TY - JOUR
T1 - Lung function decline before and after treatment of World Trade Center associated obstructive airways disease with inhaled corticosteroids and long-acting beta agonists
AU - Goldfarb, David G.
AU - Putman, Barbara
AU - Lahousse, Lies
AU - Zeig-Owens, Rachel
AU - Vaeth, Brandon M.
AU - Schwartz, Theresa
AU - Hall, Charles B.
AU - Prezant, David J.
AU - Weiden, Michael D.
N1 - Funding Information:
The study was supported by CDC‐NIOSH; cooperative agreement number U01 OH011682 and contracts #200–2011‐39383, #200–2011‐39378, #200–2017‐93426 and #200–2017‐93326.
Funding Information:
The study was supported by CDC-NIOSH; cooperative agreement number U01 OH011682 and contracts #200?2011-39383, #200?2011-39378, #200?2017-93426 and #200?2017-93326.
Publisher Copyright:
© 2021 The Authors. American Journal of Industrial Medicine published by Wiley Periodicals LLC
PY - 2021/10
Y1 - 2021/10
N2 - Background: Greater than average loss of one-second forced expiratory volume (FEV1) 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 FEV1-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 FEV1 measurements before ICS/LABA initiation and two FEV1 measurements posttreatment between September 11, 2001 and September 10, 2019. Linear mixed-effects models were used to estimate FEV1-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 FEV1-slope after adjustment for baseline FEV1, 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 FEV1-slope improvement (7.9 ml/year, 95% CI: −0.5 to 17.2). Conclusions: WTC-exposed firefighters treated with ICS/LABA had improved FEV1 slope after initiation, particularly among those who started earlier. Treatment was, however, not associated with FEV1-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 FEV1-decline who have not responded to ICS/LABA.
AB - Background: Greater than average loss of one-second forced expiratory volume (FEV1) 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 FEV1-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 FEV1 measurements before ICS/LABA initiation and two FEV1 measurements posttreatment between September 11, 2001 and September 10, 2019. Linear mixed-effects models were used to estimate FEV1-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 FEV1-slope after adjustment for baseline FEV1, 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 FEV1-slope improvement (7.9 ml/year, 95% CI: −0.5 to 17.2). Conclusions: WTC-exposed firefighters treated with ICS/LABA had improved FEV1 slope after initiation, particularly among those who started earlier. Treatment was, however, not associated with FEV1-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 FEV1-decline who have not responded to ICS/LABA.
KW - FEV-slope
KW - ICS/LABA
KW - treatment effect
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U2 - 10.1002/ajim.23272
DO - 10.1002/ajim.23272
M3 - Article
C2 - 34254700
AN - SCOPUS:85109669894
SN - 0271-3586
VL - 64
SP - 853
EP - 860
JO - American Journal of Industrial Medicine
JF - American Journal of Industrial Medicine
IS - 10
ER -
