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Background  Greater than average loss of one‐second forced expiratory volume (FEV 1 ) is a risk factor for asthma, chronic obstructive pulmonary disease (COPD), and asthma/COPD overlap syndrome in World Trade Center (WTC)‐exposed firefighters. Inhaled corticosteroids and long‐acting beta agonists (ICS/LABA) are used to treat obstructive airways disease but their impact on FEV 1 ‐trajectory in this population is unknown.    Methods  The study population included WTC‐exposed male firefighters who were treated with ICS/LABA for 2 years or longer (with initiation before 2015), had at least two FEV 1  measurements before ICS/LABA initiation and two FEV 1  measurements posttreatment between September 11, 2001 and September 10, 2019. Linear mixed‐effects models were used to estimate FEV 1 ‐slope pre‐ and post‐treatment.    Results  During follow‐up, 1023 WTC‐exposed firefighters were treated with ICS/LABA for 2 years or longer. When comparing intervals 6 years before and 6 years after treatment, participants had an 18.7 ml/year (95% confidence interval [CI]: 11.3–26.1) improvement in FEV 1 ‐slope after adjustment for baseline FEV 1 , race, height, WTC exposure, weight change, blood eosinophil concentration, and smoking status. After stratification by median date of ICS/LABA initiation (January 14, 2010), earlier ICS/LABA‐initiators had a 32.5 ml/year (95% CI: 19.5–45.5) improvement in slope but later ICS/LABA‐initiators had a nonsignificant FEV 1 ‐slope improvement (7.9 ml/year, 95% CI: −0.5 to 17.2).    Conclusions  WTC‐exposed firefighters treated with ICS/LABA had improved FEV 1  slope after initiation, particularly among those who started earlier. Treatment was, however, not associated with FEV 1 ‐slope improvement if started after the median initiation date (1/14/2010), likely because onset of disease began before treatment initiation. Research on alternative treatments is needed for patients with greater than average FEV 1 ‐decline who have not responded to ICS/LABA.

american journal of industrial medicine

Lung function decline before and after treatment of World Trade Center associated obstructive airways disease with inhaled corticosteroids and long‐acting beta agonists