Association of low FVC spirometric pattern with WTC occupational exposures

Abstract

Background: A reduced forced vital capacity without obstruction (low FVC) is the predominant spirometric abnormality reported in workers and volunteers exposed to dust, gases, and fumes at the World Trade Center (WTC) disaster site in 2001-2002. While low FVC has been associated with obesity and metabolic syndrome, its association with WTC occupational exposures has not been demonstrated. We estimated the prevalence of this abnormality and examined its association with WTC exposure level.

Methods: Longitudinal study of the relation between arrival at the WTC site within 48 h and FVC below the lower limit of normal (FVC < LLN, with normal FEV1/FVC ratio) at any time in 10,284 workers with at least two spirometries between 2002 and 2018. Logistic regression and linear mixed models were used for the multivariable analyses.

Results: The prevalence of low FVC increased from 17.0% (95% CI 15.4%, 18.5%) in June 2003, to 26.4% (95% CI 24.8%, 28.1%) in June 2018, and exceeded at both times that of obstruction. The rate of FVC decline was -43.7 ml/year during the study period. In a multivariable analysis adjusting for obesity, metabolic syndrome indicators, and other factors, early arrival at the WTC disaster site was significantly associated with low FVC, but only among men (ORadj = 1.29, 95% CI 1.17, 1.43). Longitudinal FVC rate of decline did not differ by WTC site arrival time.

Conclusions: Among WTC workers, the prevalence of low FVC increased over a 16-year period. Early arrival to the WTC disaster site was significantly associated with low FVC in males.

Keywords: 2001; Longitudinal changes in lung function; Occupational lung disease; Smoke inhalation injury; Spirometry; World Trade Center attack.

Conflict of interest statement

Conflict of interest disclosures:

This work was supported by cooperative agreements No. U01 OH011300 (AN, PI), U01 OH010401 and U01 OH011697 (RED, PI), and contract 200-2017-93325 (WTC General Responders Cohort Data Center, RGL, PI) from the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health (CDCP/NIOSH). The authors had no other relevant financial conflict of interest. The contents of this article are the sole responsibility of the authors and do not necessarily represent the official views of the CDCP/NIOSH.

Copyright © 2020 Elsevier Ltd. All rights reserved.

Figures

Figure 1.

Study flowchart.