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Wah W, Gelaw A, Glass DC, Sim MR, Hoy RF, Berecki-Gisolf J, Walker-Bone K. Systematic review of impacts of occupational exposure to wildfire smoke on respiratory function, symptoms, measures and diseases. Int J Hyg Environ Health 2024; 263:114463. [PMID: 39332351 DOI: 10.1016/j.ijheh.2024.114463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/27/2024] [Accepted: 09/15/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND Wildfire smoke contains numerous hazardous air pollutants which pose serious health risks to humans. Despite this, there has been a limited focus on the assessment of the acute physiological and longer-term respiratory effects of wildfire exposure on firefighters and other emergency workers. Therefore, we undertook a systematic review of the evidence about the respiratory impacts of occupational wildfire smoke exposure among wildfire fighters (WFF). METHODS Eligible studies from Medline, Embase and Scopus databases were included if they described the relationship between wildfire exposure and respiratory function, symptoms, measures and diseases amongst emergency personnel or firefighters who had responded to wildfires. RESULTS Twenty-six articles met the inclusion criteria. 24 out of 26 (22 out of 23 moderate/high quality) studies provided evidence of adverse respiratory effects, including reduced lung function, increased airway dysfunction and airway inflammation, upper and lower respiratory tract symptoms and increased asthma incidence related to wildfires or prescribed burns exposure among WFF and police responders. Fourteen out of 19 studies showed statistically significant declines in spirometry measures of lung function (mostly short-term studies). Two studies using complex lung function tests showed a significant effect on peripheral airway function. DISCUSSION This review found a convincing body of evidence that occupational exposure to wildfires or prescribed burns has both acute and possibly longer-term respiratory effects among WFFs and some other emergency personnel. Given that these events are increasing, more needs to be done to identify those most at risk and mitigate these risks.
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Affiliation(s)
- Win Wah
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Asmare Gelaw
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Deborah C Glass
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Malcolm R Sim
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ryan F Hoy
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Janneke Berecki-Gisolf
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Victorian Injury Surveillance Unit, Monash University Accident Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Karen Walker-Bone
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Broznitsky N, Shum M, Kinniburgh D, Lichty D, Tiu S, Toic T, Zadunayski T, Cherry N. A field investigation of 3 masks proposed as respiratory protection for wildland firefighters: a randomized controlled trial in British Columbia, Canada. Ann Work Expo Health 2024:wxae073. [PMID: 39312487 DOI: 10.1093/annweh/wxae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 09/05/2024] [Indexed: 09/25/2024] Open
Abstract
INTRODUCTION Wildland firefighters are exposed through the lungs and skin to particulate matter, fumes, and vapors containing polycyclic aromatic hydrocarbons (PAH). Wearing respiratory protection should reduce pulmonary exposure, but there is uncertainty about the most effective and acceptable type of mask. METHODS Firefighters from 6 unit crews working with the British Columbia Wildfire Service were approached and those consenting were randomly allocated within each crew to a "no mask" control group or to use 1 of 3 types of masks: X, half-face respirator with P100/multi gas cartridge; Y, cloth with alpaca filter; Z mesh fabric with a carbon filter. Crews were followed for 3 consecutive firefighting days. The mask allocated was constant for each firefighter throughout. All participants completed a brief questionnaire at the start and end of each day, giving information on mask use, respiratory symptoms, and assessment of mask qualities. Spot urine samples were collected pre and post shift to assess 1-hydroxypyrene (1-HP) concentration as an indicator of total PAH absorption. Skin wipe samples from the hands and throat were collected pre and post shift and analyzed for PAH concentration. On each day monitored, 4 participants carried sampling pumps to measure total particulates and PAHs on particles and in vapor phase. The primary outcome was the concentration of urinary 1-HP at the end of the fire day. Secondary outcomes were changes in respiratory and eye symptoms during the course of the shift, reported mask use, and perception of mask qualities. The analysis used a 3-level random intercept regression model that clustered observations within individuals and crews. We aimed to detect any relation of allocated mask type to the 4 outcomes, having allowed for estimated exposure. RESULTS Information was collected from 89 firefighters, including 14 women: 49% (37/75) of male firefighters were bearded. Nineteen fire days were monitored for a total of 263 firefighter × days, 64 to 68 for each intervention group. The end of shift 1-HP was higher than the start of the shift. Urinary 1-HP was more strongly related to PAHs on the skin than in the breathing zone. Men with beards had higher end-of-shift urinary log 1-HP/creat (ng/g) than other firefighters. None of the groups allocated a mask had lower 1-HP than the no-mask group, either in the study group overall or when stratified by beard-wearing. Among those without either beards or a failed fit-test, Mask Z reduced at the end of shift 1-HP where airborne PAH concentration was high. End-of-shift symptoms were related to particle mass in the breathing zone but was not mitigated by any of the masks. Hours electing not to wear a mask increased from the first to third shift for all mask types. Mask Z was rated as more comfortable than other types. Mask X was rated highest on fit and perceived protection. Mask Y gained the lowest ratings on fit, comfort and feelings of protection. CONCLUSIONS Allocated masks did not provide protection overall, but the results highlighted the need for a wider understanding of the circumstances in which wearing efficient protection is well-advised.
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Affiliation(s)
| | - Mona Shum
- Aura Health and Safety Corporation, Burnaby, BC V5H 1Y7, Canada
| | - David Kinniburgh
- Alberta Centre For Toxicology, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Drew Lichty
- Canada Wildfire, University of Alberta, Edmonton, AB T6G 2H1, Canada
| | - Sylvia Tiu
- Alberta Centre For Toxicology, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Taryn Toic
- Aura Health and Safety Corporation, Burnaby, BC V5H 1Y7, Canada
| | - Tanis Zadunayski
- Division of Preventive Medicine, University of Alberta, Edmonton, AB, T6G 2T4, Canada
| | - Nicola Cherry
- Division of Preventive Medicine, University of Alberta, Edmonton, AB, T6G 2T4, Canada
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Zadunayski T, Broznitsky N, Lichty D, Cherry N. Perceptions of Exposure and Mask Use in Wildland Firefighters. TOXICS 2024; 12:576. [PMID: 39195678 PMCID: PMC11360241 DOI: 10.3390/toxics12080576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/19/2024] [Accepted: 08/02/2024] [Indexed: 08/29/2024]
Abstract
Wildland firefighters are exposed to airborne particulates, polycyclic aromatic hydrocarbons (PAHs), and other hazardous substances. Respiratory protection is indicated, but information is lacking on the tasks and conditions for which mask wearing should be advised. Studies to assess respiratory protection in wildland firefighters were carried out in western Canada in 2021 and 2023. Sampling pumps measured airborne exposures and urinary 1-hydroxypyrene (1-HP) was assayed to indicate PAH absorption. Participants in 2021 reported the time for which they wore the mask during each task. In 2023, the use of masks was reported, and firefighters rated the smoke intensity. In 2021, 72 firefighters were monitored over 164 shifts and, in 2023, 89 firefighters were monitored for 263 shifts. In 2021, mask wearing was highest for those engaged in initial attack and hot spotting. Urinary 1-HP at the end of rotation was highest for those reporting initial attack, working on a prescribed fire and mop-up. In 2023, firefighter ratings of smoke intensity were strongly associated with measured particulate mass and with urinary 1-HP, but masks were not worn more often when there was higher smoke intensity. The data from the literature did not provide a clear indication of high-exposure tasks. Better task/exposure information is needed for firefighters to make informed decisions about mask wearing.
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Affiliation(s)
- Tanis Zadunayski
- Division of Preventive Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada
| | | | - Drew Lichty
- Canada Wildfire, University of Alberta, Edmonton, AB T6G 2H1, Canada
| | - Nicola Cherry
- Division of Preventive Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada
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Cochran SJ, Dunigan-Russell K, Hutton GM, Nguyen H, Schladweiler MC, Jones DP, Williams WC, Fisher AA, Gilmour MI, Dye JA, Smith MR, Miller CN, Gowdy KM. Repeated exposure to eucalyptus wood smoke alters pulmonary gene and metabolic profiles in male Long-Evans rats. Toxicol Sci 2024; 199:332-348. [PMID: 38544285 PMCID: PMC11131017 DOI: 10.1093/toxsci/kfae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Exposure to wildfire smoke is associated with both acute and chronic cardiopulmonary illnesses, which are of special concern for wildland firefighters who experience repeated exposure to wood smoke. It is necessary to better understand the underlying pathophysiology by which wood smoke exposure increases pulmonary disease burdens in this population. We hypothesize that wood smoke exposure produces pulmonary dysfunction, lung inflammation, and gene expression profiles associated with future pulmonary complications. Male Long-Evans rats were intermittently exposed to smoldering eucalyptus wood smoke at 2 concentrations, low (11.0 ± 1.89 mg/m3) and high (23.7 ± 0.077 mg/m3), over a 2-week period. Whole-body plethysmography was measured intermittently throughout. Lung tissue and lavage fluid were collected 24 h after the final exposure for transcriptomics and metabolomics. Increasing smoke exposure upregulated neutrophils and select cytokines in the bronchoalveolar lavage fluid. In total, 3446 genes were differentially expressed in the lungs of rats in the high smoke exposure and only 1 gene in the low smoke exposure (Cd151). Genes altered in the high smoke group reflected changes to the Eukaryotic Initiation Factor 2 stress and oxidative stress responses, which mirrored metabolomics analyses. xMWAS-integrated analysis revealed that smoke exposure significantly altered pathways associated with oxidative stress, lung morphogenesis, and tumor proliferation pathways. These results indicate that intermittent, 2-week exposure to eucalyptus wood smoke leads to transcriptomic and metabolic changes in the lung that may predict future lung disease development. Collectively, these findings provide insight into cellular signaling pathways that may contribute to the chronic pulmonary conditions observed in wildland firefighters.
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Affiliation(s)
- Samuel J Cochran
- Division of Pulmonary, Critical Care and Sleep Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio 43210, USA
| | - Katelyn Dunigan-Russell
- Division of Pulmonary, Critical Care and Sleep Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio 43210, USA
| | - Grace M Hutton
- Division of Pulmonary, Critical Care and Sleep Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio 43210, USA
| | - Helen Nguyen
- Oak Ridge Institute for Science and Education, U.S. Environmental Protection Agency, Center for Public Health and Environmental Assessment, Research Triangle Park, North Carolina 27711, USA
| | - Mette C Schladweiler
- Cardiopulmonary and Immunotoxicology Branch, Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Dean P Jones
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, Georgia 30322, USA
| | - Wanda C Williams
- Cardiopulmonary and Immunotoxicology Branch, Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Anna A Fisher
- Cardiopulmonary and Immunotoxicology Branch, Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - M Ian Gilmour
- Cardiopulmonary and Immunotoxicology Branch, Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Janice A Dye
- Cardiopulmonary and Immunotoxicology Branch, Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - M Ryan Smith
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, Georgia 30322, USA
- Atlanta Veterans Affairs Healthcare System, Decatur, Georgia 30033, USA
| | - Colette N Miller
- Cardiopulmonary and Immunotoxicology Branch, Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Kymberly M Gowdy
- Division of Pulmonary, Critical Care and Sleep Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio 43210, USA
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Panumasvivat J, Sapbamrer R, Sittitoon N, Khacha-Ananda S, Kiratipaisarl W, Sirikul W, Insian W, Assavanopakun P. Exploring the adverse effect of fine particulate matter (PM 2.5) on wildland firefighters' pulmonary function and DNA damage. Sci Rep 2024; 14:7932. [PMID: 38575786 PMCID: PMC10994925 DOI: 10.1038/s41598-024-58721-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 04/02/2024] [Indexed: 04/06/2024] Open
Abstract
Chiang Mai encounters severe pollution during the wildfire season. Wildland firefighters encounter various hazards while engaged in fire suppression operations, which encompass significant exposure to elevated concentrations of air pollutants resulting from combustion, especially particulate matter. The adverse effects of wildfire smoke on respiratory health are a significant concern. The objective of this study was to examine the potential adverse effects of PM2.5 exposure on the respiratory function and DNA damage of wildland firefighters. This prospective cohort study conducted in Chiang Mai from January to May 2022 planned to evaluate the health status of wildland firefighters during the pre-peak, peak, and post-peak ambient air pollution seasons. The measurement of PM2.5 was done at every forest fire station, as well as utilizing data from the Pollution Control Department. Participants received general health examinations, spirometry evaluations, and blood tests for DNA damage analysis. Pair t-tests and multiple regression models were used to examine the connection between pulmonary function parameters (FVC, FEV1) and PM2.5 concentration, with a significance level of P < 0.05. Thirty-three peak-season and twenty-one post-peak-season participants were enrolled. Four pre-peak-season wildland firefighters had FVC and FEV1 declines of > 15%. Multiple regression analysis showed a negative association between PM2.5 exposure and FVC% predicted (- 2.81%, 95% CI - 5.27 to - 0.34%, P = 0.027) and a marginally significant negative correlation with FVC (- 114.38 ml, 95% CI - 230.36 to 1.59 ml, P = 0.053). The remaining pulmonary measures showed a statistically insignificant decline. There were no significant changes in DNA damage detected. Wildland firefighters suffered a significant decline in pulmonary function associated with PM2.5 exposure. Spirometry is crucial for monitoring and promptly identifying respiratory issues that occur during wildfire seasons. Further research is recommended to explore DNA damage alterations and their potential association with PM2.5.
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Affiliation(s)
- Jinjuta Panumasvivat
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- Environmental and Occupational Medicine Excellence Center (EnOMEC), Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Ratana Sapbamrer
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- Environmental and Occupational Medicine Excellence Center (EnOMEC), Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nalin Sittitoon
- School of Environmental Health, Institute of Public Health, Suranaree University of Technology, Nakhon Ratchasima, 30000, Thailand
| | - Supakit Khacha-Ananda
- Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Wuttipat Kiratipaisarl
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Wachiranun Sirikul
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- Environmental and Occupational Medicine Excellence Center (EnOMEC), Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- Center of Data Analytics and Knowledge Synthesis for Health Care, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Wittawat Insian
- Office of Disease Prevention and Control 1 Chiang Mai, Department of Disease Control, Ministry of Public Health, Chiang Mai, 50000, Thailand
| | - Pheerasak Assavanopakun
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
- Environmental and Occupational Medicine Excellence Center (EnOMEC), Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Bowman WS, Schmidt RJ, Sanghar GK, Thompson Iii GR, Ji H, Zeki AA, Haczku A. "Air That Once Was Breath" Part 2: Wildfire Smoke and Airway Disease - "Climate Change, Allergy and Immunology" Special IAAI Article Collection: Collegium Internationale Allergologicum Update 2023. Int Arch Allergy Immunol 2024; 185:617-630. [PMID: 38527432 DOI: 10.1159/000536576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/23/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Population growth and climate change have led to more frequent and larger wildfires, increasing the exposure of individuals to wildfire smoke. Notably, asthma exacerbations and allergic airway sensitization are prominent outcomes of such exposure. SUMMARY Key research questions relate to determining the precise impact on individuals with asthma, including the severity, duration, and long-term consequences of exacerbations. Identifying specific risk factors contributing to vulnerability, such as age, genetics, comorbidities, or environmental factors, is crucial. Additionally, reliable biomarkers for predicting severe exacerbations need exploration. Understanding the long-term health effects of repeated wildfire smoke exposures in individuals with asthma and addressing healthcare disparities are important research areas. KEY MESSAGES This review discusses the need for comprehensive research efforts to better grasp wildfire smoke-induced respiratory health, particularly in vulnerable populations such as farmworkers, firefighters, pregnant women, children, the elderly, and marginalized communities. Effective mitigation would require addressing the current limitations we face by supporting research aimed at a better understanding of wildfire smoke-induced airway disease.
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Scott KA, Wingate KC, DuBose KN, Butler CR, Ramirez-Cardenas A, Hale CR. The wildland firefighter exposure and health effect (WFFEHE) study: cohort characteristics and health behavior changes in context. Ann Work Expo Health 2024; 68:122-135. [PMID: 38164597 PMCID: PMC10922597 DOI: 10.1093/annweh/wxad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES Work is an under-recognized social determinant of health. There is limited research describing US wildland firefighter (WFF) workforce demographics or how to work associates with WFF health behaviors. In this study researchers characterized a WFF cohort and tested hypotheses that WFFs used tobacco, alcohol, and sugar-sweetened beverages (SSBs) differently over the course of the fire season and that different fire crews may exhibit different behavior patterns. METHODS Researchers collected data in the field with 6 WFF crews during 2 consecutive fire seasons (2018 and 2019). WFF crews completed questionnaires before and after each season. WFFs with an initial preseason questionnaire and at least 1 follow-up questionnaire were included (n = 138). Descriptive statistics summarized WFFs' baseline demographic, employment, and health characteristics. Linear mixed models were used to test for changes in WFFs' substance use over time and assess crew-level differences. A meta-analysis of WFF longitudinal studies' population characteristics was attempted to contextualize baseline findings. RESULTS WFFs were predominately male, less than 35 yr of age, non-Hispanic White, and had healthy weight. Smokeless tobacco use and binge drinking were prevalent in this cohort (52% and 78%, respectively, among respondents). Longitudinal analyses revealed that during the fire season WFFs' use of tobacco and SSBs increased and the number of days they consumed alcohol decreased. Crew-level associations varied by substance. The meta-analysis was not completed due to cross-study heterogeneity and inconsistent reporting. DISCUSSION WFF agencies can promote evidence-based substance use prevention and management programs and modify working conditions that may influence WFF stress or substance use.
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Affiliation(s)
- Kenneth A. Scott
- United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, CO, USA
| | | | - Kathleen N. DuBose
- United States Department of the Interior, Office of Wildland Fire, Denver, CO, USA
| | - Corey R. Butler
- United States Department of the Interior, Office of Occupational Safety and Health, Denver, CO, USA
| | - Alejandra Ramirez-Cardenas
- United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, CO, USA
| | - Christa R. Hale
- United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, CO, USA
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Nakayasu ES, Gritsenko MA, Kim YM, Kyle JE, Stratton KG, Nicora CD, Munoz N, Navarro KM, Claborne D, Gao Y, Weitz KK, Paurus VL, Bloodsworth KJ, Allen KA, Bramer LM, Montes F, Clark KA, Tietje G, Teeguarden J, Burnum-Johnson KE. Elucidating regulatory processes of intense physical activity by multi-omics analysis. Mil Med Res 2023; 10:48. [PMID: 37853489 PMCID: PMC10583322 DOI: 10.1186/s40779-023-00477-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/28/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Physiological and biochemical processes across tissues of the body are regulated in response to the high demands of intense physical activity in several occupations, such as firefighting, law enforcement, military, and sports. A better understanding of such processes can ultimately help improve human performance and prevent illnesses in the work environment. METHODS To study regulatory processes in intense physical activity simulating real-life conditions, we performed a multi-omics analysis of three biofluids (blood plasma, urine, and saliva) collected from 11 wildland firefighters before and after a 45 min, intense exercise regimen. Omics profiles post- versus pre-exercise were compared by Student's t-test followed by pathway analysis and comparison between the different omics modalities. RESULTS Our multi-omics analysis identified and quantified 3835 proteins, 730 lipids and 182 metabolites combining the 3 different types of samples. The blood plasma analysis revealed signatures of tissue damage and acute repair response accompanied by enhanced carbon metabolism to meet energy demands. The urine analysis showed a strong, concomitant regulation of 6 out of 8 identified proteins from the renin-angiotensin system supporting increased excretion of catabolites, reabsorption of nutrients and maintenance of fluid balance. In saliva, we observed a decrease in 3 pro-inflammatory cytokines and an increase in 8 antimicrobial peptides. A systematic literature review identified 6 papers that support an altered susceptibility to respiratory infection. CONCLUSION This study shows simultaneous regulatory signatures in biofluids indicative of homeostatic maintenance during intense physical activity with possible effects on increased infection susceptibility, suggesting that caution against respiratory diseases could benefit workers on highly physical demanding jobs.
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Affiliation(s)
- Ernesto S Nakayasu
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA.
| | - Marina A Gritsenko
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Young-Mo Kim
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Jennifer E Kyle
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Kelly G Stratton
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Carrie D Nicora
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Nathalie Munoz
- Environmental and Molecular Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Kathleen M Navarro
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, CO, 80204, USA
| | - Daniel Claborne
- Computational Analytics Division, Pacific Northwest National Laboratory, Richland, WA, 99352, USA
| | - Yuqian Gao
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Karl K Weitz
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Vanessa L Paurus
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Kent J Bloodsworth
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Kelsey A Allen
- National Security Directorate, Pacific Northwest National Laboratory, Richland, WA, 99352, USA
| | - Lisa M Bramer
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Fernando Montes
- Los Angeles County Fire Department, Los Angeles, CA, 90063, USA
| | - Kathleen A Clark
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Respiratory Health Division, Morgantown, WV, 26505, USA
| | - Grant Tietje
- National Security Directorate, Pacific Northwest National Laboratory, Richland, WA, 99352, USA
| | - Justin Teeguarden
- Environmental and Molecular Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA.
- Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR, 97331, USA.
| | - Kristin E Burnum-Johnson
- Environmental and Molecular Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA.
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9
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Mueller AK, Singh A, Webber MP, Hall CB, Prezant DJ, Zeig-Owens R. Comparing self-reported obstructive airway disease in firefighters with and without World Trade Center exposure. Am J Ind Med 2023; 66:243-251. [PMID: 36597815 DOI: 10.1002/ajim.23455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/21/2022] [Accepted: 12/01/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The degree to which routine, non-World Trade Center (WTC) firefighting exposures contribute to the WTC exposure-obstructive airway disease (OAD) relationship is unknown. Our objective was to compare the frequency of self-reported OAD diagnoses in WTC-exposed firefighters from the Fire Department of the City of New York (FDNY) compared with non-WTC-exposed firefighters from other cities and the general population. METHODS A total of 9792 WTC-exposed male FDNY firefighters and 3138 non-WTC-exposed male firefighters from Chicago, Philadelphia, and San Francisco who were actively employed on 9/11/01 and completed a health questionnaire were included. Logistic regression estimated odds ratios of self-reported asthma and COPD diagnoses in firefighters (WTC-exposed vs. non-WTC-exposed; all firefighters vs. general population), adjusting for age, race, smoking status, and last medical visit. RESULTS WTC-exposed firefighters were, on average, younger on 9/11 (mean ± SD = 40.2 ± 7.4 vs. 44.1 ± 9.1) and less likely to report ever-smoking (32.9% vs. 41.8%) than non-WTC-exposed firefighters. Odds of any OAD and asthma were 4.5 and 6.3 times greater, respectively, in WTC-exposed versus non-WTC-exposed. Odds of COPD were also greater in WTC-exposed versus non-WTC-exposed, particularly among never-smokers. Compared with the general population, WTC-exposed firefighters had greater odds of both asthma and COPD, while the nonexposed had lower odds of asthma and greater odds of COPD. CONCLUSIONS Odds ratios for OAD diagnoses were greater in WTC-exposed firefighters versus both non-WTC-exposed and the general population after adjusting for covariates. While asthma and other OADs are known occupational hazards of firefighting, WTC exposure significantly compounded these adverse respiratory effects.
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Affiliation(s)
- Alexandra K Mueller
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Division of Pulmonology, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Ankura Singh
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Division of Pulmonology, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Mayris P Webber
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - David J Prezant
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Division of Pulmonology, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Rachel Zeig-Owens
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Division of Pulmonology, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
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10
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Eden MJ, Matz J, Garg P, Gonzalez MP, McElderry K, Wang S, Gollner MJ, Oakes JM, Bellini C. Prolonged smoldering Douglas fir smoke inhalation augments respiratory resistances, stiffens the aorta, and curbs ejection fraction in hypercholesterolemic mice. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 861:160609. [PMID: 36470384 PMCID: PMC10699119 DOI: 10.1016/j.scitotenv.2022.160609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 06/17/2023]
Abstract
While mounting evidence suggests that wildland fire smoke (WFS) inhalation may increase the burden of cardiopulmonary disease, the occupational risk of repeated exposure during wildland firefighting remains unknown. To address this concern, we evaluated the cardiopulmonary function in mice following a cumulative exposure to lab-scale WFS equivalent to a mid-length wildland firefighter (WLFF) career. Dosimetry analysis indicated that 80 exposure hours at a particulate concentration of 22 mg/m3 yield in mice the same cumulative deposited mass per unit of lung surface area as 3600 h of wildland firefighting. To satisfy this condition, male Apoe-/- mice were whole-body exposed to either air or smoldering Douglas fir smoke (DFS) for 2 h/day, 5 days/week, over 8 consecutive weeks. Particulate size in DFS fell within the respirable range for both mice and humans, with a count median diameter of 110 ± 20 nm. Expiratory breath hold in mice exposed to DFS significantly reduced their minute volume (DFS: 27 ± 4; Air: 122 ± 8 mL/min). By the end of the exposure time frame, mice in the DFS group exhibited a thicker (DFS: 109 ± 3; Air: 98 ± 3 μm) and less distensible (DFS: 23 ± 1; Air: 28 ± 1 MPa-1) aorta with reduced diastolic blood augmentation capacity (DFS: 53 ± 2; Air: 63 ± 2 kPa). Cardiac magnetic resonance imaging further revealed larger end-systolic volume (DFS: 14.6 ± 1.1; Air: 9.9 ± 0.9 μL) and reduced ejection-fraction (DFS: 64.7 ± 1.0; Air: 75.3 ± 0.9 %) in mice exposed to DFS. Consistent with increased airway epithelium thickness (DFS: 10.4 ± 0.8; Air: 7.6 ± 0.3 μm), airway Newtonian resistance was larger following DFS exposure (DFS: 0.23 ± 0.03; Air: 0.20 ± 0.03 cmH2O-s/mL). Furthermore, parenchyma mean linear intercept (DFS: 36.3 ± 0.8; Air: 33.3 ± 0.8 μm) and tissue thickness (DFS: 10.1 ± 0.5; Air: 7.4 ± 0.7 μm) were larger in DFS mice. Collectively, mice exposed to DFS manifested early signs of cardiopulmonary dysfunction aligned with self-reported events in mid-career WLFFs.
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Affiliation(s)
- Matthew J Eden
- Department of Bioengineering, Northeastern University, MA, USA
| | - Jacqueline Matz
- Department of Bioengineering, Northeastern University, MA, USA
| | - Priya Garg
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | | | | | - Siyan Wang
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Michael J Gollner
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Jessica M Oakes
- Department of Bioengineering, Northeastern University, MA, USA
| | - Chiara Bellini
- Department of Bioengineering, Northeastern University, MA, USA.
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11
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Barbosa JV, Farraia M, Branco PTBS, Alvim-Ferraz MCM, Martins FG, Annesi-Maesano I, Sousa SIV. The Effect of Fire Smoke Exposure on Firefighters' Lung Function: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16799. [PMID: 36554677 PMCID: PMC9779288 DOI: 10.3390/ijerph192416799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/07/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
Firefighters are exposed to a range of harmful substances during firefighting. Exposure to fire smoke has been associated with a decrease in their lung function. However, the cause-effect relationship between those two factors is not yet demonstrated. This meta-analysis aimed to evaluate the potential associations between firefighters' occupational exposure and their lung function deterioration. Studies were identified from PubMed, Web of Science, Scopus and Science Direct databases (August 1990-March 2021). The studies were included when reporting the lung function values of Forced Expiratory Volume in 1 s (FEV1) or Forced Vital Capacity (FVC). The meta-analyses were performed using the generic inverse variance in R software with a random-effects model. Subgroup analysis was used to determine if the lung function was influenced by a potential study effect or by the participants' characteristics. A total of 5562 participants from 24 studies were included. No significant difference was found between firefighters' predicted FEV1 from wildland, 97.64% (95% CI: 91.45-103.82%; I2 = 99%), and urban fires, 99.71% (95% CI: 96.75-102.67%; I2 = 98%). Similar results were found for the predicted FVC. Nevertheless, the mean values of firefighters' predicted lung function varied significantly among studies, suggesting many confounders, such as trials' design, statistical methods, methodologies applied, firefighters' daily exposure and career length, hindering an appropriate comparison between the studies.
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Affiliation(s)
- Joana V. Barbosa
- Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE), Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Mariana Farraia
- Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE), Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Pedro T. B. S. Branco
- Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE), Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Maria Conceição M. Alvim-Ferraz
- Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE), Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Fernando G. Martins
- Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE), Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Isabella Annesi-Maesano
- Desbrest Institute of Epidemiology and Public Health (IDESP), Institut National de la Santé et de la Recherche Médicale (INSERM), Montpellier University, 34093 Montpellier, France
| | - Sofia I. V. Sousa
- Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE), Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
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12
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Cherry N, Broznitsky N, Fedun M, Zadunayski T. Respiratory Tract and Eye Symptoms in Wildland Firefighters in Two Canadian Provinces: Impact of Discretionary Use of an N95 Mask during Successive Rotations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13658. [PMID: 36294236 PMCID: PMC9603074 DOI: 10.3390/ijerph192013658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
We examined whether discretionary use of an N95 mask reduced symptom reporting in wildland firefighters. The study collected data from two Canadian provinces during the 2021 fire season, with each firefighter followed for up to 4 rotations. Participants completed questionnaires on symptoms at the start and end of each rotation, when they reported also on mask use (if any) and completed a task checklist. Eighty firefighters contributed data. Nineteen firefighters were successfully fit-tested for N95 masks to wear whenever they felt conditions justified. Start-of-rotation symptoms reflected total hours firefighting in 2021. Symptoms of eye, nose and throat irritation and cough were more bothersome at the end of rotation. Cough, throat and nose (but not eye) symptoms were reported as significantly less bothersome at the end of rotation by those allocated masks, having allowed for crew type and start-of-rotation symptoms. Among those allocated a mask, use was most frequent during initial attack and least during driving and patrol. Reasons for not wearing included high work difficulty and low comfort. It is concluded that symptoms in wildland firefighters increased with hours of exposure. While provision of an N95 mask reduced symptoms, work is needed to overcome barriers to respiratory protection.
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Affiliation(s)
- Nicola Cherry
- Division of Preventive Medicine, University of Alberta, Edmonton, AL T6G 2T4, Canada
| | | | - Mike Fedun
- Alberta Wildfire Service, Agriculture and Forestry Alberta, Edmonton, AL T5S 1L3, Canada
| | - Tanis Zadunayski
- Division of Preventive Medicine, University of Alberta, Edmonton, AL T6G 2T4, Canada
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13
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Evoy R, Hystad P, Bae H, Kincl L. The impact of wildfire smoke and temperature on traumatic worker injury claims, Oregon 2009-2018. Health Sci Rep 2022; 5:e820. [PMID: 36177399 PMCID: PMC9476546 DOI: 10.1002/hsr2.820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 11/07/2022] Open
Abstract
Background and Aims As average temperatures rise and wildfire events increase in the United States, outdoor workers may be at an increased risk of injury. Recent research suggests that heat exposure increases outdoor workers' risk of traumatic injuries, but co-exposures of heat and wildfire smoke have not been evaluated. Methods Oregon workers' compensation data from 2009 to 2018 were linked to satellite data by the date of injury to determine if acute heat (maximum Heat Index) and wildfire smoke (presence/absence) were associated with a traumatic injury. North American Industry Classification System (NAICS) codes were utilized to identify accepted, disabling injury claims from construction (NAICS 23) and agriculture, forestry, fishing, and hunting (NAICS 11). Claims from April to October were analyzed using negative binomial models to calculate incident rate ratios (IRR) by heat and wildfire exposure for All workers and specifically for Agricultural (Ag)/Construction workers. Results During the study period, 91,895 accepted, traumatic injury claims were analyzed. All workers had an injury IRR of 1.04 (95% confidence interval [CI]: 1.02-1.06) while Ag/Construction workers had an IRR of 1.11 (95% CI: 1.06-1.16) when wildfire smoke was present. When the maximum Heat Index was 75°F or greater, the IRR significantly increased as temperatures increased. When the maximum Heat Index was above 80-84°F, All workers had an IRR of 1.04 (95% CI: 1.01-1.06) while Ag/construction workers had an IRR of 1.14 (95% CI: 1.08-1.21) with risk increasing with increased temperatures. In joint models, heat remained associated with injury rates, but not wildfire smoke. No multiplicative interactions between exposures were observed. Conclusion Increasing temperature was associated with increased rates of traumatic injury claims in Oregon that were more pronounced in Ag/Construction workers. Future work should focus on further understanding these associations and effective injury prevention strategies.
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Affiliation(s)
- Richard Evoy
- Environmental and Occupational Health Program, College of Public Health and Human SciencesOregon State UniversityCorvallisOregonUSA
| | - Perry Hystad
- Environmental and Occupational Health Program, College of Public Health and Human SciencesOregon State UniversityCorvallisOregonUSA
| | - Harold Bae
- Biostatistics Program, College of Public Health and Human SciencesOregon State UniversityCorvallisOregonUSA
| | - Laurel Kincl
- Environmental and Occupational Health Program, College of Public Health and Human SciencesOregon State UniversityCorvallisOregonUSA
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14
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Navarro KM, Butler CR, Fent K, Toennis C, Sammons D, Ramirez-Cardenas A, Clark KA, Byrne DC, Graydon PS, Hale CR, Wilkinson AF, Smith DL, Alexander-Scott MC, Pinkerton LE, Eisenberg J, Domitrovich JW. The Wildland Firefighter Exposure and Health Effect (WFFEHE) Study: Rationale, Design, and Methods of a Repeated-Measures Study. Ann Work Expo Health 2022; 66:714-727. [PMID: 34919119 PMCID: PMC9203592 DOI: 10.1093/annweh/wxab117] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 11/18/2021] [Accepted: 12/06/2021] [Indexed: 01/04/2023] Open
Abstract
The wildland firefighter exposure and health effect (WFFEHE) study was a 2-year repeated-measures study to investigate occupational exposures and acute and subacute health effects among wildland firefighters. This manuscript describes the study rationale, design, methods, limitations, challenges, and lessons learned. The WFFEHE cohort included fire personnel ages 18-57 from six federal wildland firefighting crews in Colorado and Idaho during the 2018 and 2019 fire seasons. All wildland firefighters employed by the recruited crews were invited to participate in the study at preseason and postseason study intervals. In 2019, one of the crews also participated in a 3-day midseason study interval where workplace exposures and pre/postshift measurements were collected while at a wildland fire incident. Study components assessed cardiovascular health, pulmonary function and inflammation, kidney function, workplace exposures, and noise-induced hearing loss. Measurements included self-reported risk factors and symptoms collected through questionnaires; serum and urine biomarkers of exposure, effect, and inflammation; pulmonary function; platelet function and arterial stiffness; and audiometric testing. Throughout the study, 154 wildland firefighters participated in at least one study interval, while 144 participated in two or more study interval. This study was completed by the Centers for Disease Control and Prevention's National Institute for Occupational Safety and Health through a collaborative effort with the U.S. Department of Agriculture Forest Service, Department of the Interior National Park Service, and Skidmore College. Conducting research in the wildfire environment came with many challenges including collecting study data with study participants with changing work schedules and conducting study protocols safely and operating laboratory equipment in remote field locations. Forthcoming WFFEHE study results will contribute to the scientific evidence regarding occupational risk factors and exposures that can impact wildland firefighter health over a season and across two wildland fire seasons. This research is anticipated to lead to the development of preventive measures and policies aimed at reducing risk for wildland firefighters and aid in identifying future research needs for the wildland fire community.
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Affiliation(s)
- Kathleen M. Navarro
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, CO, USA,Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, USA,Author to whom correspondence should be addressed. Tel: +1-303-236-5953;
| | - Corey R. Butler
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, CO, USA,United States Department of the Interior, Denver, CO, USA
| | - Kenneth Fent
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, USA
| | - Christine Toennis
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Health Effects Laboratory Division, Cincinnati, OH, USA
| | - Deborah Sammons
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Health Effects Laboratory Division, Cincinnati, OH, USA
| | - Alejandra Ramirez-Cardenas
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, CO, USA
| | - Kathleen A. Clark
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Respiratory Health Division, Morgantown, VA, USA
| | - David C. Byrne
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, USA
| | - Pamela S. Graydon
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, USA
| | - Christa R. Hale
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, CO, USA
| | - Andrea F. Wilkinson
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, USA,First Responder Health and Safety Laboratory, Skidmore College, Saratoga Springs, NY, USA
| | - Denise L. Smith
- First Responder Health and Safety Laboratory, Skidmore College, Saratoga Springs, NY, USA
| | - Marissa C. Alexander-Scott
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Health Effects Laboratory Division, Cincinnati, OH, USA
| | - Lynne E. Pinkerton
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, USA,Maximus, Attain, Falls Church, VA, USA
| | - Judith Eisenberg
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, USA
| | - Joseph W. Domitrovich
- United States Forest Service, National Technology and Development Program, Missoula, MT, USA
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15
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Rajnoveanu AG, Rajnoveanu RM, Motoc NS, Postolache P, Gusetu G, Man MA. COPD in Firefighters: A Specific Event-Related Condition Rather than a Common Occupational Respiratory Disorder. Medicina (B Aires) 2022; 58:medicina58020239. [PMID: 35208563 PMCID: PMC8878660 DOI: 10.3390/medicina58020239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/23/2022] [Accepted: 02/03/2022] [Indexed: 12/02/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Smoking remains the most important risk factor, but occupational exposures may play an essential role as well. Firefighters are among occupations regularly exposed to a variety of irritative inhalational products, and they may be expected to develop respiratory health problems because of such an occupational exposure. To better understand and characterize this relationship, we performed an extensive search of the scientific literature, and we identified two major research areas: firefighters exposed to wildland fire smoke and firefighters involved in the World Trade Centre disaster-related operations. Most of the studies did not report a significant increase in COPD diagnosis in firefighters. An accelerated rate of decline in lung function was seen, a short time after major exposure events. This is the reason for an increased rate of exacerbations observed in individuals already diagnosed with obstructive respiratory disorders. A limited number of studies not covering these specific circumstances of exposure were found. They reported long-term morbidity and mortality data, and the results are controversial. Major confounding factors for most of the studies were the “healthy worker effect” and the lack of useful data regarding smoking habits. Efforts should be made in the future to better characterize specific biomarkers for the progression of COPD; to establish exposure limits; and to implement preventive strategies like rotation of workers, smoking cessation programs, and long-term monitoring programs for respiratory disorders.
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Affiliation(s)
- Armand-Gabriel Rajnoveanu
- Occupational Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Ruxandra-Mioara Rajnoveanu
- Palliative Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-742-029662
| | - Nicoleta Stefania Motoc
- Pneumology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (N.S.M.); (M.A.M.)
| | - Paraschiva Postolache
- Medical Department, Gr T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Gabriel Gusetu
- Cardiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Milena Adina Man
- Pneumology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (N.S.M.); (M.A.M.)
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16
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Pelletier C, Ross C, Bailey K, Fyfe TM, Cornish K, Koopmans E. Health research priorities for wildland firefighters: a modified Delphi study with stakeholder interviews. BMJ Open 2022; 12:e051227. [PMID: 35115350 PMCID: PMC8814744 DOI: 10.1136/bmjopen-2021-051227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The increase in global wildland fire activity has accelerated the urgency to understand health risks associated with wildland fire suppression. The aim of this project was to identify occupational health research priorities for wildland firefighters and related personnel. DESIGN In order to identify, rank and rate health research priorities, we followed a modified Delphi approach. Data collection involved a two-stage online survey followed by semi-structured interviews. SETTING British Columbia, Canada. PARTICIPANTS Participants included any current or past wildland firefighter or individuals engaged in related roles. There were 132 respondents to the first survey. Responses to the first survey were analysed to produce 10 research topics which were ranked by 75 participants in the second survey (response rate: 84%). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the identification, ranking and level of agreement of research priorities through a two-round online survey. We contextualised these findings through deductive and inductive qualitative content analysis of semi-structured interviews. RESULTS The most important research priorities identified were (% consensus): effects of smoke inhalation on respiratory health (89%), fatigue and sleep (80%), mental health (78%), stress (76%) and long-term risk of disease (67%). Interviews were completed with 14 individuals. Two main themes were developed from an inductive content analysis of interview transcripts: (1) understanding the dynamic risk environment; and (2) organisational fit of mitigation strategies. CONCLUSIONS Participants expressed a general concern with the unknown mental and physical health impacts of their jobs, including the long-term risk of morbidity and mortality. Future research must address knowledge gaps in our understanding of the health impacts of wildland fire and work to develop appropriate mitigation strategies while considering the needs of workers and unpredictable workplace environment. TRIAL REGISTRATION NUMBER Open Science Framework, https://osf.io/ugz4s/.
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Affiliation(s)
- Chelsea Pelletier
- School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Christopher Ross
- School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Katherine Bailey
- School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Trina M Fyfe
- Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Katie Cornish
- Health Research Institute, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Erica Koopmans
- Health Research Institute, University of Northern British Columbia, Prince George, British Columbia, Canada
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17
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Chen D, Lawrence KG, Pratt GC, Stenzel MR, Stewart PA, Groth CP, Banerjee S, Christenbury K, Curry MD, Jackson WB, Kwok RK, Blair A, Engel LS, Sandler DP. Fine Particulate Matter and Lung Function among Burning-Exposed Deepwater Horizon Oil Spill Workers. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:27001. [PMID: 35103485 PMCID: PMC8805798 DOI: 10.1289/ehp8930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 11/01/2021] [Accepted: 01/03/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND During the 2010 Deepwater Horizon (DWH) disaster, controlled burning was conducted to remove oil from the water. Workers near combustion sites were potentially exposed to increased fine particulate matter [with aerodynamic diameter ≤2.5μm (PM2.5)] levels. Exposure to PM2.5 has been linked to decreased lung function, but to our knowledge, no study has examined exposure encountered in an oil spill cleanup. OBJECTIVE We investigated the association between estimated PM2.5 only from burning/flaring of oil/gas and lung function measured 1-3 y after the DWH disaster. METHODS We included workers who participated in response and cleanup activities on the water during the DWH disaster and had lung function measured at a subsequent home visit (n=2,316). PM2.5 concentrations were estimated using a Gaussian plume dispersion model and linked to work histories via a job-exposure matrix. We evaluated forced expiratory volume in 1 s (FEV1; milliliters), forced vital capacity (FVC; milliliters), and their ratio (FEV1/FVC; %) in relation to average and cumulative daily maximum exposures using multivariable linear regressions. RESULTS We observed significant exposure-response trends associating higher cumulative daily maximum PM2.5 exposure with lower FEV1 (p-trend=0.04) and FEV1/FVC (p-trend=0.01). In comparison with the referent group (workers not involved in or near the burning), those with higher cumulative exposures had lower FEV1 [-166.8mL, 95% confidence interval (CI): -337.3, 3.7] and FEV1/FVC (-1.7, 95% CI: -3.6, 0.2). We also saw nonsignificant reductions in FVC (high vs. referent: -120.9, 95% CI: -319.4, 77.6; p-trend=0.36). Similar associations were seen for average daily maximum PM2.5 exposure. Inverse associations were also observed in analyses stratified by smoking and time from exposure to spirometry and when we restricted to workers without prespill lung disease. CONCLUSIONS Among oil spill workers, exposure to PM2.5 specifically from controlled burning of oil/gas was associated with significantly lower FEV1 and FEV1/FVC when compared with workers not involved in burning. https://doi.org/10.1289/EHP8930.
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Affiliation(s)
- Dazhe Chen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kaitlyn G. Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Gregory C. Pratt
- Division of Environmental Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mark R. Stenzel
- Exposure Assessment Applications, LLC, Arlington, Virginia, USA
| | | | - Caroline P. Groth
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Sudipto Banerjee
- Department of Biostatistics, Fielding School of Public Health, University of California–Los Angeles, Los Angeles, California, USA
| | | | | | | | - Richard K. Kwok
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
- Office of the Director, National Institute of Environmental Health Sciences, Bethesda, Maryland, USA
| | - Aaron Blair
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Lawrence S. Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
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18
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Koopmans E, Cornish K, Fyfe TM, Bailey K, Pelletier CA. Health risks and mitigation strategies from occupational exposure to wildland fire: a scoping review. J Occup Med Toxicol 2022; 17:2. [PMID: 34983565 PMCID: PMC8725416 DOI: 10.1186/s12995-021-00328-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/24/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Due to accelerating wildland fire activity, there is mounting urgency to understand, prevent, and mitigate the occupational health impacts associated with wildland fire suppression. The objectives of this review of academic and grey literature were to: 1. Identify the impact of occupational exposure to wildland fires on physical, mental, and emotional health; and 2. Examine the characteristics and effectiveness of prevention, mitigation, or management strategies studied to reduce negative health outcomes associated with occupational exposure to wildland fire. METHODS Following established scoping review methods, academic literature as well as government and industry reports were identified by searching seven academic databases and through a targeted grey literature search. 4679 articles were screened using pre-determined eligibility criteria. Data on study characteristics, health outcomes assessed, prevention or mitigation strategies studied, and main findings were extracted from each included document. The results of this scoping review are presented using descriptive tables and a narrative summary to organize key findings. RESULTS The final sample was comprised of 100 articles: 76 research articles and 24 grey literature reports. Grey literature focused on acute injuries and fatalities. Health outcomes reported in academic studies focused on respiratory health (n = 14), mental health (n = 16), and inflammation and oxidative stress (n = 12). The identified studies evaluated short-term outcomes measuring changes across a single shift or wildland fire season. Most research was conducted with wildland firefighters and excluded personnel such as aviation crews, contract crews, and incident management teams. Five articles reported direct study of mitigation strategies, focusing on the potential usage of masks, advanced hygiene protocols to reduce exposure, fluid intake to manage hydration and core temperature, and glutamine supplementation to reduce fatigue. CONCLUSIONS While broad in scope, the evidence base linking wildland fire exposure to any one health outcome is limited. The lack of long-term evidence on changes in health status or morbidity is a clear evidence gap and there is a need to prioritize research on the mental and physical health impact of occupational exposure to wildland fire.
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Affiliation(s)
- Erica Koopmans
- Health Research Institute, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Katie Cornish
- Health Research Institute, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Trina M Fyfe
- Northern Medical Program, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Katherine Bailey
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Chelsea A Pelletier
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada.
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Abstract
Firefighters are the professional force at high risk of suffering potential health consequences due to their chronic exposure to numerous hazardous pollutants during firefighting activities. Unfortunately, determination of fire emission exposure is very challenging. As such, the identification and development of appropriate biomarkers is critical in meeting this need. This chapter presents a critical review of current information related with the use of different urinary biomarkers of effect and exposure in occupationally exposed firefighters over the last 25 years. Evidence suggests that urinary isoprostanes and mutagenicity testing are promising biomarkers of early oxidative stress. Data indicate that firefighters participating in firefighting activities present with increased urinary biomarkers of exposure. These include polycyclic aromatic hydrocarbons, heavy metals and metalloids, organo-chlorine and -phosphorus compounds, environmental phenols, phthalates, benzene and toluene. More studies are urgently needed to better evaluate firefighter occupational safety and health and to support the implementation of preventive measures and mitigation strategies to promote the protection of this chronically exposed group of workers.
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Wu CM, Adetona O, Song C. Acute cardiovascular responses of wildland firefighters to working at prescribed burn. Int J Hyg Environ Health 2021; 237:113827. [PMID: 34403889 DOI: 10.1016/j.ijheh.2021.113827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
Wildland firefighters at prescribed burns are exposed to elevated levels of wildland fire smoke (WFS) while performing physically demanding tasks. WFS exposure has been linked to increases in hospital and emergency admissions for cardiovascular disorders in the general population. However, knowledge about the cardiovascular effect of occupational WFS exposure among wildland firefighters is limited. To provide a better understanding of the effect of this exposure scenario on acute hemodynamic responses, resting systolic/diastolic blood pressure (SBP/DBP) and heart rate (HR) of wildland firefighters were measured before (pre-shift), after (post-shift), and the morning (next morning) immediately following prescribed burn shifts (burn days) and regular work shifts (non-burn days). A total of 38 firefighters (34 males and 4 females) participated in this study and resting BP and HR were recorded on 9 burn days and 7 non-burn days. On burn days, HR significantly increased from pre-to post-shift (13.25 bpm, 95% CI: 7.47 to 19.02 bpm) while SBP significantly decreased in the morning following the prescribed burns compared to pre-shift (-6.25 mmHg, 95% CI: -12.30 to -0.20 mmHg). However, this was due to the decrease of SBP in the firefighters who were hypertensive (-8.46 mmHg, 95% CI: -16.08 to -0.84 mmHg). Significant cross-shift reductions (post-shift/next morning vs. pre-shift) were observed in SBP on burn days compared to non-burn days (-7.01 mmHg, 95% CI: -10.94 to -3.09 mmHg and -8.64 mmHg, 95% CI: -13.81 to -3.47 mmHg, respectively). A significant reduction on burn days was also observed from pre-shift to the following morning for HR compared to non-burn days (-7.28 bpm, 95% CI: -13.50 to -1.06 bpm) while HR significantly increased in pre-to post-shift on burn days compared to non-burn days (10.61 bpm, 95% CI: 5.05 to 16.17 bpm). The decreased BP observed in wildland firefighters might be due to a high level of carbon monoxide exposure and exercise-induced hypotension. The increase in HR immediately after prescribed burns might be attributable to WFS exposure and physical exertion in prescribed burn shifts. The results suggest that wildland firefighting exposure might cause a distinct hemodynamic response, including SBP reduction and HR increment, especially for those who have pre-existing hypertension.
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Affiliation(s)
- Chieh-Ming Wu
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA.
| | - Olorunfemi Adetona
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Chi Song
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
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Navarro KM, Clark KA, Hardt DJ, Reid CE, Lahm PW, Domitrovich JW, Butler CR, Balmes JR. Wildland firefighter exposure to smoke and COVID-19: A new risk on the fire line. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 760:144296. [PMID: 33341613 PMCID: PMC7962897 DOI: 10.1016/j.scitotenv.2020.144296] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/12/2020] [Accepted: 11/30/2020] [Indexed: 05/19/2023]
Abstract
Throughout the United States, wildland firefighters respond to wildfires, performing arduous work in remote locations. Wildfire incidents can be an ideal environment for the transmission of infectious diseases, particularly for wildland firefighters who congregate in work and living settings. In this review, we examine how exposure to wildfire smoke can contribute to an increased likelihood of SARS-CoV-2 infection and severity of coronavirus disease (COVID-19). Human exposure to particulate matter (PM), a component of wildfire smoke, has been associated with oxidative stress and inflammatory responses; increasing the likelihood for adverse respiratory symptomology and pathology. In multiple epidemiological studies, wildfire smoke exposure has been associated with acute lower respiratory infections, such as bronchitis and pneumonia. Co-occurrence of SARS-CoV-2 infection and wildfire smoke inhalation may present an increased risk for COVID-19 illness in wildland firefighters due to PM based transport of SARS CoV-2 virus and up-regulation of angiotensin-converting enzyme II (ACE-2) (i.e. ACE-2 functions as a trans-membrane receptor, allowing the SARS-CoV-2 virus to gain entry into the epithelial cell). Wildfire smoke exposure may also increase risk for more severe COVID-19 illness such as cytokine release syndrome, hypotension, and acute respiratory distress syndrome (ARDS). Current infection control measures, including social distancing, wearing cloth masks, frequent cleaning and disinfecting of surfaces, frequent hand washing, and daily screening for COVID-19 symptoms are very important measures to reduce infections and severe health outcomes. Exposure to wildfire smoke may introduce additive or even multiplicative risk for SARS-CoV-2 infection and severity of disease in wildland firefighters. Thus, additional mitigative measures may be needed to prevent the co-occurrence of wildfire smoke exposure and SARS-CoV-2 infection.
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Affiliation(s)
- Kathleen M Navarro
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, United States of America.
| | - Kathleen A Clark
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Respiratory Health Division, Morgantown, WV, United States of America
| | - Daniel J Hardt
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Spokane, WA, United States of America
| | - Colleen E Reid
- Geography Department, University of Colorado, Boulder, CO, United States of America
| | - Peter W Lahm
- USDA Forest Service, Fire and Aviation Management, Washington, DC, United States of America
| | - Joseph W Domitrovich
- USDA Forest Service, National Technology and Development Program, Missoula, MT, United States of America
| | - Corey R Butler
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, CO, United States of America
| | - John R Balmes
- Department of Medicine, University of California, San Francisco, CA, United States of America; School of Public Health, University of California, Berkeley, CA, United States of America
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22
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Nelson J, Chalbot MCG, Pavicevic Z, Kavouras IG. Characterization of exhaled breath condensate (EBC) non-exchangeable hydrogen functional types and lung function of wildland firefighters. J Breath Res 2020; 14:046010. [PMID: 32969351 DOI: 10.1088/1752-7163/abb761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Inhalation of smoke is shown to be associated with adverse respiratory outcomes in firefighters. Due to invasiveness of procedures to obtain airways lining fluid, the immediate responses of the target organ (i.e. lung) are secondarily assessed through biomarkers in blood and urine. The objective of this study was to identify changes in metabolic profile of exhaled breath condensate (EBC) and lung function of firefighters exposed to wildfires smoke. A total of 29 subjects were studied over 16 events; 14 of these subjects provided cross-shift EBC samples. The predominant types of non-exchangeable hydrogen in EBC were saturated oxygenated hydrogen, aliphatic alkyl and allylic. Non-exchangeable allylic and oxygenated hydrogen concentrations decreased in post-exposure EBC samples. Longer exposures were correlated with increased abundance of oxidized carbon in ketones, acids and esters. Post-exposure lung function declines (forced expiratory volume in 1 s (FEV1): 0.08 l, forced vital capacity (FVC): 0.07 l, FEV1/FVC: 0.03 l, peak expiratory flow (PEF): 0.39 l s-1) indicated airways inflammation. They were related to exposure intensity (FEV1 and FVC) and exposure duration (PEF). This study showed that EBC characterization of non-exchangeable hydrogen types by NMR may provide insights on EBC molecular compositions in response to smoke inhalation and facilitate targeted analysis to identify specific biomarkers.
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Affiliation(s)
- Jordan Nelson
- Department of Environmental Health Sciences, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35219, United States of America
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Abstract
Anthropogenic disasters may be defined as any disaster caused by human action or inaction. Natural disasters occur without human interference. Injuries caused by terrorists and related criminal activities may be broadly grouped into 3 categories: blunt, blast, and penetrating trauma. Most terrorist and criminal activities that create a mass-casualty situation are performed using the weapons most readily available, such as firearms or explosives. A consistent pattern, comparing terrorism with interpersonal violence, is the greater severity of impact on the victim.
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Abstract
Inflammation is a common and essential event in the pathogenesis of diverse diseases. Decades of research has converged on an understanding that all combustion-derived particulate matter (PM) is inflammatory to some extent in the lungs and also systemically, substantially explaining a significant portion of the massive cardiopulmonary disease burden associated with these exposures. In general, this means that efforts to do the following can all be beneficial: reduce particulates at the source, decrease the inflammatory potential of PM output, and, where PM inhalation is unavoidable, administer anti-inflammatory treatment. A range of research, including basic illumination of inflammatory pathways, assessment of disease burden in large cohorts, tailored treatment trials, and epidemiologic, animal, and in vitro studies, is highlighted in this review. However, meaningful translation of this research to decrease the burden of disease and deliver a clear and cohesive message to guide daily clinical practice remains rudimentary. Ongoing efforts to better understand substantial differences in the concentration and type of PM to which the global community is exposed and then distill how that influences inflammation promises to have real-world benefit. This review addresses this complex topic in 3 sections, including ambient PM (typically associated with ground-level transportation), wildfire-induced PM, and PM from indoor biomass burning. Recognizing the overlap between these domains, we also describe differences and suggest future directions to better inform clinical practice and public health.
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Affiliation(s)
- Weidong Wu
- Department of Occupational and Environmental Health, School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Yuefei Jin
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Chris Carlsten
- Air Pollution Exposure Laboratory, Department of Medicine and School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
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25
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Xu X, Shang Y, Tian L, Weng W, Tu J. Fate of the inhaled smoke particles from fire scenes in the nasal airway of a realistic firefighter: A simulation study. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2019; 16:273-285. [PMID: 30668285 DOI: 10.1080/15459624.2019.1572900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Understanding the inhalation, transport and deposition of smoke particles during fire missions are important to evaluating the health risks for firefighters. In this study, measurements from Underwriters Laboratories' large-scale fire experiments on smoke particle size distribution and concentration in three residential fire scenes were incorporated into models to investigate the fate of inhaled toxic ultrafine particulates in a realistic firefighter nasal cavity model. Deposition equations were developed, and the actual particle dosimetry (in mass, number and surface area) was evaluated. A strong monotonic growth of nasal airway dosages of simulated smoke particles was identified for airflow rates and fire duration across all simulated residential fire scene conditions. Even though the "number" dosage of arsenic in the limited ventilation living room fire was similar to the "number" dosage of chromium in the living room, particle mass and surface area dosages simulated in the limited living room were 90-200 fold higher than that in the ventilated living room. These were also confirmed when comparing the dosimetry in the living room and the kitchen. This phenomenon implied that particles with larger size were the dominant factors in mass and surface area dosages. Firefighters should not remove the self-contained breathing apparatus (SCBA) during fire suppression and overhaul operations, especially in smoldering fires with limited ventilation.
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Affiliation(s)
- Xiaoyu Xu
- a Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University , Beijing , China
- b School of Engineering - Mechanical and Automotive , RMIT University , Bundoora , Victoria , Australia
- c School of Mechanical and Manufacturing Engineering , University of New South Wales , Sydney , New South Wales , Australia
| | - Yidan Shang
- b School of Engineering - Mechanical and Automotive , RMIT University , Bundoora , Victoria , Australia
| | - Lin Tian
- b School of Engineering - Mechanical and Automotive , RMIT University , Bundoora , Victoria , Australia
| | - Wenguo Weng
- a Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University , Beijing , China
| | - Jiyuan Tu
- b School of Engineering - Mechanical and Automotive , RMIT University , Bundoora , Victoria , Australia
- c School of Mechanical and Manufacturing Engineering , University of New South Wales , Sydney , New South Wales , Australia
- d Key Laboratory of Ministry of Education for Advanced Reactor Engineering and Safety , Institute of Nuclear and New Energy Technology, Tsinghua University , Beijing , China
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26
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Reinhardt TE, Broyles G. Factors affecting smoke and crystalline silica exposure among wildland firefighters. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2019; 16:151-164. [PMID: 30407130 DOI: 10.1080/15459624.2018.1540873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Smoke exposure data among U.S. wildland firefighters for carbon monoxide, respirable particulate and respirable crystalline silica are presented from a field surveillance program between 2009 and 2012. Models to predict fireline-average exposure to each inhalation hazard were developed and fit to the available data. The models identify factors to consider when defining similar exposure groups and designing future data collection. Task-based rather than shift-average data collection is important because the work activity representing the majority of fireline time, the position up- or downwind of the fire, and the proportion of time this combination represented were significant factors in the model for carbon monoxide, and all but wind position were significant for respirable particulate matter. The wind position versus the fire was not important for respirable quartz exposure. The crew type was an important factor in each model.
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Affiliation(s)
- Timothy E Reinhardt
- a Wood Environment & Infrastructure Solutions, Inc. , Seattle , Washington , USA
| | - George Broyles
- b USDA Forest Service , Technology & Development , Boise , Idaho , USA
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27
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Wu CM, Adetona A, Song C(C, Naeher L, Adetona O. Measuring acute pulmonary responses to occupational wildland fire smoke exposure using exhaled breath condensate. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2019; 75:65-69. [PMID: 30668286 PMCID: PMC6646110 DOI: 10.1080/19338244.2018.1562413] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Wildland firefighters are directly exposed to elevated levels of wildland fire (WF) smoke. Although studies demonstrate WF smoke exposure is associated with lung function changes, few studies that use invasive sample collection methods have been conducted to investigate underlying biochemical changes. These methods are also either unrepresentative of the deeper airways or capable of inducing inflammation. In the present study, levels of biomarkers of oxidative stress (8-isoprostane) and pro-inflammatory response (interleukin-6 [IL-6], interleukin-8 [IL-8], C-reactive protein [CRP], and soluble intercellular adhesion molecule-1 [sICAM-1]) were determined in exhaled breath condensate (EBC) samples that were collected from firefighters before, after, and next morning following prescribed burn and regular work shifts. Results show only a marginal cross-shift increase in 8-isoprostane on burn days (.05 < p value < .1), suggesting WF smoke exposure causes mild pulmonary responses.
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Affiliation(s)
- Chieh-Ming Wu
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH
| | | | - Chi (Chuck) Song
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH
| | - Luke Naeher
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, GA
| | - Olorunfemi Adetona
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH
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Gianniou N, Giannakopoulou C, Dima E, Kardara M, Katsaounou P, Tsakatikas A, Roussos C, Koulouris N, Rovina N. Acute effects of smoke exposure on airway and systemic inflammation in forest firefighters. J Asthma Allergy 2018; 11:81-88. [PMID: 29719412 PMCID: PMC5922237 DOI: 10.2147/jaa.s136417] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The aim of this study was to assess respiratory health and airway and systemic inflammation in professional forest firefighters post firefighting. Methods A total of 60 firefighters who participated in forest firefighting operations in Greece during 2008 were included in the study. A questionnaire consisting of symptoms and exposure, pulmonary function, atopy, bronchial hyperresponsiveness, and markers of inflammation in induced sputum, serum, and bronchoalveolar lavage (BAL) fluid was assessed. Results A measurable eosinophilic and neutrophilic inflammation was shown to be induced in the bronchial airways after acute exposure during forest firefighting. This was associated with increased respiratory symptoms from the upper and lower respiratory tract and pulmonary function impairment. Additionally, a measurable systemic inflammatory response was demonstrated. This study showed that acute exposure during forest firefighting significantly augments the intensity of airway and systemic inflammation in relation to the baseline inflammatory background due to chronic exposure. Conclusion The repeated acute exposures during firefighting augment the burden of chronic airway and systemic inflammation and may eventually lead to allergic sensitization of the airways and increased incidence of rhinitis and asthma after prolonged exposure.
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Affiliation(s)
- Niki Gianniou
- Pulmonary and Critical Care Department, Evangelismos Hospital
| | | | - Efrossini Dima
- 1 Department of Pulmonary Medicine, "Sotiria" Hospital; Athens Medical School
| | - Matina Kardara
- "M. Simos" Laboratories, Department of Critical Care and Pulmonary Services, National and Kapodistrian University of Athens, Athens
| | | | | | - Charis Roussos
- Pulmonary and Critical Care Department, Evangelismos Hospital.,1 Department of Pulmonary Medicine, "Sotiria" Hospital; Athens Medical School.,"M. Simos" Laboratories, Department of Critical Care and Pulmonary Services, National and Kapodistrian University of Athens, Athens
| | - Nikolaos Koulouris
- 1 Department of Pulmonary Medicine, "Sotiria" Hospital; Athens Medical School
| | - Nikoletta Rovina
- 1 Department of Pulmonary Medicine, "Sotiria" Hospital; Athens Medical School
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29
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Black C, Tesfaigzi Y, Bassein JA, Miller LA. Wildfire smoke exposure and human health: Significant gaps in research for a growing public health issue. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2017; 55:186-195. [PMID: 28892756 PMCID: PMC5628149 DOI: 10.1016/j.etap.2017.08.022] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 08/26/2017] [Indexed: 05/02/2023]
Abstract
Understanding the effect of wildfire smoke exposure on human health represents a unique interdisciplinary challenge to the scientific community. Population health studies indicate that wildfire smoke is a risk to human health and increases the healthcare burden of smoke-impacted areas. However, wildfire smoke composition is complex and dynamic, making characterization and modeling difficult. Furthermore, current efforts to study the effect of wildfire smoke are limited by availability of air quality measures and inconsistent air quality reporting among researchers. To help address these issues, we conducted a substantive review of wildfire smoke effects on population health, wildfire smoke exposure in occupational health, and experimental wood smoke exposure. Our goal was to evaluate the current literature on wildfire smoke and highlight important gaps in research. In particular we emphasize long-term health effects of wildfire smoke, recovery following wildfire smoke exposure, and health consequences of exposure in children.
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Affiliation(s)
- Carolyn Black
- California National Primate Research Center, United States
| | | | - Jed A Bassein
- California National Primate Research Center, United States
| | - Lisa A Miller
- California National Primate Research Center, United States; Department of Anatomy, Physiology, and Cell Biology, School of Veterinary Medicine, University of California Davis, Davis, CA, United States.
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30
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Pramchoo W, Geater AF, Jamulitrat S, Geater SL, Tangtrakulwanich B. Occupational Tasks Influencing Lung Function and Respiratory Symptoms Among Charcoal-Production Workers: A Time-Series Study. Saf Health Work 2017; 8:250-257. [PMID: 28951801 PMCID: PMC5605886 DOI: 10.1016/j.shaw.2016.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 11/07/2016] [Accepted: 11/20/2016] [Indexed: 11/25/2022] Open
Abstract
Background Tasks involved in traditional charcoal production expose workers to various levels of charcoal dust and wood smoke. This study aimed to identify specific tasks influencing lung function and respiratory symptoms. Methods Interviews, direct observation, and task/symptom checklists were used to collect data from 50 charcoal-production workers on 3 nonwork days followed by 11 workdays. The peak expiratory flow rate (PEFR) was measured four times per day. Results The PEFR was reduced and the prevalence of respiratory symptoms increased over the first 6–7 workdays. The PEFR increased until evening on nonwork days but not on workdays. Loading the kiln and collecting charcoal from within the kiln markedly reduced the PEFR and increased the odds of respiratory symptoms. Conclusion Tasks involving entry into the kiln were strongly associated with a short-term drop in the PEFR and the occurrence of respiratory symptoms, suggesting a need for the use of protective equipment and/or the operation of an effective kiln ventilation system.
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Affiliation(s)
- Walaiporn Pramchoo
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Alan F Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Silom Jamulitrat
- Department of Community Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sarayut L Geater
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Boonsin Tangtrakulwanich
- Department of Orthopedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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31
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Abreu A, Costa C, Pinho E Silva S, Morais S, do Carmo Pereira M, Fernandes A, Moraes de Andrade V, Teixeira JP, Costa S. Wood smoke exposure of Portuguese wildland firefighters: DNA and oxidative damage evaluation. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2017; 80:596-604. [PMID: 28524757 DOI: 10.1080/15287394.2017.1286896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Portugal is among the European Union countries most devastated by forest fires each year. In the last three decades, more than 3.8 million hectares of forest were burned. Wildland firefighters are exposed to a variety of hazards, including many toxic combustion products that may lead to deleterious health effects. Epidemiological studies showed a positive association between firefighting and several chronic diseases, including cancer. Results from biomonitoring studies in firefighters, particularly concerning genotoxicity evaluation, constitute a valuable tool for investigating important occupational hazards. Thus, the aim of this study was to assess genotoxicity in a group of wildland firefighters using the comet assay for DNA damage and oxidative stress. Both parameters were increased in firefighters compared to controls, but significance was only found for basal DNA damage. No significant influence was found regarding major confounding variables on the genotoxic endpoints studied, with the exception of age. Data obtained provide preliminary information on human health effects of wildland firefighting exposure at genetic and molecular levels. These findings may also provide new important data to serve as public awareness to the potential adverse health risks involving wildland firefighting. Implementation of security and hygiene measures in this sector as well as good practices campaigns may be crucial to decrease risk.
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Affiliation(s)
- Ana Abreu
- a EPIUnit-Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal
- b Environmental Health Department, National Institute of Health, Environmental Health Department , Porto , Portugal
| | - Carla Costa
- a EPIUnit-Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal
- b Environmental Health Department, National Institute of Health, Environmental Health Department , Porto , Portugal
| | - Susana Pinho E Silva
- b Environmental Health Department, National Institute of Health, Environmental Health Department , Porto , Portugal
| | - Simone Morais
- c REQUIMTE/LAQV, Instituto Superior de Engenharia do Instituto Politécnico do Porto Rua Dr. António Bernardino de Almeida , Porto , Portugal
| | - Maria do Carmo Pereira
- d LEPABE, Department of Chemical Engineering, Faculty of Engineering of the University of Porto Rua Dr. Roberto Frias , Porto , Portugal
| | - Adília Fernandes
- e Escola Superior de Saúde, Instituto Politécnico de Bragança, Avenida D. Afonso V , Bragança , Portugal
| | - Vanessa Moraes de Andrade
- f Laboatory of Molecular and Cellular Biology Graduate Programme of Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, UNESC , Santa Catarina , Brazil
| | - João Paulo Teixeira
- a EPIUnit-Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal
- b Environmental Health Department, National Institute of Health, Environmental Health Department , Porto , Portugal
| | - Solange Costa
- a EPIUnit-Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal
- b Environmental Health Department, National Institute of Health, Environmental Health Department , Porto , Portugal
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Butler C, Marsh S, Domitrovich JW, Helmkamp J. Wildland firefighter deaths in the United States: A comparison of existing surveillance systems. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2017; 14:258-270. [PMID: 27754819 PMCID: PMC5702908 DOI: 10.1080/15459624.2016.1250004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Wildland fire fighting is a high-risk occupation requiring considerable physical and psychological demands. Multiple agencies publish fatality summaries for wildland firefighters; however, the reported number and types vary. At least five different surveillance systems capture deaths, each with varying case definitions and case inclusion/exclusion criteria. Four are population-level systems and one is case-based. System differences create challenges to accurately characterize fatalities. Data within each of the five surveillance systems were examined to better understand the types of wildland firefighter data collected, to assess each system's utility in characterizing wildland firefighter fatalities, and to determine each system's potential to inform prevention strategies. To describe similarities and differences in how data were recorded and characterized, wildland fire deaths for three of the population-based systems were matched and individual fatalities across systems were compared. Between 2001 and 2012, 247 unique deaths were captured among the systems; 73% of these were captured in all three systems. Most common causes of death in all systems were associated with aviation, vehicles, medical events, and entrapments/burnovers. The data show that, although the three systems often report similar annual summary statistics, events captured in each system vary each year depending on the types of events that the system is designed to track, such as inclusion/exclusion of fatalities associated with the Hometown Heroes Survivor Benefits Act of 2003. The overarching and central goal of each system is to collect accurate and timely information to improve wildland firefighter safety and health. Each system is unique and has varying inclusion and exclusion criteria for capturing and tracking different subsets of wildland firefighter tasks and duties. Use of a common case definition and better descriptions and interpretations of the data and the results would help to more accurately characterize wildland firefighter traumatic injuries and illnesses, lessen the likelihood for misinterpretation of wildland firefighter fatality data, and assist with defining the true occupational injury burden within this high-risk population.
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Affiliation(s)
- Corey Butler
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, Colorado
| | - Suzanne Marsh
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Safety Research, Morgantown, West Virginia
| | - Joseph W. Domitrovich
- United States Forest Service, Missoula Technology and Development Center, Missoula, Montana
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Measured Pulmonary and Systemic Markers of Inflammation and Oxidative Stress Following Wildland Firefighter Simulations. J Occup Environ Med 2017; 58:407-13. [PMID: 27058482 DOI: 10.1097/jom.0000000000000688] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE A controlled human exposure study was conducted to investigate the impact of inhalational exposures to wood smoke PM2.5 on measured concentrations of airway and systemic inflammatory biomarkers. METHODS Mimicking wildland firefighter activities, 10 participants were exposed to three doses of wood smoke PM2.5 (filtered-air, 250 μg/m, and 500 μg/m) while exercising on a treadmill. Exhaled breath condensate (EBC) and blood plasma samples were obtained pre-, immediately post-, and 1-hour postexposure. 8-isoprostane, pH, and myeloperoxidase were measured in EBC, while H2O2, surfactant protein D, and pentraxin-3 (PTX3) were measured in both EBC and plasma. RESULTS Only pH, 8-isoprostane, and PTX3 displayed significant changes when comparing pre- and postexposures. CONCLUSIONS Markers of inflammation and oxidative stress, including PTX3, pH, and 8-isoprostane in EBC and/or plasma, are sensitive to wood smoke inhalation, with further investigations warranted.
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Adetona O, Reinhardt TE, Domitrovich J, Broyles G, Adetona AM, Kleinman MT, Ottmar RD, Naeher LP. Review of the health effects of wildland fire smoke on wildland firefighters and the public. Inhal Toxicol 2016; 28:95-139. [PMID: 26915822 DOI: 10.3109/08958378.2016.1145771] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Each year, the general public and wildland firefighters in the US are exposed to smoke from wildland fires. As part of an effort to characterize health risks of breathing this smoke, a review of the literature was conducted using five major databases, including PubMed and MEDLINE Web of Knowledge, to identify smoke components that present the highest hazard potential, the mechanisms of toxicity, review epidemiological studies for health effects and identify the current gap in knowledge on the health impacts of wildland fire smoke exposure. Respiratory events measured in time series studies as incidences of disease-caused mortality, hospital admissions, emergency room visits and symptoms in asthma and chronic obstructive pulmonary disease patients are the health effects that are most commonly associated with community level exposure to wildland fire smoke. A few recent studies have also determined associations between acute wildland fire smoke exposure and cardiovascular health end-points. These cardiopulmonary effects were mostly observed in association with ambient air concentrations of fine particulate matter (PM2.5). However, research on the health effects of this mixture is currently limited. The health effects of acute exposures beyond susceptible populations and the effects of chronic exposures experienced by the wildland firefighter are largely unknown. Longitudinal studies of wildland firefighters during and/or after the firefighting career could help elucidate some of the unknown health impacts of cumulative exposure to wildland fire smoke, establish occupational exposure limits and help determine the types of exposure controls that may be applicable to the occupation.
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Affiliation(s)
- Olorunfemi Adetona
- a Department of Environmental Health Science , College of Public Health, University of Georgia , Athens , GA , USA .,b Division of Environmental Health Sciences , College of Public Health, the Ohio State University , Columbus , OH , USA
| | - Timothy E Reinhardt
- c AMEC Foster Wheeler Environment & Infrastructure, Inc , Seattle , WA , USA
| | - Joe Domitrovich
- d USDA Forest Service, Missoula Technology and Development Center , Missoula , MT , USA
| | - George Broyles
- e SDA Forest Service, San Dimas Technology and Development Center , San Dimas , CA , USA
| | - Anna M Adetona
- a Department of Environmental Health Science , College of Public Health, University of Georgia , Athens , GA , USA
| | - Michael T Kleinman
- f Center for Occupational and Environmental Health, University of California , Irvine , CA , USA , and
| | - Roger D Ottmar
- g USDA Forest Service, Pacific Northwest Research Station , Seattle , WA , USA
| | - Luke P Naeher
- a Department of Environmental Health Science , College of Public Health, University of Georgia , Athens , GA , USA
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Gianniou N, Katsaounou P, Dima E, Giannakopoulou CE, Kardara M, Saltagianni V, Trigidou R, Kokkini A, Bakakos P, Markozannes E, Litsiou E, Tsakatikas A, Papadopoulos C, Roussos C, Koulouris N, Rovina N. Prolonged occupational exposure leads to allergic airway sensitization and chronic airway and systemic inflammation in professional firefighters. Respir Med 2016; 118:7-14. [DOI: 10.1016/j.rmed.2016.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/07/2016] [Accepted: 07/07/2016] [Indexed: 11/30/2022]
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Semmens EO, Domitrovich J, Conway K, Noonan CW. A cross-sectional survey of occupational history as a wildland firefighter and health. Am J Ind Med 2016; 59:330-5. [PMID: 26792645 DOI: 10.1002/ajim.22566] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Little is known regarding the impact of long-term wildland firefighting on health. Our objective was to investigate associations between duration of wildland firefighting experience and the prevalence of self-reported health outcomes. METHODS We ascertained employment, health, and demographic information on 499 current wildland firefighters (WLFFs) via questionnaire. RESULTS Relative to those with less than 10 years of experience as a WLFF, those with 10-19 years of experience had significantly greater odds of having ever been diagnosed with hypertension, as did those with 20 or more years of experience. Significant associations were observed for report of physician-diagnosed heart arrhythmia and previous knee surgery. CONCLUSIONS We observed significant links between a greater number of years as a WLFF and self-report of two subclinical cardiovascular risk factors as well as markers of musculoskeletal health. Additional studies are needed to determine if findings can be generalized to all WLFFs.
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Affiliation(s)
- Erin O. Semmens
- Department of Biomedical and Pharmaceutical Sciences; Center for Environmental Health Sciences; University of Montana; Missoula Montana
| | - Joseph Domitrovich
- United States Department of Agriculture Forest Service; Missoula Technology and Development Center; Missoula Montana
| | - Kathrene Conway
- Department of Biomedical and Pharmaceutical Sciences; Center for Environmental Health Sciences; University of Montana; Missoula Montana
| | - Curtis W. Noonan
- Department of Biomedical and Pharmaceutical Sciences; Center for Environmental Health Sciences; University of Montana; Missoula Montana
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Ahn YS, Jeong KS. Mortality due to malignant and non-malignant diseases in Korean professional emergency responders. PLoS One 2015; 10:e0120305. [PMID: 25756281 PMCID: PMC4355623 DOI: 10.1371/journal.pone.0120305] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 02/06/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study was conducted to estimate the cause-specific mortality in male emergency responders (ER), compare with that of Korean men. Mortality was also compared between more experienced firefighters (i.e., firefighters employed ≥ 20 years and firefighters employed ≥ 10 to < 20 years) and less experienced firefighters and non-firefighters (i.e., firefighters employed < 10 years and non-firefighters) to investigate associations between mortality and exposure to occupational hazards. METHODS The cohort was comprised of 33,442 males who were employed as ERs between 1980 and 2007 and not deceased as of 1991. Work history was merged with the death registry from the National Statistical Office of Korea to follow-up on mortality between 1992 and 2007. Standardized mortality ratios (SMR) for ERs were calculated in reference to the Korean male population. Adjusted relative risks (ARRs) of mortalities for firefighters employed ≥ 20 years and ≥ 10 years to < 20 years were calculated in reference to non-firefighters and firefighters employed < 10 years. RESULTS Overall (SMR = 0.43, 95%CI = 0.39-0.47) and some kinds of cause-specific mortalities were significantly lower among ERs compared with the Korean male population. No significant increase in mortality was observed across the major ICD-10 classifications among ERs. Mortality due to exposure to smoke, fire, and flames (SMR = 3.11, 95% CI = 1.87-4.85), however, was significantly increased among ERs. All-cause mortality (ARR = 1.46, 95% CI=1.13-1.89), overall cancer mortality (ARR = 1.54, 95% CI = 1.02-2.31) and mortality of external injury, poisoning and external causes (ARR = 3.13, 95% CI = 1.80-5.46) were significantly increased among firefighters employed ≥ 20 years compared to those of non-firefighters and firefighters employed < 10 years. CONCLUSIONS An increase in mortality due to all cancer and external injury, poisoning, and external causes in firefighters employed ≥ 20 years compared with non-firefighters and firefighters employed < 10 years suggests occupational exposure.
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Affiliation(s)
- Yeon-Soon Ahn
- Department of Occupational and Environmental Medicine, Dongguk University, Dongguk University Ilsan Hospital, Goyang, the Republic of Korea
| | - Kyoung Sook Jeong
- Department of Occupational and Environmental Medicine, Dongguk University, Dongguk University Ilsan Hospital, Goyang, the Republic of Korea
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Gaughan DM, Siegel PD, Hughes MD, Chang CY, Law BF, Campbell CR, Richards JC, Kales SF, Chertok M, Kobzik L, Nguyen PS, O'Donnell CR, Kiefer M, Wagner GR, Christiani DC. Arterial stiffness, oxidative stress, and smoke exposure in wildland firefighters. Am J Ind Med 2014; 57:748-56. [PMID: 24909863 DOI: 10.1002/ajim.22331] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To assess the association between exposure, oxidative stress, symptoms, and cardiorespiratory function in wildland firefighters. METHODS We studied two Interagency Hotshot Crews with questionnaires, pulse wave analysis for arterial stiffness, spirometry, urinary 8-iso-prostaglandin F2α (8-isoprostane) and 8-hydroxy-2'-deoxyguanosine (8-OHdG), and the smoke exposure marker (urinary levoglucosan). Arterial stiffness was assessed by examining levels of the aortic augmentation index, expressed as a percentage. An oxidative stress score comprising the average of z-scores created for 8-OHdG and 8-isoprostane was calculated. RESULTS Mean augmentation index % was higher for participants with higher oxidative stress scores after adjusting for smoking status. Specifically for every one unit increase in oxidative stress score the augmentation index % increased 10.5% (95% CI: 2.5, 18.5%). Higher mean lower respiratory symptom score was associated with lower percent predicted forced expiratory volume in one second/forced vital capacity. CONCLUSIONS Biomarkers of oxidative stress may serve as indicators of arterial stiffness in wildland firefighters.
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Affiliation(s)
- Denise M. Gaughan
- Department of Preventive Medicine and the Institute for Translational Epidemiology; Icahn School of Medicine at Mount Sinai; New York New York
- Department of Environmental Health (Environmental and Occupational Medicine and Epidemiology Program); Harvard School of Public Health; Boston Massachusetts
| | - Paul D. Siegel
- Health Effects Laboratory Division; National Institute for Occupational Safety and Health; Morgantown West Virginia
| | - Michael D. Hughes
- Department of Biostatistics; Harvard School of Public Health; Boston Massachusetts
| | - Chiung-Yu Chang
- Department of Environmental Health (Environmental and Occupational Medicine and Epidemiology Program); Harvard School of Public Health; Boston Massachusetts
| | - Brandon F. Law
- Health Effects Laboratory Division; National Institute for Occupational Safety and Health; Morgantown West Virginia
| | - Corey R. Campbell
- Western States Office; National Institute for Occupational Safety and Health; Denver Colorado
| | - Jennifer C. Richards
- Department of Health and Exercise Science; Colorado State University; Fort Collins Colorado
| | - Stefanos F. Kales
- Department of Environmental Health (Environmental and Occupational Medicine and Epidemiology Program); Harvard School of Public Health; Boston Massachusetts
| | - Marcia Chertok
- Department of Environmental Health (Environmental and Occupational Medicine and Epidemiology Program); Harvard School of Public Health; Boston Massachusetts
| | - Lester Kobzik
- Department of Environmental Health (Molecular and Integrative Physiological Sciences); Harvard School of Public Health; Boston Massachusetts
| | - Phuong-son Nguyen
- Department of Environmental Health (Molecular and Integrative Physiological Sciences); Harvard School of Public Health; Boston Massachusetts
| | - Carl R. O'Donnell
- Beth Israel Deaconess Medical Center; Division of Pulmonary and Critical Care Medicine; Boston Massachusetts
| | - Max Kiefer
- Western States Office; National Institute for Occupational Safety and Health; Denver Colorado
| | - Gregory R. Wagner
- Department of Environmental Health (Environmental and Occupational Medicine and Epidemiology Program); Harvard School of Public Health; Boston Massachusetts
| | - David C. Christiani
- Department of Environmental Health (Environmental and Occupational Medicine and Epidemiology Program); Harvard School of Public Health; Boston Massachusetts
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Gaughan DM, Piacitelli CA, Chen BT, Law BF, Virji MA, Edwards NT, Enright PL, Schwegler-Berry DE, Leonard SS, Wagner GR, Kobzik L, Kales SN, Hughes MD, Christiani DC, Siegel PD, Cox-Ganser JM, Hoover MD. Exposures and cross-shift lung function declines in wildland firefighters. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2014; 11:591-603. [PMID: 24568319 PMCID: PMC7781241 DOI: 10.1080/15459624.2014.895372] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Respiratory problems are common among wildland firefighters. However, there are few studies directly linking occupational exposures to respiratory effects in this population. Our objective was to characterize wildland fire fighting occupational exposures and assess their associations with cross-shift changes in lung function. We studied 17 members of the Alpine Interagency Hotshot Crew with environmental sampling and pulmonary function testing during a large wildfire. We characterized particles by examining size distribution and mass concentration, and conducting elemental and morphological analyses. We examined associations between cross-shift lung function change and various analytes, including levoglucosan, an indicator of wood smoke from burning biomass. The levoglucosan component of the wildfire aerosol showed a predominantly bimodal size distribution: a coarse particle mode with a mass median aerodynamic diameter about 12 μm and a fine particle mode with a mass median aerodynamic diameter < 0.5 μm. Levoglucosan was found mainly in the respirable fraction and its concentration was higher for fire line construction operations than for mop-up operations. Larger cross-shift declines in forced expiratory volume in one second were associated with exposure to higher concentrations of respirable levoglucosan (p < 0.05). Paired analyses of real-time personal air sampling measurements indicated that higher carbon monoxide (CO) concentrations were correlated with higher particulate concentrations when examined by mean values, but not by individual data points. However, low CO concentrations did not provide reliable assurance of concomitantly low particulate concentrations. We conclude that inhalation of fine smoke particles is associated with acute lung function decline in some wildland firefighters. Based on short-term findings, it appears important to address possible long-term respiratory health issues for wildland firefighters. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resources: a file containing additional information on historical studies of wildland fire exposures, a file containing the daily-exposure-severity questionnaire completed by wildland firefighter participants at the end of each day, and a file containing additional details of the investigation of correlations between carbon monoxide concentrations and other measured exposure factors in the current study.].
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Affiliation(s)
- Denise M Gaughan
- a Department of Preventive Medicine and the Institute for Translational Epidemiology , Icahn School of Medicine at Mount Sinai , New York , New York
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Exposure of Wildland Firefighters to Carbon Monoxide, Fine Particles, and Levoglucosan. ACTA ACUST UNITED AC 2013; 57:979-91. [DOI: 10.1093/annhyg/met024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Akpinar-Elci M, White SK, Siegel PD, Park JH, Visotcky A, Kreiss K, Cox-Ganser JM. Markers of upper airway inflammation associated with microbial exposure and symptoms in occupants of a water-damaged building. Am J Ind Med 2013; 56:522-30. [PMID: 23390064 DOI: 10.1002/ajim.22165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Water damage in buildings has been associated with reports of upper airway inflammation among occupants. METHODS This survey included a questionnaire, allergen skin testing, nasal nitric oxide, and nasal lavage on 153 participants. We conducted exposure assessments of 297 workstations and analyzed collected dust for fungi, endotoxin, and (1 → 3)-β-D-glucan to create floor-specific averages. RESULTS Males had higher levels of nasal inflammatory markers, and females reported more symptoms. ECP, IL-8, and MPO were significantly associated with nasal symptoms, flu-like achiness, or chills. Fungi and glucan were positively associated with blowing out thick mucus. Endotoxin was significantly associated with ECP in overall models, and with ECP, IL-8, MPO, and neutrophils among non-atopic females. CONCLUSIONS In this study, we documented an association between endotoxin and nasal inflammatory markers among office workers. The results of our study suggest that a non-allergic response may contribute to symptoms occurring among occupants in this water-damaged building.
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Affiliation(s)
| | - Sandra K. White
- Division of Respiratory Disease Studies; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention; Morgantown, WV
| | - Paul D. Siegel
- Health Effects Laboratory Division; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention; Morgantown, WV
| | - Ju-Hyeong Park
- Division of Respiratory Disease Studies; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention; Morgantown, WV
| | - Alexis Visotcky
- Division of Respiratory Disease Studies; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention; Morgantown, WV
| | - Kathleen Kreiss
- Division of Respiratory Disease Studies; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention; Morgantown, WV
| | - Jean M. Cox-Ganser
- Division of Respiratory Disease Studies; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention; Morgantown, WV
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Adetona O, Zhang JJ, Hall DB, Wang JS, Vena JE, Naeher LP. Occupational exposure to woodsmoke and oxidative stress in wildland firefighters. THE SCIENCE OF THE TOTAL ENVIRONMENT 2013; 449:269-75. [PMID: 23434577 DOI: 10.1016/j.scitotenv.2013.01.075] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 01/17/2013] [Accepted: 01/25/2013] [Indexed: 05/19/2023]
Abstract
Experimental studies indicate that exposure to woodsmoke could induce oxidative stress. However studies have not been conducted among the general population and specialized occupational groups despite the existence of elevated woodsmoke exposure situations. Therefore, we investigated whether there were across workshift changes in oxidative stress biomarkers among wildland firefighters who are occupationally exposed to elevated levels of woodsmoke. We collected pre- and post-workshift urine samples from 19 wildland firefighters before and after prescribed burns. We measured malondialdehyde (MDA) and 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxo-dG) in the samples, and analyzed whether there were cross-shift changes in their levels, and the relationships between the changes and the length of firefighting career, age of firefighter, and quantified workshift exposure to particulate matter. Overall no significant cross-shift change was observed for 8-oxodG or MDA in the urine samples of the firefighters. Changes in both biomarkers were also not associated with PM2.5, which was used as a marker of exposure. However, overall unadjusted geometric mean 8-oxo-dG levels in the samples (31 μg/g creatinine) was relatively higher compared to those measured in healthy individuals in many occupational or general population studies. Additionally, cross-shift changes in 8-oxo-dG excretion were dependent on the length of firefighting career (p=0.01) or age of the subject (p=0.01). Significant increases in 8-oxo-dG level from pre-shift to post-shift were observed for those who had been firefighters for 2 years or less. The results indicate that oxidative stress response measured as cross-shift changes in 8-oxo-dG may depend on age or the length of a firefighter's career. These results suggest the need to investigate the longer term health effects of cumulative exposure of woodsmoke exposure among wildland firefighters, because increased body burden of oxidative stress is a risk factor for many diseases and is theorized to be involved in aging.
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Affiliation(s)
- Olorunfemi Adetona
- The University of Georgia, College of Public Health, Department of Environmental Health Science, Athens, GA 30602, USA
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Dunn KH, Shulman S, Stock AL, Naeher LP. Personal carbon monoxide exposures among firefighters at prescribed forest burns in the Southeastern United States. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2013; 68:55-59. [PMID: 23298425 DOI: 10.1080/19338244.2011.633126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Exposure to combustion products from wildland fires causes respiratory irritation and decreased lung function among firefighters. The authors evaluated carbon monoxide (CO) exposures of a group of wildland firefighters who conducted prescribed burns in the southeastern United States of America. A total of 149 person-days of samples were collected using data logging CO monitors. A questionnaire was administered to collect data on job tasks and self-reported smoke exposure. Overall, the highest exposures were seen amongst firefighters assigned to holding and mop-up tasks (geometric mean [GM]: 2.6 ppm), whereas the lowest were associated with lighting and jobs such as burn boss (GM: 1.6 and 0.3 ppm, respectively). The self-reported smoke exposure showed a significant linear trend with increasing CO exposure. The numbers of acres burned or burn duration, however, were not good predictors of exposure.
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Affiliation(s)
- K H Dunn
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
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Britton C, Lynch CF, Torner J, Peek-Asa C. Fire characteristics associated with firefighter injury on large federal wildland fires. Ann Epidemiol 2012; 23:37-42. [PMID: 23212031 DOI: 10.1016/j.annepidem.2012.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/02/2012] [Accepted: 11/09/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Wildland fires present many injury hazards to firefighters. We estimate injury rates and identify fire-related factors associated with injury. METHODS Data from the National Interagency Fire Center from 2003 to 2007 provided the number of injuries in which the firefighter could not return to his or her job assignment, person-days worked, and fire characteristics (year, region, season, cause, fuel type, resistance to control, and structures destroyed). We assessed fire-level risk factors of having at least one reported injury using logistic regression. Negative binomial regression was used to examine incidence rate ratios associated with fire-level risk factors. RESULTS Of 867 fires, 9.5% required the most complex management and 24.7% required the next-highest level of management. Fires most often occurred in the western United States (82.8%), during the summer (69.6%), caused by lightening (54.9%). Timber was the most frequent fuel source (40.2%). Peak incident management level, person-days of exposure, and the fire's resistance to control were significantly related to the odds of a fire having at least one reported injury. However, the most complex fires had a lower injury incidence rate than less complex fires. CONCLUSIONS Although fire complexity and the number of firefighters were associated with the risk for at least one reported injury, the more experienced and specialized firefighting teams had lower injury incidence.
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Affiliation(s)
- Carla Britton
- Department of Epidemiology, University of Iowa, IA 52242, USA
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Britton C, Lynch CF, Ramirez M, Torner J, Buresh C, Peek-Asa C. Epidemiology of injuries to wildland firefighters. Am J Emerg Med 2012; 31:339-45. [PMID: 23158597 DOI: 10.1016/j.ajem.2012.08.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 08/24/2012] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Wildland fires have significant ecologic and economic impact in the United States. Despite the number of firefighters involved in controlling them, little is known about the injuries that they sustain. We hypothesized that the mechanism of injury would predict injury characteristics and severity of fire-related injuries. METHODS We examined firefighter injuries reported to the US Department of the Interior from the years 2003 to 2007. Associations between the injury mechanism and the injury diagnosis and body part were assessed. A logistic regression model was used to evaluate the odds of disabling injury associated with mechanism of injury after controlling for demographic and temporal variables. RESULTS A total of 1301 nonfatal injuries to wildland firefighters were reported during the 5-year period. Mechanism of injury was significantly associated with the type of injury and injured body part (P ≤ .001). The most common injury mechanism was slips/trips/falls followed by equipment/tools/machinery. Injuries from poisoning or environmental exposure were less likely to lead to severe injury than slips, trips, or falls (odds ratio, 0.45; 95% confidence interval, 0.21-0.95). Compared with injuries in the early and peak season, those in the late season had more than twice the odds of being severe (odds ratio, 2.24; 95% confidence interval, 1.23-4.10). DISCUSSION This study contributes important knowledge for implementing evidence-based injury prevention programs, for planning emergency medical responses on fire incidents and for provoking further inquiry into occupational risk factors affecting this high-risk occupational group.
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Affiliation(s)
- Carla Britton
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
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Adetona O, Hall DB, Naeher LP. Lung function changes in wildland firefighters working at prescribed burns. Inhal Toxicol 2012; 23:835-41. [PMID: 22035123 DOI: 10.3109/08958378.2011.617790] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Although decline in lung function across workshift has been observed in wildland firefighters, measurements have been restricted to days when they worked at fires. Consequently, such results could have been confounded by normal circadian variation associated with lung function. OBJECTIVES We investigated the across-shift changes in lung function of wildland firefighters, and the effect of cumulative exposure on lung function during the burn season. MATERIALS AND METHODS We measured forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), forced expiratory flow from 25% to 75% of FVC (FEF₂₅₋₇₅), and peak expiratory flow (PEF) of wildland firefighters before and after their workshifts. In all, 501 pre-shift and 488 post-shift measurements were collected over 22 prescribed burn days and 43 non-burn days from 24 non-smoking wildland firefighters during the dormant winter burn seasons of 2003 and 2004. We compared changes in the spirometry measures across the workshift on burn days to those observed on non-burn days. We also assessed the effect of cumulative exposure during the burn season on the spirometry measures. RESULTS There were no significant differences in the across workshift changes on burn days compared to those on non-burn days for all the spirometry measures. However, for a given point in time during the season, each additional day of exposure was estimated to be associated with declines of 24 ml in pre-shift FVC and 24 ml in pre-shift FEV₁ (p <0.01). DISCUSSION AND CONCLUSION Cumulative exposure to woodsmoke was associated with slight decrements in lung function among the wildland firefighters.
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Affiliation(s)
- Olorunfemi Adetona
- Department of Environmental Health Science, The University of Georgia, College of Public Health, Athens, GA, USA
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McNamara ML, Semmens EO, Gaskill S, Palmer C, Noonan CW, Ward TJ. Base camp personnel exposure to particulate matter during wildland fire suppression activities. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2012; 9:149-156. [PMID: 22364357 DOI: 10.1080/15459624.2011.652934] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Wildland fire base camps commonly house thousands of support personnel for weeks at a time. The selection of the location of these base camps is largely a strategic decision that incorporates many factors, one of which is the potential impact of biomass smoke from the nearby fire event. Biomass smoke has many documented adverse health effects due, primarily, to high levels of fine particulate matter (PM(2.5)). Minimizing particulate matter exposure to potentially susceptible individuals working as support personnel in the base camp is vital. In addition to smoke from nearby wildland fires, base camp operations have the potential to generate particulate matter via vehicle emissions, dust, and generator use. We monitored particulate matter at three base camps during the fire season of 2009 in Washington, Oregon, and California. During the sampling events, 1-min time-weighted averages of PM(2.5) and particle counts from three size fractions (0.3-0.5 microns, 0.5-1.0 microns, and 1.0-2.5 microns) were measured. Results showed that all PM size fractions (as well as overall PM(2.5) concentrations) were higher during the overnight hours, a trend that was consistent at all camps. Our results provide evidence of camp-based, site-specific sources of PM(2.5) that could potentially exceed the contributions from the nearby wildfire. These exposures could adversely impact wildland firefighters who sleep in the camp, as well as the camp support personnel, who could include susceptible individuals. A better understanding of the sources and patterns of poor air quality within base camps would help to inform prevention strategies to reduce personnel exposures.
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Affiliation(s)
- Marcy L McNamara
- Center for Environmental Health Sciences, Department of Biomedical and Pharmaceutical Sciences, The University of Montana, Missoula, Montana 59812, USA
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Nakayama Wong LS, Aung HH, Lamé MW, Wegesser TC, Wilson DW. Fine particulate matter from urban ambient and wildfire sources from California's San Joaquin Valley initiate differential inflammatory, oxidative stress, and xenobiotic responses in human bronchial epithelial cells. Toxicol In Vitro 2011; 25:1895-905. [PMID: 21703343 DOI: 10.1016/j.tiv.2011.06.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 06/02/2011] [Accepted: 06/03/2011] [Indexed: 01/27/2023]
Abstract
Environmental particulate matter (PM) exposure has been correlated with pathogenesis of acute airway inflammatory disease such as asthma and COPD. PM size and concentration have been studied extensively, but the additional effects of particulate components such as biological material, transition metals, and polycyclic aromatic hydrocarbons could also impact initial disease pathogenesis. In this study, we compared urban ambient particulate matter (APM) collected from Fresno, California with wildfire (WF) particulate matter collected from Escalon, California on early transcriptional responses in human bronchial epithelial cells (HBE). Global gene expression profiling of APM treated HBE activated genes related to xenobiotic metabolism (CYP 1B1), endogenous ROS generation and response genes (DUOX1, SOD2, PTGS2) and pro-inflammatory responses associated with asthma or COPD such as IL-1α, IL-1β, IL-8, and CCL20. WF PM treatments also induced a pro-inflammatory gene response, but elicited a more robust xenobiotic metabolism and oxidative stress response. Inhibitor studies targeting endotoxin, ROS, and trace metals, found endotoxin inhibition had modest selective inhibition of inflammation while inhibition of hydrogen peroxide and transition metals had broad effects suggesting additional interactions with xenobiotic metabolism pathways. APM induced a greater inflammatory response while WF PM had more marked metabolism and ROS related responses.
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Affiliation(s)
- L S Nakayama Wong
- School of Veterinary Medicine, Department of Pathology, Microbiology, and Immunology, University of California, Davis, CA 95616, United States
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Aldrich TK, Gustave J, Hall CB, Cohen HW, Webber MP, Zeig-Owens R, Cosenza K, Christodoulou V, Glass L, Al-Othman F, Weiden MD, Kelly KJ, Prezant DJ. Lung function in rescue workers at the World Trade Center after 7 years. N Engl J Med 2010; 362:1263-72. [PMID: 20375403 PMCID: PMC4940972 DOI: 10.1056/nejmoa0910087] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The terrorist attacks on the World Trade Center on September 11, 2001, exposed thousands of Fire Department of New York City (FDNY) rescue workers to dust, leading to substantial declines in lung function in the first year. We sought to determine the longer-term effects of exposure. METHODS Using linear mixed models, we analyzed the forced expiratory volume in 1 second (FEV(1)) of both active and retired FDNY rescue workers on the basis of spirometry routinely performed at intervals of 12 to 18 months from March 12, 2000, to September 11, 2008. RESULTS Of the 13,954 FDNY workers who were present at the World Trade Center between September 11, 2001, and September 24, 2001, a total of 12,781 (91.6%) participated in this study, contributing 61,746 quality-screened spirometric measurements. The median follow-up was 6.1 years for firefighters and 6.4 years for emergency-medical-services (EMS) workers. In the first year, the mean FEV(1) decreased significantly for all workers, more for firefighters who had never smoked (a reduction of 439 ml; 95% confidence interval [CI], 408 to 471) than for EMS workers who had never smoked (a reduction of 267 ml; 95% CI, 263 to 271) (P<0.001 for both comparisons). There was little or no recovery in FEV(1) during the subsequent 6 years, with a mean annualized reduction in FEV(1) of 25 ml per year for firefighters and 40 ml per year for EMS workers. The proportion of workers who had never smoked and who had an FEV(1) below the lower limit of the normal range increased during the first year, from 3% to 18% for firefighters and from 12% to 22% for EMS workers, stabilizing at about 13% for firefighters and 22% for EMS workers during the subsequent 6 years. CONCLUSIONS Exposure to World Trade Center dust led to large declines in FEV(1) for FDNY rescue workers during the first year. Overall, these declines were persistent, without recovery over the next 6 years, leaving a substantial proportion of workers with abnormal lung function.
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Affiliation(s)
- Thomas K Aldrich
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
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Quirce S, Lemière C, de Blay F, del Pozo V, Gerth Van Wijk R, Maestrelli P, Pauli G, Pignatti P, Raulf-Heimsoth M, Sastre J, Storaas T, Moscato G. Noninvasive methods for assessment of airway inflammation in occupational settings. Allergy 2010; 65:445-58. [PMID: 19958319 DOI: 10.1111/j.1398-9995.2009.02274.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The present document is a consensus statement reached by a panel of experts on noninvasive methods for assessment of airway inflammation in the investigation of occupational respiratory diseases, such as occupational rhinitis, occupational asthma, and nonasthmatic eosinophilic bronchitis. Both the upper and the lower airway inflammation have been reviewed and appraised reinforcing the concept of 'united airway disease' in the occupational settings. The most widely used noninvasive methods to assess bronchial inflammation are covered: induced sputum, fractional exhaled nitric oxide (FeNO) concentration, and exhaled breath condensate. Nasal inflammation may be assessed by noninvasive approaches such as nasal cytology and nasal lavage, which provide information on different aspects of inflammatory processes (cellular vs mediators). Key messages and suggestions on the use of noninvasive methods for assessment of airway inflammation in the investigation and diagnosis of occupational airway diseases are issued.
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Affiliation(s)
- S Quirce
- Department of Allergy, Hospital La Paz, Madrid, Spain
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