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. 2024 Jun;202(3):257-267.
doi: 10.1007/s00408-024-00697-z. Epub 2024 May 7.

Interstitial Lung Disease and Progressive Pulmonary Fibrosis: a World Trade Center Cohort 20-Year Longitudinal Study

Krystal L Cleven  1 , Rachel Zeig-Owens  1   2   3 , Alexandra K Mueller  1   2 , Brandon Vaeth  1   2 , Charles B Hall  3 , Jaeun Choi  3 , David G Goldfarb  1   2   3 , David E Schecter  1 , Michael D Weiden  2   4 , Anna Nolan  2   4 , Steve H Salzman  2 , Nadia Jaber  2 , Hillel W Cohen  3 , David J Prezant  5   6   7
Affiliations

Interstitial Lung Disease and Progressive Pulmonary Fibrosis: a World Trade Center Cohort 20-Year Longitudinal Study

Krystal L Cleven et al. Lung. 2024 Jun.

Abstract

Purpose: World Trade Center (WTC) exposure is associated with obstructive airway diseases and sarcoidosis. There is limited research regarding the incidence and progression of non-sarcoidosis interstitial lung diseases (ILD) after WTC-exposure. ILD encompasses parenchymal diseases which may lead to progressive pulmonary fibrosis (PPF). We used the Fire Department of the City of New York's (FDNY's) WTC Health Program cohort to estimate ILD incidence and progression.

Methods: This longitudinal study included 14,525 responders without ILD prior to 9/11/2001. ILD incidence and prevalence were estimated and standardized to the US 2014 population. Poisson regression modeled risk factors, including WTC-exposure and forced vital capacity (FVC), associated with ILD. Follow-up time ended at the earliest of incident diagnosis, end of study period/case ascertainment, transplant or death.

Results: ILD developed in 80/14,525 FDNY WTC responders. Age, smoking, and gastroesophageal reflux disease (GERD) prior to diagnosis were associated with incident ILD, though FVC was not. PPF developed in 40/80 ILD cases. Among the 80 cases, the average follow-up time after ILD diagnosis was 8.5 years with the majority of deaths occurring among those with PPF (PPF: n = 13; ILD without PPF: n = 6).

Conclusions: The prevalence of post-9/11 ILD was more than two-fold greater than the general population. An exposure-response gradient could not be demonstrated. Half the ILD cases developed PPF, higher than previously reported. Age, smoking, and GERD were risk factors for ILD and PPF, while lung function was not. This may indicate that lung function measured after respirable exposures would not identify those at risk for ILD or PPF.

Keywords: Emergency Medical Service Providers; Firefighters; Interstitial lung disease; Progressive pulmonary fibrosis; Pulmonary fibrosis; World trade center.

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Conflict of interest statement

Krystal L. Cleven, Rachel Zeig-Owens, Alexandra K. Mueller, Brandon Vaeth, Charles B. Hall, Jaeun Choi, David G. Goldfarb, Nadia Jaber, Hillel W. Cohen, David J. Prezant reports financial support provided by the National Institute for Occupational Safety and Health (contract numbers 75D301-22-R-72142 and 75D301-22-R-72244). Michael D. Weiden reports a consulting/advisory relationship with Barasch & McGarry Law Firm.

Figures

Fig. 1
Fig. 1
Mean FVC % predicted per year from time of post-9/11 ILD diagnosis by PPF status. Due to small numbers after year 9, follow-up after diagnosis was restricted to 9 years. Abbreviations: FVC, forced vital capacity; ILD, interstitial lung disease; PPF, progressive pulmonary fibrosis
See this image and copyright information in PMC

References

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