Characterization of Persistent Uncontrolled Asthma Symptoms in Community Members Exposed to World Trade Center Dust and Fumes

Joan Reibman, Caralee Caplan-Shaw, Yinxiang Wu, Mengling Liu, Milan R. Amin, Kenneth I. Berger, Maria L. Cotrina-Vidal, Angeliki Kazeros, Nedim Durmus, Maria-Elena Fernandez-Beros, Roberta M. Goldring, Rebecca Rosen and Yongzhao Shao
Additional contact information
Joan Reibman: Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
Caralee Caplan-Shaw: Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
Yinxiang Wu: Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
Mengling Liu: Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
Milan R. Amin: Department of Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, NY 10016, USA
Kenneth I. Berger: Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
Maria L. Cotrina-Vidal: World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA
Angeliki Kazeros: Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
Nedim Durmus: Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
Maria-Elena Fernandez-Beros: Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
Roberta M. Goldring: Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
Rebecca Rosen: World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA
Yongzhao Shao: Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA

IJERPH, 2020, vol. 17, issue 18, 1-17

Abstract: The destruction of the World Trade Center (WTC) towers on the 11th of September, 2001 released a vast amount of aerosolized dust and smoke resulting in acute and chronic exposures to community members as well as responders. The WTC Environmental Health Center (WTC EHC) is a surveillance and treatment program for a diverse population of community members, including local residents and local workers with WTC dust exposure. Many of these patients have reported persistent lower respiratory symptoms (LRS) despite treatment for presumed asthma. Our goal was to identify conditions associated with persistent uncontrolled LRS despite standard asthma management. We recruited 60 patients who were uncontrolled at enrollment and, after a three-month run-in period on high-dose inhaled corticosteroid and long acting bronchodilator, reassessed their status as Uncontrolled or Controlled based on a score from the Asthma Control Test (ACT). Despite this treatment, only 11 participants (18%) gained Controlled status as defined by the ACT. We compared conditions associated with Uncontrolled and Controlled status. Those with Uncontrolled symptoms had higher rates of upper airway symptoms. Many patients had persistent bronchial hyper-reactivity (BHR) and upper airway hyper-reactivity as measured by paradoxical vocal fold movement (PVFM). We found a significant increasing trend in the percentage of Controlled with respect to the presence of BHR and PVFM. We were unable to identify significant differences in lung function or inflammatory markers in this small group. Our findings suggest persistent upper and lower airway hyper-reactivity that may respond to standard asthma treatment, whereas others with persistent LRS necessitate additional diagnostic evaluation, including a focus on the upper airway.

Keywords: World Trade Center; WTC survivors; environmental exposure; asthma; rhinosinusitis; bronchial hyper-responsiveness; paradoxical vocal fold movement (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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