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Chest. Lessons from the WTC Disaster: Airway Disease Presenting as Restrictive Dysfunction
[Source: Chest, full page: (LINK). Abstract, edited.]
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Original Research| February 7, 2013
Lessons from the WTC Disaster: Airway Disease Presenting as Restrictive Dysfunction
Kenneth I. Berger, MD; Joan Reibman, MD; Beno W. Oppenheimer, MD; Ioannis Vlahos, MD; Denise Harrison, MD; Roberta M. Goldring
Author and Funding Information: Andr? Cournand Pulmonary Physiology Laboratory (Berger, Oppenheimer, Goldring); World Trade Center Environmental Health Center, Bellevue Hospital (Berger, Reibman, Goldring); Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine (Berger, Reibman, Oppenheimer, Harrison, Goldring); Department of Radiology, St. George?s Healthcare NHS Trust (Vlahos); NYU World Trade Center Health Program Clinical Center of Excellence (Harrison)
Corresponding author: Kenneth I. Berger, M.D., Associate Professor of Medicine, Physiology and Neuroscience, New York University School of Medicine, 550 First Ave, Room RR-108, New York, NY 10016 Email: kenneth.berger@nyumc.org
Supported by: Centers for Disease Control [grant 200-2011-39413]; National Institute for Occupational Safety & Health [grant 5E11OH009630]; and American Red Cross Liberty Disaster Relief Fund, City of New York.
CHEST. February 7, 2013doi:10.1378/chest.12-1411 - Published online
Abstract
Introduction:
The present study: 1) characterizes a physiologic phenotype of restrictive dysfunction due to airway injury; and 2) compares this phenotype to the phenotype of interstitial lung disease (ILD).
Methods:
Retrospective study of 54 persistently symptomatic subjects following World Trade Center (WTC) dust exposure. Inclusion criteria were, reduced vital capacity (VC), FEV<SUB>1</SUB>/VC >77%, and normal chest roentgenogram. Measurements included spirometry, plethysmography, diffusing capacity (D<SUB>L</SUB>CO), impulse oscillometry (IOS), inspiratory/expiratory computed tomography (CT) and lung compliance (n=16).
Results:
VC was reduced (46-83% predicted) due to reduction of expiratory reserve volume (43?26% predicted) with preservation of inspiratory capacity (85?16% predicted). Total lung capacity (TLC) was reduced confirming restriction (73?8% predicted), however, elevated residual volume to TLC ratio (0.35?0.08) suggested air trapping. D<SUB>L</SUB>CO was reduced (78?15% predicted) with elevated D<SUB>L</SUB>CO/alveolar volume (5.3?0.8 [ml/mmHg/min]/l). IOS demonstrated abnormalities in resistance and/or reactance in 50/54 subjects. CT demonstrated bronchial wall thickening and/or air trapping in 40/54 subjects; parenchymal disease was not evident in any subject. Specific compliance at FRC (0.07?0.02 [l/cmH<SUB>2</SUB>O]/l) and recoil pressure (P<SUB>el</SUB>) at TLC (27?7 cmH<SUB>2</SUB>O) were normal. In contrast to ILD patients, lung expansion was not limited since inspiratory capacity, P<SUB>el</SUB> and inspiratory muscle pressure were normal. Reduced TLC was attributable to reduced FRC, compatible with airway closure in the tidal range.
Conclusions:
This study describes a distinct physiologic phenotype of restriction due to airway dysfunction. This pattern was observed following WTC dust exposure, has been reported in other clinical settings (e.g. asthma), and should be incorporated into the definition of restrictive dysfunction.
-Lessons from the WTC Disaster: Airway Disease Presenting as Restrictive Dysfunction
Kenneth I. Berger, MD; Joan Reibman, MD; Beno W. Oppenheimer, MD; Ioannis Vlahos, MD; Denise Harrison, MD; Roberta M. Goldring
Author and Funding Information: Andr? Cournand Pulmonary Physiology Laboratory (Berger, Oppenheimer, Goldring); World Trade Center Environmental Health Center, Bellevue Hospital (Berger, Reibman, Goldring); Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine (Berger, Reibman, Oppenheimer, Harrison, Goldring); Department of Radiology, St. George?s Healthcare NHS Trust (Vlahos); NYU World Trade Center Health Program Clinical Center of Excellence (Harrison)
Corresponding author: Kenneth I. Berger, M.D., Associate Professor of Medicine, Physiology and Neuroscience, New York University School of Medicine, 550 First Ave, Room RR-108, New York, NY 10016 Email: kenneth.berger@nyumc.org
Supported by: Centers for Disease Control [grant 200-2011-39413]; National Institute for Occupational Safety & Health [grant 5E11OH009630]; and American Red Cross Liberty Disaster Relief Fund, City of New York.
CHEST. February 7, 2013doi:10.1378/chest.12-1411 - Published online
Abstract
Introduction:
The present study: 1) characterizes a physiologic phenotype of restrictive dysfunction due to airway injury; and 2) compares this phenotype to the phenotype of interstitial lung disease (ILD).
Methods:
Retrospective study of 54 persistently symptomatic subjects following World Trade Center (WTC) dust exposure. Inclusion criteria were, reduced vital capacity (VC), FEV<SUB>1</SUB>/VC >77%, and normal chest roentgenogram. Measurements included spirometry, plethysmography, diffusing capacity (D<SUB>L</SUB>CO), impulse oscillometry (IOS), inspiratory/expiratory computed tomography (CT) and lung compliance (n=16).
Results:
VC was reduced (46-83% predicted) due to reduction of expiratory reserve volume (43?26% predicted) with preservation of inspiratory capacity (85?16% predicted). Total lung capacity (TLC) was reduced confirming restriction (73?8% predicted), however, elevated residual volume to TLC ratio (0.35?0.08) suggested air trapping. D<SUB>L</SUB>CO was reduced (78?15% predicted) with elevated D<SUB>L</SUB>CO/alveolar volume (5.3?0.8 [ml/mmHg/min]/l). IOS demonstrated abnormalities in resistance and/or reactance in 50/54 subjects. CT demonstrated bronchial wall thickening and/or air trapping in 40/54 subjects; parenchymal disease was not evident in any subject. Specific compliance at FRC (0.07?0.02 [l/cmH<SUB>2</SUB>O]/l) and recoil pressure (P<SUB>el</SUB>) at TLC (27?7 cmH<SUB>2</SUB>O) were normal. In contrast to ILD patients, lung expansion was not limited since inspiratory capacity, P<SUB>el</SUB> and inspiratory muscle pressure were normal. Reduced TLC was attributable to reduced FRC, compatible with airway closure in the tidal range.
Conclusions:
This study describes a distinct physiologic phenotype of restriction due to airway dysfunction. This pattern was observed following WTC dust exposure, has been reported in other clinical settings (e.g. asthma), and should be incorporated into the definition of restrictive dysfunction.
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