Steven Stellman - Case-control study of lung function in World Trade Center Health Registry area residents and workers

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      Friedman, S. M., Maslow, C. B., Reibman, J., Pillai, P. S.,   Goldring, R. M., Farfel, M. R., Stellman, S. D., Berger, K. I.   184 (5) 582-9-

      Abstract: RATIONALE: Residents and area workers   who inhaled dust and fumes from the World Trade Center disaster   reported lower respiratory symptoms in two World Trade Center   Health Registry surveys (2003-2004 and 2006-2007), but lung   function data were lacking. OBJECTIVES: To examine the   relationship between persistent respiratory symptoms and   pulmonary function in a nested case-control study of exposed   adult residents and area workers 7-8 years after September 11,   2001. METHODS: Registrants reporting post September 11th onset of   a lower respiratory symptom in the first survey and the same   symptom in the second survey were solicited as potential cases.   Registrants without lower respiratory symptoms in either Registry   survey were solicited as potential control subjects. Final   case-control status was determined by lower respiratory symptoms   at a third interview (the study), when spirometry and impulse   oscillometry were also performed. MEASUREMENTS AND MAIN RESULTS:   We identified 180 cases and 473 control subjects. Cases were more   likely than control subjects to have abnormal spirometry (19% vs.   11%; P < 0.05), and impulse oscillometry measurements of   elevated airway resistance (R5; 68% vs. 27%; P < 0.0001) and   frequency dependence of resistance (R(5)(-)(2)(0); 36% vs. 7%; P   < 0.0001). When spirometry was normal, cases were more likely   than control subjects to have elevated R(5) and R(5)(-)(2)(0)   (62% vs. 25% and 27% vs. 6%, respectively; both P < 0.0001).   Associations between symptoms and oscillometry held when factors   significant in bivariate comparisons (body mass index,   spirometry, and exposures) were analyzed using logistic   regression. CONCLUSIONS: This study links persistent respiratory   symptoms and oscillometric abnormalities in World Trade   Center-exposed residents and area workers. Elevated R(5) and   R(5)(-)(2)(0) in cases despite normal spirometry suggested distal   airway dysfunction as a mechanism for symptoms.

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