• Justin K Niles, Mayris P Webber, Hillel W Cohen, Charles B Hall, Rachel Zeig-Owens, Fen Ye, Michelle S Glaser, Jessica Weakley, Michael D Weiden, Thomas K Aldrich, Anna Nolan, Lara Glass, Kerry J Kelly, and David J Prezant.
• Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA.
• Am. J. Ind. Med. 2013 Aug 1; 56 (8): 870-80.

BackgroundThis study utilizes a four-level pyramid framework to understand the relationship between symptom reports and/or abnormal pulmonary function and diagnoses of airway diseases (AD), including asthma, recurrent bronchitis and COPD/emphysema in WTC-exposed firefighters. We compare the distribution of pyramid levels at two time-points: by 9/11/2005 and by 9/11/2010.MethodsWe studied 6,931 WTC-exposed FDNY firefighters who completed a monitoring exam during the early period and at least two additional follow-up exams 9/11/2005-9/11/2010.ResultsBy 9/11/2005 the pyramid structure was as follows: 4,039 (58.3%) in Level 1, no respiratory evaluation or treatment; 1,608 (23.2%) in Level 2, evaluation or treatment without AD diagnosis; 1,005 (14.5%) in Level 3, a single AD diagnosis (asthma, emphysema/COPD, or recurrent bronchitis); 279 (4.0%) in Level 4, asthma and another AD. By 9/11/2010, the pyramid distribution changed considerably, with Level 1 decreasing to 2,612 (37.7% of the cohort), and Levels 3 (N = 1,530) and 4 (N = 796) increasing to 22.1% and 11.5% of the cohort, respectively. Symptoms, spirometry measurements and healthcare utilization were associated with higher pyramid levels.ConclusionsRespiratory diagnoses, even four years after a major inhalation event, are not the only drivers of future healthcare utilization. Symptoms and abnormal FEV-1 values must also be considered if clinicians and healthcare administrators are to accurately anticipate future treatment needs, years after initial exposure.Copyright © 2013 Wiley Periodicals, Inc.

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