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Lung function decline before and after treatment of World Trade Center associated obstructive airways disease with inhaled corticosteroids and long‐acting beta agonists
Author(s) -
Goldfarb David G.,
Putman Barbara,
Lahousse Lies,
ZeigOwens Rachel,
Vaeth Brandon M.,
Schwartz Theresa,
Hall Charles B.,
Prezant David J.,
Weiden Michael D.
Publication year - 2021
Publication title -
american journal of industrial medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.7
H-Index - 104
eISSN - 1097-0274
pISSN - 0271-3586
DOI - 10.1002/ajim.23272
Subject(s) - medicine , copd , asthma , population , confidence interval , inhalation , world trade center , anesthesia , environmental health , archaeology , terrorism , history
Abstract 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.