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Review
. 2022 Dec 14;19(24):16799.
doi: 10.3390/ijerph192416799.

The Effect of Fire Smoke Exposure on Firefighters' Lung Function: A Meta-Analysis

Joana V Barbosa  1   2 , Mariana Farraia  1 , Pedro T B S Branco  1   2 , Maria Conceição M Alvim-Ferraz  1   2 , Fernando G Martins  1   2 , Isabella Annesi-Maesano  3 , Sofia I V Sousa  1   2
Affiliations
Review

The Effect of Fire Smoke Exposure on Firefighters' Lung Function: A Meta-Analysis

Joana V Barbosa et al. Int J Environ Res Public Health. .

Abstract

Firefighters are exposed to a range of harmful substances during firefighting. Exposure to fire smoke has been associated with a decrease in their lung function. However, the cause-effect relationship between those two factors is not yet demonstrated. This meta-analysis aimed to evaluate the potential associations between firefighters' occupational exposure and their lung function deterioration. Studies were identified from PubMed, Web of Science, Scopus and Science Direct databases (August 1990-March 2021). The studies were included when reporting the lung function values of Forced Expiratory Volume in 1 s (FEV1) or Forced Vital Capacity (FVC). The meta-analyses were performed using the generic inverse variance in R software with a random-effects model. Subgroup analysis was used to determine if the lung function was influenced by a potential study effect or by the participants' characteristics. A total of 5562 participants from 24 studies were included. No significant difference was found between firefighters' predicted FEV1 from wildland, 97.64% (95% CI: 91.45-103.82%; I2 = 99%), and urban fires, 99.71% (95% CI: 96.75-102.67%; I2 = 98%). Similar results were found for the predicted FVC. Nevertheless, the mean values of firefighters' predicted lung function varied significantly among studies, suggesting many confounders, such as trials' design, statistical methods, methodologies applied, firefighters' daily exposure and career length, hindering an appropriate comparison between the studies.

Keywords: FVC and FEV1; firefighters; lung function; meta-analysis; occupational exposure.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram describing the search and selection procedures of the meta-analysis.
Figure 2
Figure 2
Predicted FEV1 in firefighters stratified by studies’ publication year. Forest plot displaying the weight of the predicted FEV1 mean value and heterogeneity [13,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62].
Figure 3
Figure 3
Predicted FEV1 in firefighters stratified by study location. Forest plot displaying the weight of the predicted FEV1 mean value and heterogeneity [13,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62].
Figure 4
Figure 4
Predicted FEV1 in firefighters stratified by participants’ age. Forest plot displaying the weight of the predicted FEV1 mean value and heterogeneity [13,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,56,57,58,59,60,61,62].
Figure 5
Figure 5
Predicted FEV1 in firefighters stratified by smoking practices. Forest plot displaying the weight of the predicted FEV1 mean value and heterogeneity. “Non-smokers” was assigned to all the studies wherein less than or equal to 10% of the participants were smokers, and “Smokers” was assigned to the studies wherein more than 10% of the participants were smokers [13,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,56,57,58,59,60,61,62].
Figure 6
Figure 6
Predicted FEV1 in firefighters stratified by fire type. Forest plot displaying the weight of the predicted FEV1 mean value and heterogeneity [13,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62].
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