Predictors of Asthma/COPD Overlap in FDNY Firefighters With World Trade Center Dust Exposure
| Autor: | Kenneth I. Berger, David J. Prezant, Hillel W. Cohen, Theresa Schwartz, Ankura Singh, Michael D. Weiden, Anna Nolan, Barbara Putman, Rachel Zeig-Owens, Mayris P. Webber, Charles B. Hall, Charles Liu |
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| Rok vydání: | 2018 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty COPD medicine.drug_class business.industry Hazard ratio Eosinophil Critical Care and Intensive Care Medicine medicine.disease respiratory tract diseases Pulmonary function testing 03 medical and health sciences FEV1/FVC ratio 0302 clinical medicine medicine.anatomical_structure 030228 respiratory system Bronchodilator Internal medicine medicine Lung volumes 030212 general & internal medicine Cardiology and Cardiovascular Medicine business Asthma |
| Zdroj: | Chest. 154:1301-1310 |
| ISSN: | 0012-3692 |
| Popis: | Background Previously healthy firefighters with World Trade Center (WTC) dust exposure developed airway disease. Risk factors for irritant-associated asthma/COPD overlap are poorly defined. Methods This study included 2,137 WTC-exposed firefighters who underwent a clinically indicated bronchodilator pulmonary function test (BD-PFT) between 9/11/2001 and 9/10/2017. A post-BD FEV1 increase of > 12% and 200 mL from baseline defined asthma, and a post-BD FEV1/FVC ratio Results BD-PFT diagnosed asthma/COPD overlap in 99 subjects (4.6%), isolated-asthma in 202 (9.5%), and isolated-COPD in 215 (10.1%). Eosinophil concentration ≥ 300 cells/μL was associated with increased risk of asthma/COPD overlap (hazard ratio [HR], 1.85; 95% CI, 1.16-2.95) but not with isolated-asthma or isolated-COPD. Serum IL-4 also predicted asthma/COPD overlap (HR, 1.51 per doubling of cytokine concentration; 95% CI, 1.17-1.95). Greater IL-21 concentration was associated with both isolated-asthma and isolated-COPD (HRs of 1.73 [95% CI, 1.27-2.35] and 2.06 [95% CI, 1.31-3.23], respectively). Conclusions In WTC-exposed firefighters, elevated blood eosinophil and IL-4 levels are associated with subsequent asthma/COPD overlap. Disease-specific T-helper cell type 2 biomarkers present years before diagnosis suggest patient-intrinsic predisposition to irritant-associated asthma/COPD overlap. |
| Databáze: | OpenAIRE |
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