Faculty Bibliography

BACKGROUND: Few longitudinal studies characterize firefighters' pulmonary function. We sought to determine whether firefighters have excessive FEV1 decline rates compared with controls. METHODS: We examined serial FEV1s from approximately 6 months pre-hire to approximately 5 years post-hire in newly-hired male, never-smoking, non-Hispanic Black and White firefighters, hired between 2003-2006, without prior respiratory disease or World Trade Center exposure. Similarly-defined Emergency Medical Service (EMS) workers served as controls. RESULTS: Through 6/30/2011, 940 (82%) firefighters and 97 (72%) EMS workers who met study criteria had >/=4 acceptable post-hire spirometries. Pre-hire FEV1% averaged higher for firefighters than EMS: 99% vs. 95%, reflecting more stringent job entry criteria. FEV1 (adjusted for baseline age & height) declined by an average of 45ml/yr both for firefighters and EMS, with Fire-EMS decline rate differences averaging 0.2 ml/yr (CI -9.2,9.6). 4% of each group had FEV1<lower limit of normal before hire, increasing to 7% for firefighters and 17.5% for EMS, but similar percentages of both groups had adjusted FEV1 decline rates >10%. Mixed effects modeling showed significant influence of weight gain but not baseline weight: FEV1 declined by approximately 8 ml per kg gained for both groups. Adjusting for weight change, FEV1 decline averaged 38 ml/yr for firefighters, 34 ml/yr for EMS. CONCLUSION: During the first 5 years of duty, firefighters do not show greater longitudinal FEV1 decline than EMS controls, and fewer of them develop abnormal lung function. Weight gain is associated with a small loss of lung function, of questionable clinical relevance in this fit and active population.1Pulmonary Medicine Division, Dept of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY. taldrich@montefiore.org; mdinkels@montefiore.org2Bureau of Health Services and Office of Medical Affairs, New York City Fire Dept, Brooklyn, NY. Yef@fdny.nyc.gov; webberm@fdny.nyc.gov; cosenzka@fdny.nyc.gov; christv@fdny.nyc.gov; kellykj@fdny.nyc.gov; Prezand@fdny.nyc.gov3Biostatistics Division, Dept of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY. charles.hall@einstein.yu.edu; hillel.cohen@einstein.yu.edu4Epidemiology Division, Dept of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY. webberm@fdny.nyc.gov; hillel.cohen@einstein.yu.edu5Pulmonary Medicine Division, Dept of Medicine, NYU School of Medicine, NY, NY. michael.weiden@nyumc.org; anna.nolan@med.nyu.eduAddress reprint requests to: Thomas Aldrich, MD, Pulmonary Medicine Division, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10467, or taldrich@montefiore.orgFunding/Support:This work was supported by the National Institutes of Health [Grants K23HL084191, K24A1080298, RO1HL057879, HL090316, U01CA008617, U10-OH008243, U10-OH008242].

BACKGROUND: Tuberculosis (TB) causes 1.45 million deaths annually world wide, the majority of which occur in the developing world. Active TB disease represents immune failure to control latent infection from airborne spread. Acid-fast bacillus (AFB) seen on sputum smear is a biomarker for contagiousness. METHODS: We enrolled 73 tuberculosis patients with extensive infiltrates into a research study using bronchoalveolar lavage (BAL) to sample lung immune cells and assay BAL cell cytokine production. All patients had sputum culture demonstrating Mycobacterium tuberculosis and 59/73 (81%) had AFB identified by microscopy of the sputum. Compared with smear negative patients, smear positive patients at presentation had a higher proportion with smoking history, a higher proportion with temperature >38.5(0) C, higher BAL cells/ml, lower percent lymphocytes in BAL, higher IL-4 and IL-12p40 in BAL cell supernatants. There was no correlation between AFB smear and other BAL or serum cytokines. Increasing IL-4 was associated with BAL PMN and negatively associated with BAL lymphocytes. Each 10-fold increase in BAL IL-4 and IL-12p40 increased the odds of AFB smear positivity by 7.4 and 2.2-fold, respectively, in a multi-variable logistic model. CONCLUSION: Increasing IL-4 and IL-12p40 production by BAL cells are biomarkers for AFB in sputum of patients who present with radiographically advanced TB. They likely reflect less effective immune control of pathways for controlling TB, leading to patients with increased infectiousness.

OBJECTIVE: After 9/11/2001, some Fire Department of New York (FDNY) workers had excessive lung function decline. We hypothesized that early serum matrix metalloproteinases (MMP) expression predicts World Trade Center-Lung Injury (WTC-LI) years later. METHODS: This is a nested case-control analysis of never-smoking male firefighters with normal pre-exposure Forced Expiratory Volume in one second (FEV1) who had serum drawn up to 155 days post 9/11/2001. Serum MMP-1, 2,3,7,8, 9, 12 and 13 were measured. Cases of WTC-LI (N = 70) were defined as having an FEV1 one standard deviation below the mean (FEV1