Abstract Rationale We have previously shown short term lung function trajectories in community members (survivors) exposed to the environmental disaster from World Trade Center destruction. However, the long-term effect on lung function trajectories remains unclear. Moreover, evaluation of post- as well as pre-bronchodilator (BD) measures can distinguish between persistent and reversible impairments in the exposed population. Methods We analyzed pre- and post-BD FEV1 and FVC measurements from 6,636 participants enrolled and followed in the WTC Environmental Health Center (EHC) between 2007 and 2023. We used acute exposure to the WTC dust defined by dust-cloud exposure status (yes or no). Linear mixed-effects models were used to estimate longitudinal changes in lung function associated with WTC dust-cloud exposure, adjusting for age, sex, height, race/ethnicity, income, BMI category, and smoking status. Interaction terms between time and dust-cloud exposure, BMI category, and smoking status were included to identify whether these factors modified the rate of lung function decline over time. Results Longitudinally, post-BD spirometry measures showed more evident effect of dust-cloud exposure and smoking compared with pre-BD measures. Post-BD FEV1 declined more rapidly among dust-cloud-exposed individuals than among those not exposed (e.g., -31.27 mL/year vs. -29.80 mL/year of FEV1 decline in the normal BMI group among non-smokers). The steepest decline was observed among smokers with dust-cloud exposure (-34.82 mL/year in the normal BMI group), indicating a synergistic effect of WTC exposure and smoking on post-BD FEV1 with the impact of smoking being stronger than that of dust-cloud exposure. In post-BD FVC analyses, participants with both WTC exposure and current smoking also showed the greatest decline (-33.65 mL/year in the normal BMI group). However, the effect of WTC dust-cloud exposure on FVC decline was greater than that of smoking (e.g., -32.19 mL/year among dust-cloud-exposed non-smokers vs. -31.47 mL/year among non-exposed smokers). Overall, those with normal BMI demonstrated the steepest decline, followed by the overweight and obese groups. Conclusions WTC-related exposures were associated with accelerated longitudinal declines in lung function, particularly among smokers. The stronger effects observed in post-BD measures suggest predominantly non-reversible impairments consistent with chronic airway injury originating from early disaster-related exposures. These findings highlight the long-term respiratory consequences of WTC exposure and targeted interventions to mitigate further lung function decline in this population. Importantly these findings underscore the importance of including post-BD measures for surveillance in this and other environmentally exposed populations. This abstract is funded by: CDC/NIOSH Grant U01OH012637, CDC/NIOSH Contracts 200-2017-93327 and 200-2017-93427
Lee et al. (Fri,) studied this question.