TY - JOUR
T1 - Lessons from the world trade center disaster
T2 - Airway disease presenting as restrictive dysfunction
AU - Berger, Kenneth I.
AU - Reibman, Joan
AU - Oppenheimer, Beno W.
AU - Vlahos, Ioannis
AU - Harrison, Denise
AU - Goldring, Roberta M.
N1 - Funding Information:
Funding/Support: This work was supported by the Centers for Disease Control and Prevention [ Grants 200-2011-39413, 200-2011-39391, and 200-2011-39397 ], the National Institute for Occupational Safety and Health [ Grant 5E11OH009630 ], and the American Red Cross Liberty Disaster Relief Fund, City of New York.
PY - 2013/7
Y1 - 2013/7
N2 - Background: 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: This is a retrospective study of 54 persistently symptomatic subjects following World Trade Center (WTC) dust exposure. Inclusion criteria were reduced vital capacity (VC), FEV1VC > 77%, and normal chest roentgenogram. Measurements included spirometry, plethysmography, diffusing capacity of lung for carbon monoxide (DLCO), impulse oscillometry (IOS), inspiratory/expiratory CT scan, and lung compliance (n = 16). Results: VC was reduced (46% to 83% predicted) because of the reduction of expiratory reserve volume (43% ± 26% predicted) with preservation of inspiratory capacity (IC) (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 (AT). DLCO was reduced (78% ± 15% predicted) with elevated DLCO /alveolar volume (5.3 ± 0.8 [mL/mm Hg/min]/L). IOS demonstrated abnormalities in resistance and/or reactance in 50 of 54 subjects. CT scan demonstrated bronchial wall thickening and/or AT in 40 of 54 subjects; parenchymal disease was not evident in any subject. Specific compliance at functional residual capacity (FRC) (0.07 ± 0.02 [L/cm H2O]/L) and recoil pressure (Pel) at TLC (27 ± 7 cm H 2O) were normal. In contrast to patients with ILD, lung expansion was not limited, since IC, Pel, 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 (eg, asthma), and should be incorporated into the definition of restrictive dysfunction.
AB - Background: 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: This is a retrospective study of 54 persistently symptomatic subjects following World Trade Center (WTC) dust exposure. Inclusion criteria were reduced vital capacity (VC), FEV1VC > 77%, and normal chest roentgenogram. Measurements included spirometry, plethysmography, diffusing capacity of lung for carbon monoxide (DLCO), impulse oscillometry (IOS), inspiratory/expiratory CT scan, and lung compliance (n = 16). Results: VC was reduced (46% to 83% predicted) because of the reduction of expiratory reserve volume (43% ± 26% predicted) with preservation of inspiratory capacity (IC) (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 (AT). DLCO was reduced (78% ± 15% predicted) with elevated DLCO /alveolar volume (5.3 ± 0.8 [mL/mm Hg/min]/L). IOS demonstrated abnormalities in resistance and/or reactance in 50 of 54 subjects. CT scan demonstrated bronchial wall thickening and/or AT in 40 of 54 subjects; parenchymal disease was not evident in any subject. Specific compliance at functional residual capacity (FRC) (0.07 ± 0.02 [L/cm H2O]/L) and recoil pressure (Pel) at TLC (27 ± 7 cm H 2O) were normal. In contrast to patients with ILD, lung expansion was not limited, since IC, Pel, 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 (eg, asthma), and should be incorporated into the definition of restrictive dysfunction.
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U2 - 10.1378/chest.12-1411
DO - 10.1378/chest.12-1411
M3 - Article
C2 - 23392588
AN - SCOPUS:84880048119
SN - 0012-3692
VL - 144
SP - 249
EP - 257
JO - Chest
JF - Chest
IS - 1
ER -