The respiratory pyramid: From symptoms to disease in World Trade Center exposed firefighters12. Issue 8 (20th June 2013)

• Record Type: Journal Article
• Authors: Niles, Justin K.; Webber, Mayris P.; Cohen, Hillel W.; Hall, Charles B.; Zeig‐Owens, Rachel; Ye, Fen; Glaser, Michelle S.; Weakley, Jessica; Weiden, Michael D.; Aldrich, Thomas K.; Nolan, Anna; Glass, Lara; Kelly, Kerry J.; Prezant, David J.
• Is Part Of: American journal of industrial medicine. Volume 56:Issue 8(2013:Aug.)
• Page Start: 870
• Page End: 880
• Publication Date: 2013-06-20
• Subjects: Medicine, Industrial -- Periodicals; Médecine du travail -- Périodiques; 616.9803
• DOI: 10.1002/ajim.22171
• Languages: English
• ISSNs: 0271-3586

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="ajim22171-sec-0001" sec-type="section"> <title>Background</title> <p>This study utilizes a four‐level pyramid framework to understand the relationship between symptom reports and/or abnormal pulmonary function and diagnoses of airway diseases (AD), including asthma, recurrent bronchitis and COPD/emphysema in WTC‐exposed firefighters. We compare the distribution of pyramid levels at two time‐points: by 9/11/2005 and by 9/11/2010.</p> </sec> <sec id="ajim22171-sec-0002" sec-type="section"> <title>Methods</title> <p>We studied 6, 931 WTC‐exposed FDNY firefighters who completed a monitoring exam during the early period and at least two additional follow‐up exams 9/11/2005–9/11/2010.</p> </sec> <sec id="ajim22171-sec-0003" sec-type="section"> <title>Results</title> <p>By 9/11/2005 the pyramid structure was as follows: 4, 039 (58.3%) in Level 1, no respiratory evaluation or treatment; 1, 608 (23.2%) in Level 2, evaluation or treatment without AD diagnosis; 1, 005 (14.5%) in Level 3, a single AD diagnosis (asthma, emphysema/COPD, or recurrent bronchitis); 279 (4.0%) in Level 4, asthma and another AD. By 9/11/2010, the pyramid distribution changed considerably, with Level 1 decreasing to 2, 612 (37.7% of the cohort), and Levels 3 (N = 1, 530) and 4 (N = 796) increasing to 22.1% and 11.5% of the cohort, respectively. Symptoms, spirometry measurements and healthcare utilization were associated with higher pyramid levels.</p> </sec> <sec id="ajim22171-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Respiratory diagnoses, even four years after a major inhalation event, are not the only drivers of future healthcare utilization. Symptoms and abnormal FEV‐1 values must also be considered if clinicians and healthcare administrators are to accurately anticipate future treatment needs, years after initial exposure. Am. J. Ind. Med. 56:870–880, 2013. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>