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Javed U, Podury S, Kwon S, Liu M, Kim D, Fallah Zadeh A, Li Y, Khan A, Francois F, Schwartz T, Zeig-Owens R, Grunig G, Veerappan A, Zhou J, Crowley G, Prezant D, Nolan A. Biomarkers of Airway Disease, Barrett's and Underdiagnosed Reflux Noninvasively (BAD-BURN): a Case-Control Observational Study Protocol. RESEARCH SQUARE 2024:rs.3.rs-4355584. [PMID: 38798396 PMCID: PMC11118699 DOI: 10.21203/rs.3.rs-4355584/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND Particulate matter exposure (PM) is a cause of aerodigestive disease globally. The destruction of the World Trade Center (WTC) exposed fifirst responders and inhabitants of New York City to WTC-PM and caused obstructive airways disease (OAD), gastroesophageal Refux disease (GERD) and Barrett's Esophagus (BE). GERD not only diminishes health-related quality of life but also gives rise to complications that extend beyond the scope of BE. GERD can incite or exacerbate allergies, sinusitis, bronchitis, and asthma. Disease features of the aerodigestive axis can overlap, often necessitating more invasive diagnostic testing and treatment modalities. This presents a need to develop novel non-invasive biomarkers of GERD, BE, airway hyperreactivity (AHR), treatment efficacy, and severity of symptoms. METHODS Our observational case-cohort study will leverage the longitudinally phenotyped Fire Department of New York (FDNY)-WTC exposed cohort to identify Biomarkers of Airway Disease, Barrett's and Underdiagnosed Refux Noninvasively (BAD-BURN). Our study population consists of n = 4,192 individuals from which we have randomly selected a sub-cohort control group (n = 837). We will then recruit subgroups of i. AHR only ii. GERD only iii. BE iv. GERD/BE and AHR overlap or v. No GERD or AHR, from the sub-cohort control group. We will then phenotype and examine non-invasive biomarkers of these subgroups to identify under-diagnosis and/or treatment efficacy. The findings may further contribute to the development of future biologically plausible therapies, ultimately enhance patient care and quality of life. DISCUSSION Although many studies have suggested interdependence between airway and digestive diseases, the causative factors and specific mechanisms remain unclear. The detection of the disease is further complicated by the invasiveness of conventional GERD diagnosis procedures and the limited availability of disease-specific biomarkers. The management of Refux is important, as it directly increases risk of cancer and negatively impacts quality of life. Therefore, it is vital to develop novel noninvasive disease markers that can effectively phenotype, facilitate early diagnosis of premalignant disease and identify potential therapeutic targets to improve patient care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05216133; January 18, 2022.
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Affiliation(s)
- Urooj Javed
- New York University Grossman School of Medicine (NYUGSoM)
| | - Sanjiti Podury
- New York University Grossman School of Medicine (NYUGSoM)
| | - Sophia Kwon
- New York University Grossman School of Medicine (NYUGSoM)
| | - Mengling Liu
- New York University Grossman School of Medicine (NYUGSoM)
| | - Daniel Kim
- New York University Grossman School of Medicine (NYUGSoM)
| | | | - Yiwei Li
- New York University Grossman School of Medicine (NYUGSoM)
| | - Abraham Khan
- New York University Grossman School of Medicine (NYUGSoM)
| | - Fritz Francois
- New York University Grossman School of Medicine (NYUGSoM)
| | | | | | | | - Arul Veerappan
- New York University Grossman School of Medicine (NYUGSoM)
| | - Joanna Zhou
- New York University Grossman School of Medicine (NYUGSoM)
| | - George Crowley
- New York University Grossman School of Medicine (NYUGSoM)
| | - David Prezant
- New York University Grossman School of Medicine (NYUGSoM)
| | - Anna Nolan
- New York University Grossman School of Medicine (NYUGSoM)
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Crowley G, Kim J, Kwon S, Lam R, Prezant DJ, Liu M, Nolan A. PEDF, a pleiotropic WTC-LI biomarker: Machine learning biomarker identification and validation. PLoS Comput Biol 2021; 17:e1009144. [PMID: 34288906 PMCID: PMC8328304 DOI: 10.1371/journal.pcbi.1009144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 08/02/2021] [Accepted: 06/03/2021] [Indexed: 12/01/2022] Open
Abstract
Biomarkers predict World Trade Center-Lung Injury (WTC-LI); however, there remains unaddressed multicollinearity in our serum cytokines, chemokines, and high-throughput platform datasets used to phenotype WTC-disease. To address this concern, we used automated, machine-learning, high-dimensional data pruning, and validated identified biomarkers. The parent cohort consisted of male, never-smoking firefighters with WTC-LI (FEV1, %Pred< lower limit of normal (LLN); n = 100) and controls (n = 127) and had their biomarkers assessed. Cases and controls (n = 15/group) underwent untargeted metabolomics, then feature selection performed on metabolites, cytokines, chemokines, and clinical data. Cytokines, chemokines, and clinical biomarkers were validated in the non-overlapping parent-cohort via binary logistic regression with 5-fold cross validation. Random forests of metabolites (n = 580), clinical biomarkers (n = 5), and previously assayed cytokines, chemokines (n = 106) identified that the top 5% of biomarkers important to class separation included pigment epithelium-derived factor (PEDF), macrophage derived chemokine (MDC), systolic blood pressure, macrophage inflammatory protein-4 (MIP-4), growth-regulated oncogene protein (GRO), monocyte chemoattractant protein-1 (MCP-1), apolipoprotein-AII (Apo-AII), cell membrane metabolites (sphingolipids, phospholipids), and branched-chain amino acids. Validated models via confounder-adjusted (age on 9/11, BMI, exposure, and pre-9/11 FEV1, %Pred) binary logistic regression had AUCROC [0.90(0.84–0.96)]. Decreased PEDF and MIP-4, and increased Apo-AII were associated with increased odds of WTC-LI. Increased GRO, MCP-1, and simultaneously decreased MDC were associated with decreased odds of WTC-LI. In conclusion, automated data pruning identified novel WTC-LI biomarkers; performance was validated in an independent cohort. One biomarker—PEDF, an antiangiogenic agent—is a novel, predictive biomarker of particulate-matter-related lung disease. Other biomarkers—GRO, MCP-1, MDC, MIP-4—reveal immune cell involvement in WTC-LI pathogenesis. Findings of our automated biomarker identification warrant further investigation into these potential pharmacotherapy targets. Disease related to air pollution causes millions of deaths annually. Large swathes of the general population, as well as certain occupations such as 1st responders and military personnel, are exposed to particulate matter (PM)—a major component of air pollution. Our longitudinal cohort of FDNY firefighters exposed to the World Trade Center dust cloud on 9/11 is a unique research opportunity to characterize the impact of a single, intense PM exposure by looking at pre- and post-exposure phenotype; however, PM-related lung disease and PM’s systemic effects are complex and call for a systems biological approach coupled with novel computational modelling techniques to fully understand pathogenesis. In the present study, we integrate clinical and environmental biomarkers with the serum metabolome, cytokines, and chemokines to develop a model for early disease detection and identification of potential signaling cascades of PM-related chronic lung disease.
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Affiliation(s)
- George Crowley
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York, United States of America
| | - James Kim
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York, United States of America
| | - Sophia Kwon
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York, United States of America
| | - Rachel Lam
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York, United States of America
| | - David J. Prezant
- Bureau of Health Services, Fire Department of New York, Brooklyn, New York, United States of America
- Department of Medicine, Pulmonary Medicine Division, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Mengling Liu
- Department of Environmental Medicine, New York University School of Medicine, New York, New York, United States of America
- Department of Population Health, Division of Biostatistics, New York University School of Medicine, New York, New York, United States of America
| | - Anna Nolan
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York, United States of America
- Bureau of Health Services, Fire Department of New York, Brooklyn, New York, United States of America
- Department of Environmental Medicine, New York University School of Medicine, New York, New York, United States of America
- * E-mail:
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Otto CM, Hare E, Buchweitz JP, Kelsey KM, Fitzgerald SD. Fifteen-year surveillance of pathological findings associated with death or euthanasia in search-and-rescue dogs deployed to the September 11, 2001, terrorist attack sites. J Am Vet Med Assoc 2021; 257:734-743. [PMID: 32955393 DOI: 10.2460/javma.257.7.734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the cause of death (COD; whether by natural death or euthanasia for poor quality of life caused by a primary pathological condition) between search-and-rescue (SAR) dogs deployed to the World Trade Center, Pentagon, or Fresh Kills Landfill on Staten Island following the 9/11 terrorist attacks and SAR dogs that were not deployed to these sites. ANIMALS 95 deployed SAR dogs (exposed dogs) and 55 nondeployed SAR dogs (unexposed dogs). PROCEDURES Following natural death or euthanasia, 63 dogs (44 exposed and 19 unexposed) underwent a necropsy examination. For the remaining 87 dogs, the COD was categorized on the basis of information obtained from medical records or personal communications. RESULTS The median age of death was 12.8 years for exposed dogs and 12.7 years for unexposed dogs. The COD was not impacted by deployment status. In the 150 exposed and unexposed dogs, degenerative conditions were the most common COD followed by neoplasia. Respiratory disease was infrequent (overall, 7 [4.7%] dogs); 4 of 5 cases of pulmonary neoplasia occurred in unexposed dogs. However, in dogs that underwent necropsy, pulmonary particulates were reported significantly more often in exposed dogs (42/44 [95%]), compared with unexposed dogs (12/19 [63.2%]). CONCLUSIONS AND CLINICAL RELEVANCE No difference was found in the COD on the basis of disease category and organ system involved between exposed and unexposed SAR dogs. The long life spans and frequency of death attributed to degenerative causes (ie, age-related causes) suggested that the risk of long-term adverse health effects in this population of SAR dogs was low.
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Walkoff L, Hobbs S. Chest Imaging in the Diagnosis of Occupational Lung Diseases. Clin Chest Med 2021; 41:581-603. [PMID: 33153681 DOI: 10.1016/j.ccm.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Imaging plays a crucial role in the diagnosis and monitoring of occupational lung diseases (OLDs); however, the sensitivity and specificity of detection and diagnosis vary greatly depending on the imaging modality used. There is substantial overlap in appearance with non-occupation-related entities. OLDs should be considered in the differential even in the absence of a provided exposure history. Because many findings are not specific, a multidisciplinary approach is important in arriving at the diagnosis and will continue to be important as workplace-related pulmonary diseases evolve with changing industrial practices and workplace regulations.
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Affiliation(s)
- Lara Walkoff
- Divisions of Thoracic and Cardiovascular Radiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
| | - Stephen Hobbs
- Radiology Informatics and Integrated Clinical Operations, Division of Cardiovascular and Thoracic Radiology, UK HealthCare Imaging Informatics, University of Kentucky, 800 Rose Street, HX 302, Lexington, KY 40536, USA
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Synergistic Effect of WTC-Particulate Matter and Lysophosphatidic Acid Exposure and the Role of RAGE: In-Vitro and Translational Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124318. [PMID: 32560330 PMCID: PMC7344461 DOI: 10.3390/ijerph17124318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 02/07/2023]
Abstract
World Trade Center particulate matter (WTC-PM)-exposed firefighters with metabolic syndrome (MetSyn) have a higher risk of WTC lung injury (WTC-LI). Since macrophages are crucial innate pulmonary mediators, we investigated WTC-PM/lysophosphatidic acid (LPA) co-exposure in macrophages. LPA, a low-density lipoprotein metabolite, is a ligand of the advanced glycation end-products receptor (AGER or RAGE). LPA and RAGE are biomarkers of WTC-LI. Human and murine macrophages were exposed to WTC-PM, and/or LPA, and compared to controls. Supernatants were assessed for cytokines/chemokines; cell lysate immunoblots were assessed for signaling intermediates after 24 h. To explore the translatability of our in-vitro findings, we assessed serum cytokines/chemokines and metabolites of symptomatic, never-smoking WTC-exposed firefighters. Agglomerative hierarchical clustering identified phenotypes of WTC-PM-induced inflammation. WTC-PM induced GM-CSF, IL-8, IL-10, and MCP-1 in THP-1-derived macrophages and induced IL-1α, IL-10, TNF-α, and NF-κB in RAW264.7 murine macrophage-like cells. Co-exposure induced synergistic elaboration of IL-10 and MCP-1 in THP-1-derived macrophages. Similarly, co-exposure synergistically induced IL-10 in murine macrophages. Synergistic effects were seen in the context of a downregulation of NF-κB, p-Akt, -STAT3, and -STAT5b. RAGE expression after co-exposure increased in murine macrophages compared to controls. In our integrated analysis, the human cytokine/chemokine biomarker profile of WTC-LI was associated with discriminatory metabolites (fatty acids, sphingolipids, and amino acids). LPA synergistically elaborated WTC-PM’s inflammatory effects in vitro and was partly RAGE-mediated. Further research will focus on the intersection of MetSyn/PM exposure.
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McGibbon MF, Maccaro CM. Understanding and Improving Patient Access to The Never Forget the Heroes: James Zadroga, Ray Pfeifer, and Luis Alvarez Permanent Authorization of the September 11th Victim Compensation Fund Act. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2019.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Assessing the Protective Metabolome Using Machine Learning in World Trade Center Particulate Exposed Firefighters at Risk for Lung Injury. Sci Rep 2019; 9:11939. [PMID: 31481674 PMCID: PMC6722247 DOI: 10.1038/s41598-019-48458-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 08/06/2019] [Indexed: 11/09/2022] Open
Abstract
The metabolome of World Trade Center (WTC) particulate matter (PM) exposure has yet to be fully defined and may yield information that will further define bioactive pathways relevant to lung injury. A subset of Fire Department of New York firefighters demonstrated resistance to subsequent loss of lung function. We intend to characterize the metabolome of never smoking WTC-exposed firefighters, stratified by resistance to WTC-Lung Injury (WTC-LI) to determine metabolite pathways significant in subjects resistant to the loss of lung function. The global serum metabolome was determined in those resistant to WTC-LI and controls (n = 15 in each). Metabolites most important to class separation (top 5% by Random Forest (RF) of 594 qualified metabolites) included elevated amino acid and long-chain fatty acid metabolites, and reduced hexose monophosphate shunt metabolites in the resistant cohort. RF using the refined metabolic profile was able to classify cases and controls with an estimated success rate of 93.3%, and performed similarly upon cross-validation. Agglomerative hierarchical clustering identified potential influential pathways of resistance to the development of WTC-LI. These pathways represent potential therapeutic targets and warrant further research.
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Crowley G, Kwon S, Haider SH, Caraher EJ, Lam R, St-Jules DE, Liu M, Prezant DJ, Nolan A. Metabolomics of World Trade Center-Lung Injury: a machine learning approach. BMJ Open Respir Res 2018; 5:e000274. [PMID: 30233801 PMCID: PMC6135464 DOI: 10.1136/bmjresp-2017-000274] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/19/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction Biomarkers of metabolic syndrome expressed soon after World Trade Center (WTC) exposure predict development of WTC Lung Injury (WTC-LI). The metabolome remains an untapped resource with potential to comprehensively characterise many aspects of WTC-LI. This case–control study identified a clinically relevant, robust subset of metabolic contributors of WTC-LI through comprehensive high-dimensional metabolic profiling and integration of machine learning techniques. Methods Never-smoking, male, WTC-exposed firefighters with normal pre-9/11 lung function were segregated by post-9/11 lung function. Cases of WTC-LI (forced expiratory volume in 1s <lower limit of normal, n=15) and controls (n=15) were identified from previous cohorts. The metabolome of serum drawn within 6 months of 9/11 was quantified. Machine learning was used for dimension reduction to identify metabolites associated with WTC-LI. Results 580 metabolites qualified for random forests (RF) analysis to identify a refined metabolite profile that yielded maximal class separation. RF of the refined profile correctly classified subjects with a 93.3% estimated success rate. 5 clusters of metabolites emerged within the refined profile. Prominent subpathways include known mediators of lung disease such as sphingolipids (elevated in cases of WTC-LI), and branched-chain amino acids (reduced in cases of WTC-LI). Principal component analysis of the refined profile explained 68.3% of variance in five components, demonstrating class separation. Conclusion Analysis of the metabolome of WTC-exposed 9/11 rescue workers has identified biologically plausible pathways associated with loss of lung function. Since metabolites are proximal markers of disease processes, metabolites could capture the complexity of past exposures and better inform treatment. These pathways warrant further mechanistic research.
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Affiliation(s)
- George Crowley
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA
| | - Sophia Kwon
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA
| | - Syed Hissam Haider
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA
| | - Erin J Caraher
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA
| | - Rachel Lam
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA
| | - David E St-Jules
- Departmentof Population Health, Division of Health and Behavior, New York University School of Medicine, New York, USA
| | - Mengling Liu
- Department of Environmental Medicine, New York University School of Medicine, New York, USA.,Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York, USA
| | - David J Prezant
- Department of Population Health, Divison of Biostatistics, New York University School of Medicine, New York, USA.,Department of Medicine, Pulmonary Medicine Divison, Montefiore Medical Center and Albert Einstein College of Medicine, Brooklyn, New York, USA
| | - Anna Nolan
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA.,Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York, USA.,Department of Population Health, Divison of Biostatistics, New York University School of Medicine, New York, USA
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Wu CL, Lan FY, Chen BL, Chang RH, Chang WH, Pan ST, Fang PH, Lu CH, Lin CH. Respiratory symptoms among search and rescue workers who responded to the 2016 Taiwan earthquake. Occup Environ Med 2018; 75:639-646. [PMID: 29991497 DOI: 10.1136/oemed-2018-105027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/28/2018] [Accepted: 06/16/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVES High respiratory hazards among search and rescue workers (SRWs) emerged after the World Trade Center attacks on 11 September 2001. There have been limited studies on respiratory symptoms among earthquake SRWs. We investigated the respiratory symptoms and the use of respiratory protective equipment among the SRWs who responded to the 2016 Taiwan earthquake. METHODS On 6 February 2016, a 6.4-magnitude earthquake struck southern Taiwan and caused 513 injuries and 117 deaths. During the 9-day field operation, 519 firefighters affiliated with the Tainan City Government Fire Bureau participated in the search and rescue response. A standardised, self-completed questionnaire was used to collect data on demographics, dust exposures, personal protective measures and health outcomes 3 weeks after the earthquake. Descriptive and multivariate analyses adjusting for demographics and exposure variables were performed for new or worsened outcomes. RESULTS Of the 519 SRWs, 414 (80%) responded to the questionnaire. Of these SRWs, 153 (37%) reported new or worsened respiratory symptoms, with cough (23%) as the leading symptom, followed by rhinorrhoea or nasal congestion (22%) and chest tightness (6%). More than 90% of the symptoms persisted to the third week after the earthquake. The prevalence of new or worsened respiratory symptoms was significantly higher among SRWs with a higher level of exposure to dust. Prior training in response to respiratory pollutants was only 5%. CONCLUSIONS There were significant respiratory hazards among earthquake SRWs. The persistent symptoms and low coverage of training warrant further regular examination and occupational health programmes.
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Affiliation(s)
- Chen-Long Wu
- Department of Occupational and Environmental Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Fan-Yun Lan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Bo-Lei Chen
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ray Hsienho Chang
- Division of Engineering Technology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Wei Hung Chang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Tien Pan
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Pin-Hui Fang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Hsin Lu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Predictive Biomarkers of Gastroesophageal Reflux Disease and Barrett's Esophagus in World Trade Center Exposed Firefighters: a 15 Year Longitudinal Study. Sci Rep 2018; 8:3106. [PMID: 29449669 PMCID: PMC5814524 DOI: 10.1038/s41598-018-21334-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/02/2018] [Indexed: 12/12/2022] Open
Abstract
Gastroesophageal reflux disease (GERD) and Barrett’s Esophagus (BE), which are prevalent in the World Trade Center (WTC) exposed and general populations, negatively impact quality of life and cost of healthcare. GERD, a risk factor of BE, is linked to obstructive airways disease (OAD). We aim to identify serum biomarkers of GERD/BE, and assess the respiratory and clinical phenotype of a longitudinal cohort of never-smoking, male, WTC-exposed rescue workers presenting with pulmonary symptoms. Biomarkers collected soon after WTC-exposure were evaluated in optimized predictive models of GERD/BE. In the WTC-exposed cohort, the prevalence of BE is at least 6 times higher than in the general population. GERD/BE cases had similar lung function, DLCO, bronchodilator response and long-acting β-agonist use compared to controls. In confounder-adjusted regression models, TNF-α ≥ 6 pg/mL predicted both GERD and BE. GERD was also predicted by C-peptide ≥ 360 pg/mL, while BE was predicted by fractalkine ≥ 250 pg/mL and IP-10 ≥ 290 pg/mL. Finally, participants with GERD had significantly increased use of short-acting β-agonist compared to controls. Overall, biomarkers sampled prior to GERD/BE presentation showed strong predictive abilities of disease development. This study frames future investigations to further our understanding of aerodigestive pathology due to particulate matter exposure.
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Destruction of the World Trade Center Towers. Lessons Learned from an Environmental Health Disaster. Ann Am Thorac Soc 2017; 13:577-83. [PMID: 26872108 DOI: 10.1513/annalsats.201509-572ps] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The assault and subsequent collapse of the World Trade Center towers in New York City on September 11, 2001 (9/11), released more than a million tons of debris and dust into the surrounding area, engulfing rescue workers as they rushed to aid those who worked in the towers, and the thousands of nearby civilians and children who were forced to flee. In December 2015, almost 15 years after the attack, and 5 years after first enactment, Congress reauthorized the James Zadroga 9/11 Health and Compensation Act, a law designed to respond to the adverse health effects of the disaster. This reauthorization affords an opportunity to review human inhalation exposure science in relation to the World Trade Center collapse. In this Special Article, we compile observations regarding the collective medical response to the environmental health disaster with a focus on efforts to address the adverse health effects experienced by nearby community members including local residents and workers. We also analyze approaches to understanding the potential for health risk, characterization of hazardous materials, identification of populations at risk, and shortfalls in the medical response on behalf of the local community. Our overarching goal is to communicate lessons learned from the World Trade Center experience that may be applicable to communities affected by future environmental health disasters. The World Trade Center story demonstrates that communities lacking advocacy and preexisting health infrastructures are uniquely vulnerable to health disasters. Medical and public health personnel need to compensate for these vulnerabilities to mitigate long-term illness and suffering.
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Summerhill EM, Hoyle GW, Jordt SE, Jugg BJ, Martin JG, Matalon S, Patterson SE, Prezant DJ, Sciuto AM, Svendsen ER, White CW, Veress LA. An Official American Thoracic Society Workshop Report: Chemical Inhalational Disasters. Biology of Lung Injury, Development of Novel Therapeutics, and Medical Preparedness. Ann Am Thorac Soc 2017; 14:1060-1072. [PMID: 28418689 PMCID: PMC5529138 DOI: 10.1513/annalsats.201704-297ws] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This report is based on the proceedings from the Inhalational Lung Injury Workshop jointly sponsored by the American Thoracic Society (ATS) and the National Institutes of Health (NIH) Countermeasures Against Chemical Threats (CounterACT) program on May 21, 2013, in Philadelphia, Pennsylvania. The CounterACT program facilitates research leading to the development of new and improved medical countermeasures for chemical threat agents. The workshop was initiated by the Terrorism and Inhalational Disasters Section of the Environmental, Occupational, and Population Health Assembly of the ATS. Participants included both domestic and international experts in the field, as well as representatives from U.S. governmental funding agencies. The meeting objectives were to (1) provide a forum to review the evidence supporting current standard medical therapies, (2) present updates on our understanding of the epidemiology and underlying pathophysiology of inhalational lung injuries, (3) discuss innovative investigative approaches to further delineating mechanisms of lung injury and identifying new specific therapeutic targets, (4) present promising novel medical countermeasures, (5) facilitate collaborative research efforts, and (6) identify challenges and future directions in the ongoing development, manufacture, and distribution of effective and specific medical countermeasures. Specific inhalational toxins discussed included irritants/pulmonary toxicants (chlorine gas, bromine, and phosgene), vesicants (sulfur mustard), chemical asphyxiants (cyanide), particulates (World Trade Center dust), and respirable nerve agents.
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Neurologic Evaluations of Patients Exposed to the World Trade Center Disaster. J Occup Environ Med 2016; 58:1150-1154. [PMID: 27820766 DOI: 10.1097/jom.0000000000000889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Berger KI, Kalish S, Shao Y, Marmor M, Kazeros A, Oppenheimer BW, Chan Y, Reibman J, Goldring RM. Isolated small airway reactivity during bronchoprovocation as a mechanism for respiratory symptoms in WTC dust-exposed community members. Am J Ind Med 2016; 59:767-76. [PMID: 27582479 DOI: 10.1002/ajim.22639] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Small airway dysfunction occurs following WTC dust exposure, but its role in producing symptoms is unclear. METHODS Methacholine challenge (MCT) was used to assess the relationship between onset of respiratory symptoms and small airway abnormalities in 166 symptomatic WTC dust-exposed patients. Forced oscillation testing (FOT) and respiratory symptoms were assessed during MCT. FOT parameters included resistance at 5 and 20 Hz (R5 and R20 ) and the R5 minus R20 (R5-20 ). RESULTS Baseline spirometry was normal in all (mean FEV1 100 + 13% predicted, mean FEV1 /FVC 80 + 4%). MCT revealed bronchial hyperreactivity by spirometry in 67 patients. An additional 24 patients became symptomatic despite minimal FEV1 change (<5%); symptom onset coincided with increased R5 and R5-20 (P > 0.001 vs. baseline). The dose-response of FOT (reactivity) was greater compared with subjects that remained asymptomatic (P < 0.05). CONCLUSIONS FOT during MCT uncovered reactivity in small airways as a mechanism for respiratory symptoms in subjects with inhalational lung injury. Am. J. Ind. Med. 59:767-776, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Kenneth I. Berger
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
- Andre Cournand Pulmonary Physiology Laboratory; Bellevue Hospital; New York New York
| | - Samantha Kalish
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
| | - Yongzhao Shao
- Department of Population Health; NYU School of Medicine; New York New York
| | - Michael Marmor
- Department of Population Health; NYU School of Medicine; New York New York
| | - Angeliki Kazeros
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
| | - Beno W. Oppenheimer
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
- Andre Cournand Pulmonary Physiology Laboratory; Bellevue Hospital; New York New York
| | - Yinny Chan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
- Andre Cournand Pulmonary Physiology Laboratory; Bellevue Hospital; New York New York
| | - Joan Reibman
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
| | - Roberta M. Goldring
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
- Andre Cournand Pulmonary Physiology Laboratory; Bellevue Hospital; New York New York
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Systemic Inflammation Associated With World Trade Center Dust Exposures and Airway Abnormalities in the Local Community. J Occup Environ Med 2016; 57:610-6. [PMID: 26053363 DOI: 10.1097/jom.0000000000000458] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Destruction of the World Trade Center (WTC) towers on September 11, 2001, released massive dust, gas, and fumes with environmental exposures for community members. Many community members have lower respiratory symptoms (LRSs) that began after September 11, 2001, and remain persistent. We evaluated whether systemic inflammation measured by C-reactive protein was associated with WTC dust exposures, persistent LRS, and lung function. METHODS Community members self-referred for the treatment of symptoms related to September 11, 2001. C-reactive protein and lung function measurements, including spirometry and forced oscillation tests (impulse oscillometry system), were included as routine analyses in patients (2007 to 2012). RESULTS Increased C-reactive protein levels were associated with the type of WTC dust exposure, LRS, reduced spirometry, and increased forced oscillation measurements (n = 724). CONCLUSIONS Ongoing systemic inflammation measured years after the event was associated with WTC dust exposures, persistent LRS, and abnormal lung function in a community cohort. These findings have implications for treatment and surveillance.
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Lippmann M, Cohen MD, Chen LC. Health effects of World Trade Center (WTC) Dust: An unprecedented disaster's inadequate risk management. Crit Rev Toxicol 2015; 45:492-530. [PMID: 26058443 PMCID: PMC4686342 DOI: 10.3109/10408444.2015.1044601] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The World Trade Center (WTC) twin towers in New York City collapsed on 9/11/2001, converting much of the buildings' huge masses into dense dust clouds of particles that settled on the streets and within buildings throughout Lower Manhattan. About 80-90% of the settled WTC Dust, ranging in particle size from ∼2.5 μm upward, was a highly alkaline mixture of crushed concrete, gypsum, and synthetic vitreous fibers (SVFs) that was readily resuspendable by physical disturbance and low-velocity air currents. High concentrations of coarse and supercoarse WTC Dust were inhaled and deposited in the conductive airways in the head and lungs, and subsequently swallowed, causing both physical and chemical irritation to the respiratory and gastroesophageal epithelia. There were both acute and chronic adverse health effects in rescue/recovery workers; cleanup workers; residents; and office workers, especially in those lacking effective personal respiratory protective equipment. The numerous health effects in these people were not those associated with the monitored PM2.5 toxicants, which were present at low concentrations, that is, asbestos fibers, transition and heavy metals, polyaromatic hydrocarbons or PAHs, and dioxins. Attention was never directed at the very high concentrations of the larger-sized and highly alkaline WTC Dust particles that, in retrospect, contained the more likely causal toxicants. Unfortunately, the initial focus of the air quality monitoring and guidance on exposure prevention programs on low-concentration components was never revised. Public agencies need to be better prepared to provide reliable guidance to the public on more appropriate means of exposure assessment, risk assessment, and preventive measures.
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Affiliation(s)
- Morton Lippmann
- Nelson Institute of Environmental Medicine, New York University , Tuxedo, NY , USA
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Weiden MD, Kwon S, Caraher E, Berger KI, Reibman J, Rom WN, Prezant DJ, Nolan A. Biomarkers of World Trade Center Particulate Matter Exposure: Physiology of Distal Airway and Blood Biomarkers that Predict FEV₁ Decline. Semin Respir Crit Care Med 2015; 36:323-33. [PMID: 26024341 DOI: 10.1055/s-0035-1547349] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Biomarkers can be important predictors of disease severity and progression. The intense exposure to particulates and other toxins from the destruction of the World Trade Center (WTC) overwhelmed the lung's normal protective barriers. The Fire Department of New York (FDNY) cohort not only had baseline pre-exposure lung function measures but also had serum samples banked soon after their WTC exposure. This well-phenotyped group of highly exposed first responders is an ideal cohort for biomarker discovery and eventual validation. Disease progression was heterogeneous in this group in that some individuals subsequently developed abnormal lung function while others recovered. Airflow obstruction predominated in WTC-exposed patients who were symptomatic. Multiple independent disease pathways may cause this abnormal FEV1 after irritant exposure. WTC exposure activates one or more of these pathways causing abnormal FEV1 in an individual. Our hypothesis was that serum biomarkers expressed within 6 months after WTC exposure reflect active disease pathways and predict subsequent development or protection from abnormal FEV1 below the lower limit of normal known as WTC-Lung Injury (WTC-LI). We utilized a nested case-cohort control design of previously healthy never smokers who sought subspecialty pulmonary evaluation to explore predictive biomarkers of WTC-LI. We have identified biomarkers of inflammation, metabolic derangement, protease/antiprotease balance, and vascular injury expressed in serum within 6 months of WTC exposure that were predictive of their FEV1 up to 7 years after their WTC exposure. Predicting future risk of airway injury after particulate exposures can focus monitoring and early treatment on a subset of patients in greatest need of these services.
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Affiliation(s)
- Michael D Weiden
- Division of Pulmonary, Critical Care and Sleep, New York University School of Medicine, New York, New York
| | - Sophia Kwon
- Division of Pulmonary, Critical Care and Sleep, New York University School of Medicine, New York, New York
| | - Erin Caraher
- Division of Pulmonary, Critical Care and Sleep, New York University School of Medicine, New York, New York
| | - Kenneth I Berger
- Division of Pulmonary, Critical Care and Sleep, New York University School of Medicine, New York, New York
| | - Joan Reibman
- Division of Pulmonary, Critical Care and Sleep, New York University School of Medicine, New York, New York
| | - William N Rom
- Division of Pulmonary, Critical Care and Sleep, New York University School of Medicine, New York, New York
| | - David J Prezant
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York
| | - Anna Nolan
- Division of Pulmonary, Critical Care and Sleep, New York University School of Medicine, New York, New York
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Hall CB, Liu X, Zeig-Owens R, Webber MP, Aldrich TK, Weakley J, Schwartz T, Cohen HW, Glaser MS, Olivieri BL, Weiden MD, Nolan A, Kelly KJ, Prezant DJ. The Duration of an Exposure Response Gradient between Incident Obstructive Airways Disease and Work at the World Trade Center Site: 2001-2011. PLOS CURRENTS 2015; 7. [PMID: 26064784 PMCID: PMC4449208 DOI: 10.1371/currents.dis.8a93e7682624698558a76a1fa8c5893f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Adverse respiratory effects of World Trade Center (WTC) exposure have been widely documented, but the length of time that exposure remains associated with disease is uncertain. We estimate the incidence of new cases of physician-diagnosed obstructive airway disease (OAD) as a function of time since 9/11/2001 in WTC-exposed firefighters. Methods: Exposure was categorized by first WTC arrival time: high (9/11/2001 AM); moderate (9/11/2001 PM or 9/12/2001); or low (9/13-24/2001). We modeled relative rates (RR) and 95% confidence intervals (CI) of OAD incidence by exposure over the first 10 years post-9/11/2001, estimating the time(s) of change in the RR with change point models. We further examined the relationship between self-reported lower respiratory symptoms and physician diagnoses. Results: Change points were observed at 15 and 84 months post-9/11/2001, with relative incidence rates for the high versus low exposure group of 4.02 (95% CI 2.62-6.16) prior to 15 months, 1.90 (95% CI 1.49-2.44) from months 16 to 84, and 1.20 (95% CI 0.92-1.56) thereafter. Incidence in all exposure groups increased after the WTC health program began to offer free coverage of OAD medications in month 63. Self-reported lower respiratory symptoms in the first 15 months had 80.6% sensitivity, but only 35.9% specificity, for eventual OAD diagnoses. Conclusions: New OAD diagnoses are associated with WTC exposure for at least seven years. Some portion of the extended duration of that association may be due to delayed diagnoses. Nevertheless, our results support recognizing OAD among rescue workers as WTC-related even when diagnosed years after exposure.
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Affiliation(s)
- Charles B Hall
- Department of Epidemiology and Population Health and Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Xiaoxue Liu
- Montefiore Medical Center, Bronx, New York, USA; Fire Department of the City of New York, Brooklyn, New York, USA
| | - Rachel Zeig-Owens
- Montefiore Medical Center, Bronx, New York, USA; Fire Department of the City of New York, Brooklyn, New York, USA
| | - Mayris P Webber
- Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA; Fire Department of the City of New York, Brooklyn, New York, USA
| | - Thomas K Aldrich
- Division of Pulmonary Medicine, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jessica Weakley
- Montefiore Medical Center, Bronx, New York, USA; Fire Department of the City of New York, Brooklyn, New York, USA
| | - Theresa Schwartz
- Montefiore Medical Center, Bronx, New York, USA; Fire Department of the City of New York, Brooklyn, New York, USA
| | - Hillel W Cohen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michelle S Glaser
- Montefiore Medical Center, Bronx, New York, USA; Fire Department of the City of New York, Brooklyn, New York, USA
| | - Brianne L Olivieri
- Montefiore Medical Center, Bronx, New York, USA; The Fire Department of the City of New York, Brooklyn, New York, USA
| | - Michael D Weiden
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York, USA; The Fire Department of the City of New York, Brooklyn, New York, USA
| | - Anna Nolan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York, USA; The Fire Department of the City of New York, Brooklyn, New York, USA
| | - Kerry J Kelly
- The Fire Department of the City of New York, Brooklyn, New York, USA
| | - David J Prezant
- The Fire Department of the City of New York, Brooklyn, New York, USA; Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
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Seaman DM, Meyer CA, Kanne JP. Occupational and environmental lung disease. Clin Chest Med 2015; 36:249-68, viii-ix. [PMID: 26024603 DOI: 10.1016/j.ccm.2015.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Occupational and environmental lung disease remains a major cause of respiratory impairment worldwide. Despite regulations, increasing rates of coal worker's pneumoconiosis and progressive massive fibrosis are being reported in the United States. Dust exposures are occurring in new industries, for instance, silica in hydraulic fracking. Nonoccupational environmental lung disease contributes to major respiratory disease, asthma, and COPD. Knowledge of the imaging patterns of occupational and environmental lung disease is critical in diagnosing patients with occult exposures and managing patients with suspected or known exposures.
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Affiliation(s)
- Danielle M Seaman
- Duke University Medical Center, 1612 Bivins Street, Durham, NC 27707, USA.
| | - Cristopher A Meyer
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, MC 3252, Madison, WI 53792, USA
| | - Jeffrey P Kanne
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, MC 3252, Madison, WI 53792, USA
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Barna BP, Judson MA, Thomassen MJ. Carbon Nanotubes and Chronic Granulomatous Disease. NANOMATERIALS 2014; 4:508-521. [PMID: 25525507 PMCID: PMC4267561 DOI: 10.3390/nano4020508] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Use of nanomaterials in manufactured consumer products is a rapidly expanding industry and potential toxicities are just beginning to be explored. Combustion-generated multiwall carbon nanotubes (MWCNT) or nanoparticles are ubiquitous in non-manufacturing environments and detectable in vapors from diesel fuel, methane, propane, and natural gas. In experimental animal models, carbon nanotubes have been shown to induce granulomas or other inflammatory changes. Evidence suggesting potential involvement of carbon nanomaterials in human granulomatous disease, has been gathered from analyses of dusts generated in the World Trade Center disaster combined with epidemiological data showing a subsequent increase in granulomatous disease of first responders. In this review we will discuss evidence for similarities in the pathophysiology of carbon nanotube-induced pulmonary disease in experimental animals with that of the human granulomatous disease, sarcoidosis.
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Affiliation(s)
- Barbara P. Barna
- Division of Pulmonary, Critical Care and Sleep Medicine, East Carolina University, Brody Medical Sciences Building, 600 Moye Blvd. Rm. 3E-149, Greenville, NC 27834, USA; E-Mail:
| | - Marc A. Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, MC-91, 47 New Scotland Avenue, Albany, NY 12208, USA; E-Mail:
| | - Mary Jane Thomassen
- Division of Pulmonary, Critical Care and Sleep Medicine, East Carolina University, Brody Medical Sciences Building, 600 Moye Blvd. Rm. 3E-149, Greenville, NC 27834, USA; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-252-744-1117; Fax: +1-252-744-4887
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22
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Kwon S, Weiden MD, Echevarria GC, Comfort AL, Naveed B, Prezant DJ, Rom WN, Nolan A. Early elevation of serum MMP-3 and MMP-12 predicts protection from World Trade Center-lung injury in New York City Firefighters: a nested case-control study. PLoS One 2013; 8:e76099. [PMID: 24146820 PMCID: PMC3797818 DOI: 10.1371/journal.pone.0076099] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 08/20/2013] [Indexed: 01/30/2023] Open
Abstract
Objective After 9/11/2001, some Fire Department of New York (FDNY) workers had excessive lung function decline. We hypothesized that early serum matrix metalloproteinases (MMP) expression predicts World Trade Center-Lung Injury (WTC-LI) years later. Methods This is a nested case-control analysis of never-smoking male firefighters with normal pre-exposure Forced Expiratory Volume in one second (FEV1) who had serum drawn up to 155 days post 9/11/2001. Serum MMP-1, 2,3,7,8, 9, 12 and 13 were measured. Cases of WTC-LI (N = 70) were defined as having an FEV1 one standard deviation below the mean (FEV1≤77%) at subspecialty pulmonary evaluation (SPE) which was performed 32 months (IQR 21–53) post-9/11. Controls (N = 123) were randomly selected. We modeled MMP's ability as a predictor of cases status with logistic regression adjusted for time to blood draw, exposure intensity, weight gain and pre-9/11 FEV1. Results Each log-increase in MMP-3 and MMP-12 showed reduced odds of developing WTC-LI by 73% and 54% respectively. MMP-3 and MMP-12 consistently clustered together in cases, controls, and the cohort. Increasing time to blood draw significantly and independently increased the risk of WTC-LI. Conclusions Elevated serum levels of MMP-3 and MMP-12 reduce the risk of developing WTC-LI. At any level of MMP-3 or 12, increased time to blood draw is associated with a diminished protective effect.
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Affiliation(s)
- Sophia Kwon
- Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine, New York, New York, United States of America
| | - Michael D. Weiden
- Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine, New York, New York, United States of America
- New York University, School of Medicine, Department of Environmental Medicine, Tuxedo Park, New York, United States of America
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York, United States of America
| | - Ghislaine C. Echevarria
- Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine, New York, New York, United States of America
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ashley L. Comfort
- Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine, New York, New York, United States of America
| | - Bushra Naveed
- Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine, New York, New York, United States of America
| | - David J. Prezant
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York, United States of America
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, United States of America,
| | - William N. Rom
- Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine, New York, New York, United States of America
- New York University, School of Medicine, Department of Environmental Medicine, Tuxedo Park, New York, United States of America
| | - Anna Nolan
- Division of Pulmonary, Critical Care and Sleep, New York University, School of Medicine, New York, New York, United States of America
- New York University, School of Medicine, Department of Environmental Medicine, Tuxedo Park, New York, United States of America
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York, United States of America
- * E-mail:
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Longitudinal spirometry among patients in a treatment program for community members with World Trade Center-related illness. J Occup Environ Med 2013; 54:1208-13. [PMID: 22995806 DOI: 10.1097/jom.0b013e31826bb78e] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The course of lung function in community members exposed to World Trade Center (WTC) dust and fumes remains undefined. We studied longitudinal spirometry among patients in the WTC Environmental Health Center (WTCEHC) treatment program. METHODS Observational study of 946 WTCEHC patients with repeated spirometry measures analyzed on the population as a whole and stratified by smoking status, initial spirometry pattern, and WTC-related exposure category. RESULTS Improvement in forced vital capacity (54.4 mL/yr; 95% confidence interval, 45.0 to 63.8) and forced expiratory volume in 1 second (36.8 mL/yr; 95% confidence interval, 29.3 to 44.3) was noted for the population as a whole. Heavy smokers did not improve. Spirometry changes differed depending on initial spirometry pattern and exposure category. CONCLUSION These data demonstrate spirometry improvement in select populations suggesting reversibility in airway injury and reinforcing the importance of continued treatment.
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Kronholm Diab K, Jönsson BAG, Axmon A, Nielsen J. Work-related airway symptoms, nasal reactivity and health-related quality of life in female hairdressers: a follow-up study during exposure. Int Arch Occup Environ Health 2012; 87:61-71. [PMID: 23263693 PMCID: PMC3880473 DOI: 10.1007/s00420-012-0835-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 11/29/2012] [Indexed: 11/28/2022]
Abstract
Objectives Hairdressers often complain of work-related rhinitis (WR). They are infrequently sensitized to persulphates. The cause and mechanism of the symptoms and the effects on their health-related quality of life (HRQoL) remains unclear. The objectives were to follow female hairdressers with WR mainly from bleaching powder regarding nasal reactivity to persulphate and to evaluate symptoms, HRQoL and inflammatory markers in nasal lavage during a working period after vacation and compared with hairdressers without symptoms and pollen allergic women. Methods Skin prick tests to persulphate were performed in the hairdressers. Participants kept a diary of symptoms and of work tasks (hairdressers only). They completed HRQoL questionnaires. Eosinophil cationic protein (ECP) in nasal lavage fluid was examined. The symptomatic hairdressers performed nasal challenges with persulphate before and after the exposure. Results Skin prick tests were negative. Although the nasal reactivity to persulphate did not change a steady increase in nasal symptoms, especially blockage, and in ECP was noticed in the symptomatic hairdressers. The HRQoL deteriorated in the symptomatic hairdressers indicating an effect on their working situation and daily life. The atopics had more, but varying symptoms (itching, sneezing and secretion). Conclusions The difference in the clinical picture between the symptomatic hairdressers and the pollen allergic women, the increase in symptoms and ECP in the nasal lavage support the view that a sensitization to hairdresser chemicals by a mechanism not yet understood is operating. The deterioration of the HRQoL in the symptomatic hairdressers indicates a considerable effect on their life.
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Affiliation(s)
- K Kronholm Diab
- Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 85, Lund, Sweden,
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Kazeros A, Maa MT, Patrawalla P, Liu M, Shao Y, Qian M, Turetz M, Parsia S, Caplan-Shaw C, Berger KI, Goldring R, Rogers L, Reibman J. Elevated peripheral eosinophils are associated with new-onset and persistent wheeze and airflow obstruction in world trade center-exposed individuals. J Asthma 2012; 50:25-32. [PMID: 23227974 DOI: 10.3109/02770903.2012.743149] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Exposure to World Trade Center (WTC) dust and fumes is associated with the onset of asthma-like respiratory symptoms in rescue and recovery workers and exposed community members. Eosinophilic inflammation with increased lung and peripheral eosinophils has been described in subpopulations with asthma. We hypothesized that persistent asthma-like symptoms in WTC-exposed individuals would be associated with systemic inflammation characterized by peripheral eosinophils. METHODS The WTC Environmental Health Center (WTC EHC) is a treatment program for local residents, local workers, and cleanup workers with presumed WTC-related symptoms. Patients undergo a standardized evaluation including questionnaires and complete blood count. Between September 2005 and March 2009, 2462 individuals enrolled in the program and were available for analysis. Individuals with preexisting respiratory symptoms or lung disease diagnoses prior to September 2001 and current or significant tobacco use were excluded, RESULTS One thousand five hundred and seventeen individuals met the inclusion criteria. Patients had a mean age of 47 years, were mostly female (51%), and had a diverse race/ethnicity. Respiratory symptoms that developed after WTC dust/fume exposure and remained persistent included dyspnea on exertion (68%), cough (57%), chest tightness (47%), and wheeze (33%). A larger percentage of patients with wheeze had elevated peripheral eosinophils compared with those without wheeze (21% vs. 13%, p < .0001). Individuals with elevated peripheral eosinophils were more likely to have airflow obstruction on spirometry (16% vs. 7%, p = .0003). CONCLUSION Peripheral eosinophils were associated with wheeze and airflow obstruction in a diverse WTC-exposed population. These data suggest that eosinophils may participate in lung inflammation in this population with symptoms consistent with WTC-related asthma.
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Affiliation(s)
- Angeliki Kazeros
- Department of Medicine, Bellevue Hospital, New York University, NY, USA
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Abstract
AbstractAll events that result in disasters are unique, and it is impossible to become fully prepared. However, through thorough planning and preparedness, it is possible to gain a better understanding of the typical injury patterns and problems that arise from a variety of hazards. Such events have the potential to claim many lives and overwhelm local medical resources. Burn disasters vary in scope of injury and procedures required, and are much more labor and resource intensive than non-burn disasters.This review of the literature should help determine whether, despite each event having its own unique features, there still are common problems disaster responders face in the prehospital and hospital phases, what recommendations were made from these disasters, and whether these recommendations have been implemented into practice and the current disaster planning processes.The objective of this review was to assess: (1) prehospital and hospital responses used during past burn disasters; (2) problems faced during those disaster responses; (3) recommendations made following those disasters; (4) whether these recommendations were integrated into practice; and (5) the key characteristics of burn disasters and how they differ from other disasters. This review is important to determine why, despite having disaster plans, things still go wrong.
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Naveed B, Weiden MD, Kwon S, Gracely EJ, Comfort AL, Ferrier N, Kasturiarachchi KJ, Cohen HW, Aldrich TK, Rom WN, Kelly K, Prezant DJ, Nolan A. Metabolic syndrome biomarkers predict lung function impairment: a nested case-control study. Am J Respir Crit Care Med 2012; 185:392-9. [PMID: 22095549 PMCID: PMC3297095 DOI: 10.1164/rccm.201109-1672oc] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 11/04/2011] [Indexed: 01/16/2023] Open
Abstract
RATIONALE Cross-sectional studies demonstrate an association between metabolic syndrome and impaired lung function. OBJECTIVES To define if metabolic syndrome biomarkers are risk factors for loss of lung function after irritant exposure. METHODS A nested case-control study of Fire Department of New York personnel with normal pre-September 11th FEV(1) and who presented for subspecialty pulmonary evaluation before March 10, 2008. We correlated metabolic syndrome biomarkers obtained within 6 months of World Trade Center dust exposure with subsequent FEV(1). FEV(1) at subspecialty pulmonary evaluation within 6.5 years defined disease status; cases had FEV(1) less than lower limit of normal, whereas control subjects had FEV(1) greater than or equal to lower limit of normal. MEASUREMENTS AND MAIN RESULTS Clinical data and serum sampled at the first monitoring examination within 6 months of September 11, 2001, assessed body mass index, heart rate, serum glucose, triglycerides and high-density lipoprotein (HDL), leptin, pancreatic polypeptide, and amylin. Cases and control subjects had significant differences in HDL less than 40 mg/dl with triglycerides greater than or equal to 150 mg/dl, heart rate greater than or equal to 66 bpm, and leptin greater than or equal to 10,300 pg/ml. Each increased the odds of abnormal FEV(1) at pulmonary evaluation by more than twofold, whereas amylin greater than or equal to 116 pg/ml decreased the odds by 84%, in a multibiomarker model adjusting for age, race, body mass index, and World Trade Center arrival time. This model had a sensitivity of 41%, a specificity of 86%, and a receiver operating characteristic area under the curve of 0.77. CONCLUSIONS Abnormal triglycerides and HDL and elevated heart rate and leptin are independent risk factors of greater susceptibility to lung function impairment after September 11, 2001, whereas elevated amylin is protective. Metabolic biomarkers are predictors of lung disease, and may be useful for assessing risk of impaired lung function in response to particulate inhalation.
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Affiliation(s)
- Bushra Naveed
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York City, Brooklyn, New York
| | - Michael D. Weiden
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York City, Brooklyn, New York
| | - Sophia Kwon
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York
| | - Edward J. Gracely
- Drexel University College of Medicine and Drexel University School of Public Health, Philadelphia, Pennsylvania
| | - Ashley L. Comfort
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York City, Brooklyn, New York
| | - Natalia Ferrier
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York
| | - Kusali J. Kasturiarachchi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York
| | - Hillel W. Cohen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Thomas K. Aldrich
- Division of Pulmonary Medicine, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - William N. Rom
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York
| | - Kerry Kelly
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York City, Brooklyn, New York
| | - David J. Prezant
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York City, Brooklyn, New York
- Division of Pulmonary Medicine, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Anna Nolan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York City, Brooklyn, New York
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Guidotti TL, Prezant D, de la Hoz RE, Miller A. The evolving spectrum of pulmonary disease in responders to the World Trade Center tragedy. Am J Ind Med 2011; 54:649-60. [PMID: 23236631 DOI: 10.1002/ajim.20987] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
On September 11, 2001, events at the World Trade Center (WTC) exposed residents ofNew York City to WTC dust and products of combustion and pyrolysis. The majority ofWTC-exposed fire department rescue workers experienced a substantial decline in airflowover the first 12 months post-9/11, in addition to the normal age-related declinethat affected all responders, followed by a persistent plateau in pulmonary function inthe 6 years thereafter. The spectrum of the resulting pulmonary diseases consists ofchronic inflammation, characterized by airflow obstruction, and expressing itself indifferent ways in large and small airways. These conditions include irritant-inducedasthma, non-specific chronic bronchitis, aggravated pre-existing obstructive lung disease(asthma or COPD), and bronchiolitis. Conditions concomitant with airwaysobstruction, particularly chronic rhinosinusitis and upper airway disease, and gastroesophagealreflux, have been prominent in this population. Less common have beenreports of sarcoidosis or interstitial pulmonary fibrosis. Pulmonary fibrosis and bronchiolitisare generally characterized by long latency, relatively slow progression, and asilent period with respect to pulmonary function during its evolution. For these reasons,the incidence of these outcomes may be underestimated and may increase overtime. The spectrum of chronic obstructive airways disease is broad in this populationand may importantly include involvement at the bronchiolar level, manifested as smallairways disease. Protocols that go beyond conventional screening pulmonary functiontesting and imaging may be necessary to identify these diseases in order to understandthe underlying pathologic processes so that treatment can be most effective.
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Affiliation(s)
- Tee L Guidotti
- Medical Advisory Services (A Division of The NMAS Group), Rockville, Maryland 20850, USA.
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Crowley LE, Herbert R, Moline JM, Wallenstein S, Shukla G, Schechter C, Skloot GS, Udasin I, Luft BJ, Harrison D, Shapiro M, Wong K, Sacks HS, Landrigan PJ, Teirstein AS. "Sarcoid like" granulomatous pulmonary disease in World Trade Center disaster responders. Am J Ind Med 2011; 54:175-84. [PMID: 21298693 DOI: 10.1002/ajim.20924] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND More than 20,000 responders have been examined through the World Trade Center (WTC) Medical Monitoring and Treatment Program since September 11, 2001. Studies on WTC firefighters have shown elevated rates of sarcoidosis. The main objective of this study was to report the incidence of "sarcoid like" granulomatous pulmonary disease in other WTC responders. METHODS Cases of sarcoid like granulomatous pulmonary disease were identified by: patient self-report, physician report and ICD-9 codes. Each case was evaluated by three pulmonologists using the ACCESS criteria and only "definite" cases are reported. RESULTS Thirty-eight patients were classified as "definite" cases. Six-year incidence was 192/100,000. The peak annual incidence of 54 per 100,000 person-years occurred between 9/11/2003 and 9/11/2004. Incidence in black responders was nearly double that of white responders. Low FVC was the most common spirometric abnormality. CONCLUSIONS Sarcoid like granulomatous pulmonary disease is present among the WTC responders. While the incidence is lower than that reported among firefighters, it is higher than expected.
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Affiliation(s)
- Laura E Crowley
- Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA.
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Xu A, Prophete C, Chen LC, Emala CW, Cohen MD. Interactive effect of cigarette smoke extract and world trade center dust particles on airway cell cytotoxicity. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2011; 74:887-902. [PMID: 21623534 DOI: 10.1080/15287394.2011.573719] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Rescue workers and residents exposed to the environment surrounding the collapse of the World Trade Center (WTC) on September 11, 2001, have suffered a disproportionate incidence of chronic lung disease attributed to the inhalation of airborne dust. To date, the pathophysiology of this lung disease is poorly understood. The aim of this study was to examine whether airborne dust contaminants recovered from the surrounding area 24-48 h after the collapse of the WTC demonstrate direct cytotoxicity to two airway cell types that were most directly exposed to inhaled dust, airway epithelial and smooth muscle cells. It was also of interest to determine whether the presence of these dusts could modulate the effects of cigarette smoke on these cell types in that some of the individuals who responded to the collapse site were also smokers. Human cultured airway epithelial (BEAS-2B) cells were exposed to 10% cigarette smoke extract (CSE), WTC dust particles (10-53 μm; 0.01-0.5 μg/μl), or a combination of the two for 2-24 h. Cell viability was measured by determining mitochondrial integrity (MTT assays) and apoptosis (poly-ADP-ribose polymerase [PARP] immunoblotting). Conditioned cell culture media recovered from the CSE- and/or WTC dust-exposed BEAS-2B cells were then applied to cultured human airway smooth muscle cells that were subsequently assayed for mitochondrial integrity and their ability to synthesize cyclic AMP (a regulator of airway smooth muscle constriction). BEAS-2B cells underwent necrotic cell death following exposure to WTC dust or CSE for 2-24 h without evidence of apoptosis. Smooth muscle cells demonstrated cellular toxicity and enhanced cyclic AMP synthesis following exposure to conditioned media from WTC- or CSE-exposed epithelial cells. These acute toxicity assays of WTC dust and CSE offer insights into lung cell toxicity that may contribute to the pathophysiology of chronic lung disease in workers and residents exposed to WTC dust. These studies clearly showed that WTC dust (at least the supercoarse particle fraction) or CSE alone exerted direct adverse effects on airway epithelial and smooth muscle cells, and altered the signaling properties of airway smooth muscle cells. In addition the combination of CSE and WTC exerted an interactive effect on cell toxicity. It remains to be determined whether these initial cell death events might account, in part, for the chronic lung effects associated with WTC dust exposure among First Responders and others.
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Affiliation(s)
- Alice Xu
- Columbia University, New York, New York, USA
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31
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Banauch GI, Brantly M, Izbicki G, Hall C, Shanske A, Chavko R, Santhyadka G, Christodoulou V, Weiden MD, Prezant DJ. Accelerated spirometric decline in New York City firefighters with α₁-antitrypsin deficiency. Chest 2010; 138:1116-24. [PMID: 20634282 DOI: 10.1378/chest.10-0187] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND On September 11, 2001, the World Trade Center (WTC) collapse caused massive air pollution, producing variable amounts of lung function reduction in the New York City Fire Department (FDNY) rescue workforce. α₁-Antitrypsin (AAT) deficiency is a risk factor for obstructive airway disease. METHODS This prospective, longitudinal cohort study of the first 4 years post-September 11, 2001, investigated the influence of AAT deficiency on adjusted longitudinal spirometric change (FEV₁) in 90 FDNY rescue workers with WTC exposure. Workers with protease inhibitor (Pi) Z heterozygosity were considered moderately AAT deficient. PiS homozygosity or PiS heterozygosity without concomitant PiZ heterozygosity was considered mild deficiency, and PiM homozygosity was considered normal. Alternately, workers had low AAT levels if serum AAT was ≤ 20 μmol/L. RESULTS In addition to normal aging-related decline (37 mL/y), significant FEV(1) decline accelerations developed with increasing AAT deficiency severity (110 mL/y for moderate and 32 mL/y for mild) or with low AAT serum levels (49 mL/y). Spirometric rates pre-September 11, 2001, did not show accelerations with AAT deficiency. Among workers with low AAT levels, cough persisted in a significant number of participants at 4 years post-September 11, 2001. CONCLUSIONS FDNY rescue workers with AAT deficiency had significant spirometric decline accelerations and persistent airway symptoms during the first 4 years after WTC exposure, representing a novel gene-by-environment interaction. Clinically meaningful decline acceleration occurred even with the mild serum AAT level reductions associated with PiS heterozygosity (without concomitant PiZ heterozygosity).
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Affiliation(s)
- Gisela I Banauch
- Division of Pulmonary, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.
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Svendsen ER, Whittle NC, Sanders L, McKeown RE, Sprayberry K, Heim M, Caldwell R, Gibson JJ, Vena JE. GRACE: public health recovery methods following an environmental disaster. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2010; 65:77-85. [PMID: 20439226 PMCID: PMC4090107 DOI: 10.1080/19338240903390222] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Different approaches are necessary when community-based participatory research (CBPR) of environmental illness is initiated after an environmental disaster within a community. Often such events are viewed as golden scientific opportunities to do epidemiological studies. However, the authors believe that in such circumstances, community engagement and empowerment needs to be integrated into the public health service efforts in order for both those and any science to be successful, with special care being taken to address the immediate health needs of the community first, rather than the pressing needs to answer important scientific questions. The authors will demonstrate how they have simultaneously provided valuable public health service, embedded generalizable scientific knowledge, and built a successful foundation for supplemental CBPR through their on-going recovery work after the chlorine gas disaster in Graniteville, South Carolina.
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Affiliation(s)
- Erik R Svendsen
- Arnold School of Public Health and the Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC South Carolina Department of Health and Environmental Control, Columbia, SC, USA.
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Sarcoidosis in World Trade Center Rescue Workers Presenting With Rheumatologic Manifestations. J Clin Rheumatol 2010; 16:26-7. [DOI: 10.1097/rhu.0b013e3181c78856] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Weiden MD, Ferrier N, Nolan A, Rom WN, Comfort A, Gustave J, Zeig-Owens R, Zheng S, Goldring RM, Berger KI, Cosenza K, Lee R, Webber MP, Kelly KJ, Aldrich TK, Prezant DJ. Obstructive airways disease with air trapping among firefighters exposed to World Trade Center dust. Chest 2009; 137:566-74. [PMID: 19820077 DOI: 10.1378/chest.09-1580] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The World Trade Center (WTC) collapse produced a massive exposure to respirable particulates in New York City Fire Department (FDNY) rescue workers. This group had spirometry examinations pre-September 11, 2001, and post-September 11, 2001, demonstrating declines in lung function with parallel declines in FEV(1) and FVC. To date, the underlying pathophysiologic cause for this has been open to question. METHODS Of 13,234 participants in the FDNY-WTC Monitoring Program, 1,720 (13%) were referred for pulmonary subspecialty evaluation at a single institution. Evaluation included 919 full pulmonary function tests, 1,219 methacholine challenge tests, and 982 high-resolution chest CT scans. RESULTS At pulmonary evaluation (median 34 months post-September 11, 2001), median values were FEV(1) 93% predicted (interquartile range [IQR], 83%-101%), FVC 98% predicted (IQR, 89%-106%), and FEV(1)/FVC 0.78 (IQR, 0.72-0.82). The residual volume (RV) was 123% predicted (IQR, 106%-147%) with nearly all participants having normal total lung capacity, functional residual capacity, and diffusing capacity of carbon monoxide. Also, 1,051/1,720 (59%) had obstructive airways disease based on at least one of the following: FEV(1)/FVC, bronchodilator responsiveness, hyperreactivity, or elevated RV. After adjusting for age, gender, race, height and weight, and tobacco use, the decline in FEV(1) post-September 11, 2001, was significantly correlated with increased RV percent predicted (P < .0001), increased bronchodilator responsiveness (P < .0001), and increased hyperreactivity (P = .0056). CT scans demonstrated bronchial wall thickening that was significantly associated with the decline in FEV(1) post-September 11, 2001 (P = .024), increases in hyperreactivity (P < .0001), and increases in RV (P < .0001). Few had evidence for interstitial disease. CONCLUSIONS Airways obstruction was the predominant physiologic finding underlying the reduction in lung function post-September 11, 2001, in FDNY WTC rescue workers presenting for pulmonary evaluation.
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Affiliation(s)
- Michael D Weiden
- Division of Pulmonary/Critical Care, New York University, New York, NY, USA
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Laumbach RJ, Harris G, Kipen HM, Georgopoulos P, Shade P, Isukapalli SS, Efstathiou C, Galea S, Vlahov D, Wartenberg D. Lack of association between estimated World Trade Center plume intensity and respiratory symptoms among New York City residents outside of Lower Manhattan. Am J Epidemiol 2009; 170:640-9. [PMID: 19622671 DOI: 10.1093/aje/kwp165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Researchers have reported adverse health effects among rescue/recovery workers and people living near the World Trade Center on September 11, 2001. The authors investigated the occurrence of respiratory symptoms among persons living outside of Lower Manhattan in areas affected by the World Trade Center particulate matter plume. Using a novel atmospheric dispersion model, they estimated relative cumulative plume intensity in areas surrounding the World Trade Center site over a 5-day period following the collapse of the buildings. Using data from a telephone survey of residents (n = 2,755) conducted approximately 6 months after the event, the authors evaluated associations between the estimated plume intensities at individual residence locations and self-reported respiratory symptoms among nonasthmatics, as well as symptoms and nonroutine care among asthmatics. Comparing persons at or above the 75th percentile of cumulative plume intensity with those below it, there was no statistically significant difference in self-reported new-onset wheezing/cough after September 11 (16.1% vs. 13.3%; adjusted odds ratio = 1.0, 95% confidence interval: 0.7, 1.7) and no worsening of asthma from before September 11 to the 4 weeks prior to the survey (13.9% vs. 16.6%; odds ratio = 1.0, 95% confidence interval: 0.3, 2.8). These results suggest that the plume was not strongly associated with respiratory symptoms outside of Lower Manhattan, within the limitations of this retrospective study.
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Affiliation(s)
- Robert J Laumbach
- Environmental and Occupational Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, 170 Frelinghuysen Road, Piscataway, NJ 08854, USA.
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Characteristics of a residential and working community with diverse exposure to World Trade Center dust, gas, and fumes. J Occup Environ Med 2009; 51:534-41. [PMID: 19365288 DOI: 10.1097/jom.0b013e3181a0365b] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe physical symptoms in those local residents, local workers, and cleanup workers who were enrolled in a treatment program and had reported symptoms and exposure to the dust, gas, and fumes released with the destruction of the World Trade Center (WTC) on September 11, 2001. METHODS Symptomatic individuals underwent standardized evaluation and subsequent treatment. RESULTS One thousand eight hundred ninety-eight individuals participated in the WTC Environmental Health Center between September 2005 and May 2008. Upper and lower respiratory symptoms that began after September 11, 2001 and persisted at the time of examination were common in each exposure population. Many (31%) had spirometry measurements below the lower limit of normal. CONCLUSIONS Residents and local workers as well as those with work-associated exposure to WTC dust have new and persistent respiratory symptoms with lung function abnormalities 5 or more years after the WTC destruction.
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Chandran SK, Hawkshaw MJ, Sataloff RT. Otolaryngologic Symptoms in Persons Exposed to World Trade Center Dust and Particle Pollutants: A Case for Caution in Declaring a Diagnosis of Wtc Syndrome. EAR, NOSE & THROAT JOURNAL 2009. [DOI: 10.1177/014556130908800811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Since the Sept. 11, 2001, attack on the World Trade Center (WTC), the health status of survivors, rescue and cleanup workers, and residents of Lower Manhattan has been monitored. Exposure to dust and particulate matter resulted in numerous complaints of both upper and lower aerodigestive tract irritation. The symptoms, diagnoses, and management of affected persons have previously been described in the literature. However, evidence establishing causation is scarce, especially with regard to the purported long-term effects of such exposure. Many persons who were exposed to the Ground Zero site have otolaryngologic conditions that are common in persons who were not so exposed. Therefore, otolaryngologists involved in the care of such patients should be cautious about assigning a diagnosis of “WTC syndrome” without a comprehensive examination to look for other possible etiologies. A diagnosis of a treatable, potentially serious health problem should not be missed simply because a patient who was exposed to WTC irritants was presumed to have WTC syndrome. In this review, we discuss the reported otolaryngologic manifestations of exposure to the WTC site, and we describe the specific cases of 2 workers there who continue to have otolaryngologic complaints. Considerable research is needed to establish the existence and nature of any long-term sequelae of exposure to WTC fallout.
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Affiliation(s)
- Swapna K. Chandran
- Department of Otolaryngology–Head and Neck Surgery, Drexel University College of Medicine, Philadelphia
| | - Mary J. Hawkshaw
- Department of Otolaryngology–Head and Neck Surgery, Drexel University College of Medicine, Philadelphia
| | - Robert T. Sataloff
- Department of Otolaryngology–Head and Neck Surgery, Drexel University College of Medicine, Philadelphia
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Webber MP, Gustave J, Lee R, Niles JK, Kelly K, Cohen HW, Prezant DJ. Trends in respiratory symptoms of firefighters exposed to the world trade center disaster: 2001-2005. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:975-80. [PMID: 19590693 PMCID: PMC2702416 DOI: 10.1289/ehp.0800291] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 02/10/2009] [Indexed: 05/24/2023]
Abstract
BACKGROUND Respiratory symptoms, either newly reported after the World Trade Center (WTC) disaster on 11 September 2001 (9/11) or increased in severity, have been well documented in WTC-exposed workers and New York City residents. However, considerable uncertainty exists over the persistence of symptoms. OBJECTIVES In this study, our goals were to describe trends in post-9/11 respiratory and gastro-esophageal reflux disease (GERD) symptoms in WTC-exposed firefighters and to examine symptom progression in the cohort that completed both year 1 and year 4 questionnaires. METHODS We analyzed questionnaire responses from 10,378 firefighters in yearly intervals, from 2 October 2001 to 11 September 2005, defining exposure based on arrival time at the WTC site. For the cohort of 3,722 firefighters who completed the two questionnaires, we also calculated exposure duration summing months of work at the site. RESULTS In cross-sectional analyses, the prevalence of dyspnea, wheeze, rhinosinusitis, and GERD remained relatively stable, whereas cough and sore throat declined, especially between 1 and 2 years post-9/11. We found a dose-response relationship between arrival time and symptoms in all years (p < 0.01). Logistic models of symptoms at year 4 in the cohort demonstrated independent effects of earlier arrival and longer work duration: each additional month of work increased the odds of symptoms 8-11%. CONCLUSIONS Protracted work exposures increased the odds of respiratory and GERD symptoms 4 years later. In most large disasters, exposures may be unavoidable during the rescue phase, but our data strongly suggest the need to minimize additional exposures during recovery and cleanup phases.
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Affiliation(s)
- Mayris P Webber
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
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Dykewicz MS. Occupational asthma: current concepts in pathogenesis, diagnosis, and management. J Allergy Clin Immunol 2009; 123:519-28; quiz 529-30. [PMID: 19281900 DOI: 10.1016/j.jaci.2009.01.061] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 01/27/2009] [Accepted: 01/28/2009] [Indexed: 11/17/2022]
Abstract
Occupational asthma (OA) may account for 25% or more of de novo adult asthma. The nomenclature has now better defined categories of OA caused by sensitizing agents and irritants, the latter best typified by the reactive airways dysfunction syndrome. Selecting the most appropriate diagnostic testing and management is driven by assessing whether a sensitizer is involved, and if so, identifying whether the sensitizing agent is a high-molecular-weight agent such as a protein or a low-molecular-weight reactive chemical such as an isocyanate. Increased understanding of the pathogenesis of OA from reactive chemical sensitizers is leading to development of better diagnostic testing and also an understanding of why testing for sensitization to such agents can be problematic. Risk factors for OA including possible genetic factors are being delineated better. Recently published guidelines for the diagnosis and management of occupational asthma are summarized; these reflect an increasingly robust evidence basis for recommendations. The utility of diagnostic tests for OA is being better defined by evidence, including sputum analysis performed in relation to work exposure with suspected sensitizers. Preventive and management approaches are reviewed. Longitudinal studies of patients with OA continue to show that timely removal from exposure leads to the best prognosis.
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Affiliation(s)
- Mark S Dykewicz
- Allergy and Immunology Service, Section of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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40
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Goldyn SR, Condos R, Rom WN. The burden of exposure-related diffuse lung disease. Semin Respir Crit Care Med 2009; 29:591-602. [PMID: 19221957 DOI: 10.1055/s-0028-1101269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Estimating the burden of exposure-related diffuse lung disease in terms of health effects and economic burden remains challenging. Labor statistics are inadequate to define the scope of the problem, and few studies have analyzed the prevalence of exposure-related illnesses and the subsequent health care cost. Well-defined exposures, such as those associated with coal mines, asbestos mines, and stonecutting, have led to more accurate assessment of prevalence and cost. As governmental regulation of workplace exposure has increased, the prevalence of diseases such as silicosis and coal workers' pneumoconiosis has diminished. However, the health and economic effects of diseases with long latency periods, such as asbestosis and mesothelioma, continue to increase in the short term. Newer exposures, such as those related to air pollution, nylon flock, and the World Trade Center collapse, have added to these costs. As a result, estimates of cost for occupational diseases, including respiratory illnesses, exceed $26 billion annually, and the true economic burden is likely much higher.
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Affiliation(s)
- Sheryl R Goldyn
- Division of Pulmonary and Critical Care Medicine, NYU School of Medicine, New York 10016, USA
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Diab KK, Truedsson L, Albin M, Nielsen J. Persulphate challenge in female hairdressers with nasal hyperreactivity suggests immune cell, but no IgE reaction. Int Arch Occup Environ Health 2008; 82:771-7. [PMID: 19048274 DOI: 10.1007/s00420-008-0392-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 11/13/2008] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to examine the effects of persulphate on the nasal mucosa and on the immune cells in hairdressers suffering from bleaching powder associated rhinitis (BAR) versus subjects with rhinitis not previously exposed to bleaching powder. METHODS Fifteen hairdressers (S) with BAR, 14 without symptoms (WS) and 12 atopics (A) with rhinitis but without exposure to bleaching powder were studied. Each performed a nasal challenge with persulphates. Effect parameters were symptom score, acoustic rhinometry, albumin in nasal lavage, subpopulations of lymphocytes in blood and specific serum antibodies. RESULTS The S group had a post-challenge increase in nasal symptoms and nasal lavage albumin. The A group reacted to a lesser intent. The S and A groups showed an increase in Th1 cells. An HLA class II cell expression was noticed in both groups of hairdressers. No evidence of a type 1 reaction (immediate type) to persulphate was noticed. CONCLUSIONS Persulphate challenge affects hairdressers with BAR, but also atopics. The reaction may be driven by a Th1 cell activation.
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Affiliation(s)
- Kerstin Kronholm Diab
- Department of Occupational and Environmental Medicine, University Hospital, Lund, Sweden.
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Fitzgerald SD, Rumbeiha WK, Emmett Braselton W, Downend AB, Otto CM. Pathology and toxicology findings for search-and-rescue dogs deployed to the September 11, 2001, terrorist attack sites: initial five-year surveillance. J Vet Diagn Invest 2008; 20:477-84. [PMID: 18599853 DOI: 10.1177/104063870802000410] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A long-term surveillance study was conducted on 95 search-and-rescue (S&R) dogs deployed to the September 11, 2001, terrorist attack sites; an additional 55 nondeployed S&R dogs served as controls. After 5 years of surveillance, 32% of the deployed dogs have died and 24% of the nondeployed dogs. The mean age at the time of death in these 2 groups of dogs is not significantly different. Causes of death in both groups of dogs include inflammatory, degenerative, and proliferative conditions. No primary pulmonary tumors have been identified to date nor has any significant level of toxicant been found in the tissues from these dogs using assays for general organic compounds and metals or, specifically, for polychlorinated biphenyls. However, significant numbers of both deployed and nondeployed dogs have evidence of inhaled matter as demonstrated by the presence of anthracotic pigments or refractile particulate matter in pulmonary tissue. Although S&R activities in response to the 9/11 terrorist attacks exposed dogs to a wide variety of potentially toxic compounds, to date, these dogs do not appear to suffer from higher mortality or increased pulmonary disease compared with nondeployed dogs. To the authors' knowledge, the current survey represents the first long-term and large-scale survey of the pathology and toxicology of S&R dogs deployed to a major disaster site.
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Affiliation(s)
- Scott D Fitzgerald
- Diagnostic Center for Population and Animal Health, Michigan State University, Lansing, MI 48910-8104, USA.
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Prezant DJ, Levin S, Kelly KJ, Aldrich TK. Upper and lower respiratory diseases after occupational and environmental disasters. ACTA ACUST UNITED AC 2008; 75:89-100. [PMID: 18500710 DOI: 10.1002/msj.20028] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Respiratory consequences from occupational and environmental disasters are the result of inhalation exposures to chemicals, particulate matter (dusts and fibers) and/or the incomplete products of combustion that are often liberated during disasters such as fires, building collapses, explosions and volcanoes. Unfortunately, experience has shown that environmental controls and effective respiratory protection are often unavailable during the first days to week after a large-scale disaster. The English literature was reviewed using the key words-disaster and any of the following: respiratory disease, pulmonary, asthma, bronchitis, sinusitis, pulmonary fibrosis, or sarcoidosis. Respiratory health consequences after aerosolized exposures to high-concentrations of particulates and chemicals can be grouped into 4 major categories: 1) upper respiratory disease (chronic rhinosinusitis and reactive upper airways dysfunction syndrome), 2) lower respiratory diseases (reactive [lower] airways dysfunction syndrome, irritant-induced asthma, and chronic obstructive airways diseases), 3) parenchymal or interstitial lung diseases (sarcoidosis, pulmonary fibrosis, and bronchiolitis obliterans, and 4) cancers of the lung and pleura. This review describes several respiratory consequences of occupational and environmental disasters and uses the World Trade Center disaster to illustrate in detail the consequences of chronic upper and lower respiratory inflammation.
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Affiliation(s)
- David J Prezant
- Office of Medical Affairs, Fire Department of the City of New York (FDNY), Brooklyn, NY, USA.
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Fox PR, Puschner B, Ebel JG. Assessment of acute injuries, exposure to environmental toxins, and five-year health surveillance of New York Police Department working dogs following the September 11, 2001, World Trade Center terrorist attack. J Am Vet Med Assoc 2008; 233:48-59. [PMID: 18593312 DOI: 10.2460/javma.233.1.48] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine deployment logistics of New York Police Department (NYPD) working dogs that assisted in relief efforts at the World Trade Center (WTC) site following the September 11, 2001, terrorist attack; establish types and rates of related acute injuries and illnesses; identify environmental toxin exposures; and determine long-term (ie, 5-year) health effects of deployment. DESIGN Prospective cohort study. ANIMALS 27 working dogs. PROCEDURES Deployment logistics for the period from September 11, 2001, through May 30, 2002, were determined, and acute health disorders were identified by means of physical examination; a questionnaire; interviews with dog handlers; and toxicologic (blood and hair samples), clinicopathologic, microbiologic (nasal swab specimens submitted for Bacillus anthracis culture), and radiographic methods. Long-term health surveillance ended September 21, 2006. RESULTS Dogs worked a total of 1,428 days (15,148 hours) at the site. Seventeen of the 27 (62.9%) dogs had health disorders during the first week. Specific conditions included fatigue (incidence rate [events/1,000 active deployment hours], 13.1), conjunctival irritation (13.1), respiratory tract problems (12.4), decreased appetite (10.8), dehydration (10), and cuts (9.3). Only minor hematologic and serum biochemical abnormalities were identified. Bacterial culture of nasal swab specimens did not yield B anthracis. Only mild and infrequent health conditions were identified during the 5-year follow-up period. None of the dogs were identified as having chronic respiratory tract disease. Six dogs died of various causes. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that acute injuries and illnesses were common among NYPD working dogs deployed to the WTC disaster site, but that longterm health complications were minimal.
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Affiliation(s)
- Philip R Fox
- Caspary Institute of the Animal Medical Center, 510 E 62nd Street, New York, NY 10065, USA
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Banauch GI, Izbicki G, Christodoulou V, Weiden MD, Webber MP, Cohen H, Gustave J, Chavko R, Aldrich TK, Kelly KJ, Prezant DJ. Trial of prophylactic inhaled steroids to prevent or reduce pulmonary function decline, pulmonary symptoms, and airway hyperreactivity in firefighters at the world trade center site. Disaster Med Public Health Prep 2008; 2:33-9. [PMID: 18388656 DOI: 10.1097/dmp.0b013e318164ee0c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Inhaled corticosteroids (ICS) are the most effective anti-inflammatory treatment for asthmatics. This trial evaluated the effects of prophylactic ICS in firefighters exposed to the World Trade Center disaster. METHODS Inhaled budesonide via a dry powder inhaler (Pulmicort Turbuhaler, AstraZeneca, Wilmington, DE) was offered on-site to New York City firefighters between September 18 and 25, 2001. One to 2 years later, firefighters (n = 64) who completed 4 weeks of daily ICS treatment were evaluated and compared with an age- and exposure-matched comparison group (n = 72) who did not use ICS. RESULTS When spirometry results at the final visit were compared with those from the weeks following the 9/11 disaster, the treatment group had a greater increase in forced vital capacity (P = .009) and possibly a slower decline in forced expiratory volume at 1 second (P = .11), as well as a greater improvement in perceived well-being as assessed by the St George's Respiratory Questionnaire (P < .01). There was no difference in airway hyperreactivity and no evidence of adverse effects from ICS. CONCLUSIONS Because the potential for hazardous exposures is great at many disasters, disease prevention programs based on environmental controls and respiratory protection are warranted immediately. Our results suggest that, pending further study with a larger sample, prophylactic ICS should be considered, along with respiratory protection, to minimize possible lung insult.
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The world trade center clean up and recovery worker cohort study: respiratory health amongst cleanup workers approximately 20 months after initial exposure at the disaster site. J Occup Environ Med 2008; 49:1063-72. [PMID: 18000411 DOI: 10.1097/jom.0b013e31815ac4f8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Respiratory health among cleanup workers at the World Trade Center (WTC) disaster site was evaluated approximately 20 months after the initial exposure to assess the risk of lower respiratory symptoms. METHODS In 2003 a self-administered questionnaire requesting information about site experience, current respiratory and historical health, and smoking was sent to 4,546 workers employed at the site (response 25%), and 2103 workers who were never at the WTC (response 12%). RESULTS As compared with those never at the site, WTC workers were more than three times as likely to report any lower respiratory symptoms (rate ratio = 3.40, 95% confidence interval: 2.33-4.94). CONCLUSIONS These results suggest an impact on respiratory health related to work experience at the WTC and indicate further monitoring to address potential long-term effects.
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Prezant DJ. World Trade Center Cough Syndrome and its treatment. Lung 2007; 186 Suppl 1:S94-102. [PMID: 18027025 DOI: 10.1007/s00408-007-9051-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Accepted: 10/04/2007] [Indexed: 11/24/2022]
Abstract
To date, the main respiratory health consequence from the collapse of the World Trade Center (WTC) on September 11, 2001 has been the "WTC Cough Syndrome" (chronic rhinosinusitis, asthma, and/or bronchitis, often complicated by gastroesophageal reflux dysfunction). Syndrome incidence and severity have been linked to WTC dust exposure intensity. While it is too early to ascertain long-term effects of WTC dust exposure, effective treatment guidelines have been designed through a collaborative effort by the three established centers of excellence for WTC medical monitoring and treatment and the WTC Registry. These treatment recommendations are described here.
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Affiliation(s)
- David J Prezant
- Office of Medical Affairs, Fire Department of City of New York (FDNY), FDNY World Trade Center Monitoring and Treatment Program, Brooklyn, NY 11201, USA.
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Oppenheimer BW, Goldring RM, Herberg ME, Hofer IS, Reyfman PA, Liautaud S, Rom WN, Reibman J, Berger KI. Distal airway function in symptomatic subjects with normal spirometry following World Trade Center dust exposure. Chest 2007; 132:1275-82. [PMID: 17890470 DOI: 10.1378/chest.07-0913] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
RATIONALE Following collapse of the World Trade Center (WTC), individuals reported new-onset respiratory symptoms. Despite symptoms, spirometry often revealed normal airway function. However, bronchial wall thickening and air trapping were seen radiographically in some subjects. We hypothesized that symptomatic individuals following exposure to WTC dust may have functional abnormalities in distal airways not detectable with routine spirometry. METHODS One hundred seventy-four subjects with respiratory symptoms and normal spirometry results were evaluated. Impedance oscillometry (IOS) was performed to determine resistance at 5 Hz, 5 to 20 Hz, and reactance area. Forty-three subjects were also tested for frequency dependence of compliance (FDC). Testing was repeated after bronchodilation. RESULTS Predominant symptoms included cough (67%) and dyspnea (65%). Despite normal spirometry results, mean resistance at 5 Hz, 5 to 20 Hz, and reactance area were elevated (4.36 +/- 0.12 cm H(2)O/L/s, 0.86 +/- 0.05 cm H(2)O/L/s, and 6.12 +/- 0.50 cm H(2)O/L, respectively) [mean +/- SE]. Resistance and reactance normalized after bronchodilation. FDC was present in 37 of 43 individuals with improvement after bronchodilation. CONCLUSIONS Symptomatic individuals with presumed WTC dust/fume exposure and normal spirometry results displayed airway dysfunction based on the following: (1) elevated airway resistance and frequency dependence of resistance determined by IOS; (2) heterogeneity of distal airway function demonstrated by elevated reactance area on oscillometry and FDC; and (3) reversibility of these functional abnormalities to or toward normal following administration of a bronchodilator. Since spirometry results were normal in all subjects, these abnormalities likely reflect dysfunction in airways more distal to those evaluated by spirometry. Examination of distal airway function when spirometry results are normal may be important in the evaluation of subjects exposed to occupational and environmental hazards.
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Affiliation(s)
- Beno W Oppenheimer
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
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Slottje P, Witteveen AB, Twisk JWR, Smidt N, Huizink AC, van Mechelen W, Smid T. Post-disaster physical symptoms of firefighters and police officers: role of types of exposure and post-traumatic stress symptoms. Br J Health Psychol 2007; 13:327-42. [PMID: 17535500 DOI: 10.1348/135910707x198793] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine the relationships between exposure to the air disaster in Amsterdam and multiple physical symptoms among firefighters and police officers, and to explore the role of post-traumatic stress symptoms (PTSS) herein. DESIGN Historic cohort study. METHODS On average 8.5 years post-disaster, exposed professional firefighters (N=334) and police officers (N=834) and their nonexposed colleagues (N=194 and N=634, respectively) completed questionnaires on disaster exposure and current symptoms. Logistic regression with adjustment for background characteristics was used to compare exposed and nonexposed workers. PTSS were added to these models, as was the interaction between exposure and PTSS, to explore potential mediating and modifying effects, respectively. RESULTS Exposed workers reported multiple physical symptoms significantly more often. Multiple physical symptoms seemed to have particularly affected the exposed firefighters who rescued people, and the exposed police officers who supported injured victims and workers, who were involved in the identification of or search for victims and human remains, who witnessed the immediate disaster scene or had a close one affected by the disaster. These exposure effects were essentially independent of PTSS, and no significant interactions between exposure and PTSS were found. CONCLUSIONS In conclusion, the excess in post-disaster multiple physical symptoms in exposed workers could not be attributed to PTSS.
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Affiliation(s)
- Pauline Slottje
- EMGO Institute, Department of Public and Occupational Health, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, The Netherlands
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Izbicki G, Chavko R, Banauch GI, Weiden MD, Berger KI, Aldrich TK, Hall C, Kelly KJ, Prezant DJ. World Trade Center "sarcoid-like" granulomatous pulmonary disease in New York City Fire Department rescue workers. Chest 2007; 131:1414-23. [PMID: 17400664 DOI: 10.1378/chest.06-2114] [Citation(s) in RCA: 194] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Previous reports suggest that sarcoidosis occurs with abnormally high frequency in firefighters. We sought to determine whether exposure to World Trade Center (WTC) "dust" during the collapse and rescue/recovery effort increased the incidence of sarcoidosis or "sarcoid-like" granulomatous pulmonary disease (SLGPD). METHODS During the 5 years after the WTC disaster, enrollees in the Fire Department of New York (FDNY) WTC monitoring and treatment programs who had chest radiograph findings suggestive of sarcoidosis underwent evaluation, including the following: chest CT imaging, pulmonary function, provocative challenge, and biopsy. Annual incidence rates were compared to the 15 years before the WTC disaster. RESULTS After WTC dust exposure, pathologic evidence consistent with new-onset sarcoidosis was found in 26 patients: all 26 patients had intrathoracic adenopathy, and 6 patients (23%) had extrathoracic disease. Thirteen patients were identified during the first year after WTC dust exposure (incidence rate, 86/100,000), and 13 patients were identified during the next 4 years (average annual incidence rate, 22/100,000; as compared to 15/100,000 during the 15 years before the WTC disaster). Eighteen of 26 patients (69%) had findings consistent with asthma. Eight of 21 patients (38%) agreeing to challenge testing had airway hyperreactivity (AHR), findings not seen in FDNY sarcoidosis patients before the WTC disaster. CONCLUSION After the WTC disaster, the incidence of sarcoidosis or SLGPD was increased among FDNY rescue workers. This new information about the early onset of WTC-SLGPD and its association with asthma/AHR has important public health consequences for disease prevention, early detection, and treatment following environmental/occupational exposures.
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Affiliation(s)
- Gabriel Izbicki
- Pulmonary Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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