Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-10T08:17:13.475Z Has data issue: false hasContentIssue false
  • English
  • Français

Trial of Prophylactic Inhaled Steroids to Prevent or Reduce Pulmonary Function Decline, Pulmonary Symptoms, and Airway Hyperreactivity in Firefighters at the World Trade Center Site

Published online by Cambridge University Press:  08 April 2013

Gisela I. Banauch ,
Gabriel Izbicki ,
Vasilios Christodoulou ,
Michael D. Weiden ,
Mayris P. Webber ,
Hillel Cohen ,
Jackson Gustave ,
Robert Chavko ,
Thomas K. Aldrich  and
Kerry J. Kelly
...Show all authors
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Inhaled corticosteroids (ICS) are the most effective anti-inflammatory treatment for asthmatics. This trial evaluated the effects of prophylactic ICS in firefighters exposed to the World Trade Center disaster.

Methods: Inhaled budesonide via a dry powder inhaler (Pulmicort Turbuhaler, AstraZeneca, Wilmington, DE) was offered on-site to New York City firefighters between September 18 and 25, 2001. One to 2 years later, firefighters (n = 64) who completed 4 weeks of daily ICS treatment were evaluated and compared with an age- and exposure-matched comparison group (n = 72) who did not use ICS.

Results: When spirometry results at the final visit were compared with those from the weeks following the 9/11 disaster, the treatment group had a greater increase in forced vital capacity (P = .009) and possibly a slower decline in forced expiratory volume at 1 second (P = .11), as well as a greater improvement in perceived well-being as assessed by the St George's Respiratory Questionnaire (P < .01). There was no difference in airway hyperreactivity and no evidence of adverse effects from ICS.

Conclusions: Because the potential for hazardous exposures is great at many disasters, disease prevention programs based on environmental controls and respiratory protection are warranted immediately. Our results suggest that, pending further study with a larger sample, prophylactic ICS should be considered, along with respiratory protection, to minimize possible lung insult. (Disaster Med Public Health Preparedness. 2008;2:33–39)

Keywords

World Trade Centerinhaled corticosteroidfirefighterspulmonary diseasepreventive medicine
Type
Original Research and Critical Analysis
Information
Disaster Medicine and Public Health Preparedness , Volume 2 , Issue 1 , March 2008 , pp. 33 - 39
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.National Asthma Education and Prevention Program Expert Panel Report. Guidelines for the Diagnosis and Management of Asthma—Updates on Selected Topics 2002. No. 02-5075. Bethesda, MD: National Institutes of Health 2002 .Google Scholar
2.McGee, JK, Chen, LC, Cohen, MDet alChemical analysis of World Trade Center fine particulate matter for use in toxicologic assessment. Environ Health Perspect. 2003;111:972–980.Google Scholar
3.Lioy, PJ, Weisel, CP, Millette, JRet alCharacteristics of the dust/smoke aerosol that settled east of the World Trade Center (WTC) in lower Manhattan after the collapse of the WTC 11 September 2001. Environ Health Perspect. 2002;110:703–714.Google Scholar
4.Pleil, JD, Vette, AF, Johnson, BAet alAir levels of carcinogenic polycyclic aromatic hydrocarbons after the World Trade Center disaster. Proc Natl Acad Sci USA. 2004;101:11685–11688.Google Scholar
5.Centers for Disease Control and Prevention. Potential exposures to airborne and settled surface dust in residential areas of lower Manhattan following the collapse of the World Trade Center—New York City, November 4–December 11, 2001. MMWR Morb Mortal Wkly Rep. 2003;52:131–136.Google Scholar
6.Environmental Protection Agency. Toxicologic Effects of Fine Particulate Matter Derived from the Destruction of the World Trade Center. http://www.epa.gov/nheerl/wtc/WTC_report_7b3i.pdf. Accessed January 26, 2008.Google Scholar
7.Banauch, GI, Dhala, A, Prezant, DJ.Pulmonary disease in rescue workers at the World Trade Center site. Curr Opin Pulm Med. 2005;11:160–168.Google Scholar
8.Prezant, DJ, Kelly, KJ, Jackson, Bet alUse of respiratory protection among responders at the World Trade Center Site—New York City, September 2001. MMWR Morb Mortal Wkly Rep. 2002;51:6–8.Google Scholar
9.Prezant, DJ, Weiden, M, Banauch, GIet alCough and bronchial responsiveness in firefighters at the World Trade Center site. N Engl J Med. 2002;347:806–815.Google Scholar
10.Hankinson, JL, Odencrantz, JR, Fedan, KB.Spirometric reference values from a sample of the general US population. Am J Respir Crit Care Med. 1999;159:179–187.CrossRefGoogle Scholar
11.Standardization of spirometry—1987 update. Statement of the American Thoracic Society. Am Rev Respir Dis. 1987;136:1285–1298.CrossRefGoogle Scholar
12.Single breath carbon monoxide diffusion capacity (transfer factor): recommendations for standard technique. Statement of the American Thoracic Society. Am Rev Respir Dis. 1987;136:1299–1307.CrossRefGoogle Scholar
13.American Thoracic Society. standardization of spirometry, 1994 update. Am Rev Respir Dis. 1994;152:1107–1136.Google Scholar
14.Crapo, RO, Casaburi, R, Coates, ALet alGuidelines for methacholine and exercise challenge testing—1999. Am J Respir Crit Care Med. 2000;161:309–329.Google Scholar
15.Jones, PW, Quirk, FH, Baveystock, CM.The St George's Respiratory Questionnaire. Resp Med. 1991;85 B25–31.CrossRefGoogle ScholarPubMed
16.Wilson, CB, Jones, PW, O'Leary, CJet alValidation of the St George's Respiratory Questionnaire in bronchiectasis. Am J Respir Crit Care. 1997;156:536–541.Google Scholar
17.Banauch, GI, Hall, C, Weiden, Met alPulmonary function loss after World Trade Center exposure in the New York City Fire Department. Am J Respir Crit Care Med. 2006;174:312–319.Google Scholar
18.Tuncale, T, Brooks, S.World trade center dust and reactivity. Am J Respir Crit Care Med. 2004;169:883–885.CrossRefGoogle Scholar
19.Wheeler, K, McKelvey, W, Thorpe, Let alAsthma diagnosed after September 11, 2001, among rescue and recovery workers: findings from the World Trade Center health registry. Environ Health Perspect. 2007;115:1584–1590.Google Scholar
20.American Thoracic Society Quality of Life Resource. http://www.atsqol.org/sections/instruments/pt/pages/george.html. Accessed August 14, 2007.Google Scholar