Medline ® Abstracts for References 32,33
of 'Reactive airways dysfunction syndrome and irritant-induced asthma'
Symptoms, respirator use, and pulmonary function changes among New York City firefighters responding to the World Trade Center disaster.
Feldman DM, Baron SL, Bernard BP, Lushniak BD, Banauch G, Arcentales N, Kelly KJ, Prezant DJ
CONTEXT: New York City firefighters responding to the World Trade Center (WTC) disaster on September 11, 2001, were exposed to numerous hazards. A medical screening program was conducted 3 weeks after the disaster on a sample of firefighters.
OBJECTIVES: To determine whether arrival time at the WTC and other exposure variables (including respirator use) were associated with symptoms and changes in pulmonary function (after exposure - before exposure).
DESIGN: A cross-sectional comparison of firefighters representing the following groups: (1) firefighters who arrived before/during the WTC collapse, (2) firefighters who arrived 1 to 2 days after the collapse, (3) firefighters who arrived 3 to 7 days after the collapse, and (4) unexposed firefighters.
SETTING: Fire Department of New York City (FDNY) Bureau of Health Services on October 1 to 5, 2001.
POPULATION: A stratified random sample of 362 of 398 recruited working firefighters (91%). Of these, 149 firefighters (41%) were present at the WTC collapse, 142 firefighters (39%) arrived after the collapse but within 48 h, 28 firefighters (8%) arrived 3 to 7 days after the collapse, and 43 firefighters (12%) were unexposed.
MAIN OUTCOME MEASURES: New/worsening symptoms involving the eyes, skin, respiratory system, and nose and throat (NT), and changes in spirometry from before to after exposure.
RESULTS: During the first 2 weeks at the WTC site, 19% of study firefighters reported not using a respirator; 50% reported using a respirator but only rarely. Prevalence ratios (PRs) for skin, eye, respiratory, and NT symptoms showed a dose-response pattern between exposure groups based on time of arrival at the WTC site, with PRs between 2.6 and 11.4 with 95% confidence intervals (CIs) excluding 1.0 for all but skin symptoms. For those spending>7 days at the site, the PR for respiratory symptoms was 1.32 (95% CI, 1.13 to 1.55), compared with those who were exposed for<7 days. Mean spirometry results before and after exposure were within normal limits. The change in spirometry findings (after exposure - before exposure) showed near-equal reductions for FVC and FEV(1). These reductions were greater than the annual reductions measured in a referent population of incumbent FDNY firefighters prior to September 11 (p<or= 0.05). There was a 60% increased risk of a decline of>or= 450 mL in FEV(1) in those arriving during the first 48 h compared to the referent (p<or= 0.05).
CONCLUSIONS: The symptoms and pulmonary function changes following exposure at the WTC demonstrate the need for improvements in respirators and their use, as well as long-term medical monitoring of rescue workers.
National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA.
Adult-onset asthma and wheeze among irritant-exposed bleachery workers.
Andersson E, Olin AC, Hagberg S, Nilsson R, Nilsson T, Torén K
Am J Ind Med. 2003;43(5):532.
BACKGROUND: Whether new-onset asthma is associated with irritant exposure is unclear. The aim was to investigate if occupational exposure to irritant gases, especially repeated peak exposure (gassings), increased the risk of obstructive airways disease.
METHODS: Data on airway symptoms and exposure among bleachery (n = 101) and paper department workers (n = 314) were collected by a questionnaire. Incidence rates and hazard ratios (HR) (Cox regression) were calculated. Non-responders were interviewed by telephone.
RESULTS: The incidence rate for adult-onset physician-diagnosed asthma among bleachery workers reporting gassings giving rise to respiratory symptoms was 7.6/10(3) person-years and for those without gassings 2.2/10(3) person-years, compared to 1.0/10(3) person-years for paper workers. In a Cox regression model for asthma (n = 12), stratified for sex, HR for gassings were 5.6 (95% confidence intervals (CI) 1.6-20), for hay fever 3.0 (95% CI 0.8-11), and for ever smoking 0.7 (95% CI 0.2-2.4). The same model for adult-onset wheeze gave HR of 5.2 (95% CI 2.2-12), 1.7 (95% CI 0.6-5.4), and 1.1(95% CI 0.5-2.7), respectively.
CONCLUSIONS: Repeated peak exposure to irritant gases, here studied as gassings in the pulp industry, increased the risk for both adult-onset asthma and wheeze.
Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden. Eva.Andersson@ymk.gu.se