Chest
Original ResearchOccupational and Environmental Lung DiseasesLessons From the World Trade Center Disaster: Airway Disease Presenting as Restrictive Dysfunction
Section snippets
Materials and Methods
This study retrospectively analyzed data from 54 subjects with persistent respiratory symptoms and unexplained reduction in VC. Inclusion criteria were as follows: (1) exposure to WTC dust, (2) reduction in VC below the lower limit of normal (LLN) on initial screening spirometry,14 (3) FEV1/VC ≥ 77% (mean ± SD, 82% ± 5%) (this value exceeds the LLN of commonly used predicted equations and ensures that subjects with mild large airway disease were excluded15), and (4) absence of parenchymal,
Results
Table 1 illustrates clinical characteristics of the patients. Mean age was 47 ± 10 years. Potential causes for airway dysfunction included current/prior cigarette smoking in 39% of subjects, history of asthma in 15%, and obesity in 49%. Approximately one-half the cohort reported dust cloud exposure. Predominant symptoms were cough and exertional dyspnea. By design, FEV1/VC was ≥ 77% in all subjects. The expiratory flow rate measured at 50% of VC was normal (expressed relative to VC) in all
Discussion
This study demonstrates a distinct physiologic phenotype that differs from classic obstructive and restrictive patterns. The abnormality resembled a restrictive defect, with reduced VC, FRC, and TLC and preservation of FEV1/VC, but parenchymal, chest wall, or neuromuscular disease were not present. Plethysmography demonstrated AT, oscillometry demonstrated abnormalities responsive to bronchodilator, and although Dlco was variably reduced, Dlco/Va was normal or elevated in all subjects. Thus,
Acknowledgments
Author contributions: Dr Berger had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Berger: contributed to study design, data interpretation, and writing of the manuscript.
Dr Reibman: contributed to referring patients for evaluation, provided clinical and imaging data, and contributed to data interpretation and writing of the manuscript.
Dr Oppenheimer: contributed to study design, data interpretation,
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Funding/Support: This work was supported by the Centers for Disease Control and Prevention [Grants 200-2011-39413, 200-2011-39391, and 200-2011-39397], the National Institute for Occupational Safety and Health [Grant 5E11OH009630], and the American Red Cross Liberty Disaster Relief Fund, City of New York.
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