Air flow; Air Pollutants, Occupational - adverse effects; Airway obstruction; Airway Remodeling; Analysis; Bronchodilators; Care and treatment; CAT scans; Computed tomography; Diagnosis; Disease Progression; Female; Forced Expiratory Volume; Health aspects; Humans; Job Description; Lung - diagnostic imaging; Lung - physiopathology; Lung Diseases - diagnostic imaging; Lung Diseases - etiology; Lung Diseases - physiopathology; Male; Medicine; Medicine & Public Health; Middle Aged; Multidetector Computed Tomography; Occupational exposure; Occupational Exposure - adverse effects; Occupational Health; Occupational Lung Disease; Pneumology/Respiratory System; Population studies; Prognosis; Regression analysis; Regression models; Respiratory tract diseases; Risk analysis; Risk Factors; September 11 Terrorist Attacks; Spirometry; Subgroups; Time Factors; Trajectories; United States; Wall thickness; Workers; United States; Smoke inhalation injury; Spirometry; Occupational disease; World Trade Center Attack; 2001; Chronic bronchitis; Multidetector computed tomography
• DOI: 10.1007/s00408-018-0125-7
• ISSN: 0341-2040; 1432-1750

Rationale Occupational exposures at the WTC site after September 11, 2001 have been associated with several presumably inflammatory lower airway diseases. In this study, we describe the trajectories of expiratory air flow decline, identify subgroups with adverse progression, and investigate the association of a quantitative computed tomography (QCT) imaging measurement of airway wall thickness, and other risk factors for adverse progression. Methods We examined the trajectories of expiratory air flow decline in a group of 799 former WTC workers and volunteers with QCT-measured (with two independent systems) wall area percent (WAP) and at least 3 periodic spirometries. We calculated individual regression lines for first–second forced expiratory volume (FEV 1 ), identified subjects with rapidly declining and increasing (“gainers”), and compared them to subjects with normal and “stable” FEV 1 decline. We used multivariate logistic regression to model decliner vs. stable trajectories. Results The mean longitudinal FEV 1 slopes for the entire study population, and its stable, decliner, and gainer subgroups were, respectively, − 35.8, − 8, − 157.6, and + 173.62 ml/year. WAP was associated with “decliner” status (OR adj 1.08, 95% CI 1.02, 1.14, per 5% increment) compared to stable. Age, weight gain, baseline FEV 1 percent predicted, bronchodilator response, and pre-WTC occupational exposures were also significantly associated with accelerated FEV 1 decline. Analyses of gainers vs. stable subgroup showed WAP as a significant predictor in unadjusted but not consistently in adjusted analyses. Conclusions The apparent normal age-related rate of FEV 1 decline results from averaging widely divergent trajectories. WAP is significantly associated with accelerated air flow decline in WTC workers.