Lessons From the World Trade Center Disaster Airway Disease Presenting as Restrictive Dysfunction

被引:45
作者
Berger, Kenneth I. [1 ,2 ,3 ]
Reibman, Joan [2 ,3 ]
Oppenheimer, Beno W. [1 ,3 ]
Vlahos, Ioannis [5 ]
Harrison, Denise [3 ,4 ]
Goldring, Roberta M. [1 ,2 ,3 ]
机构
[1] Bellevue Hosp, Andre Cournand Pulm Physiol Lab, New York, NY USA
[2] Bellevue Hosp, World Trade Ctr, Ctr Environm Hlth, New York, NY USA
[3] NYU, Sch Med, Div Pulm Crit Care & Sleep Med, New York, NY 10016 USA
[4] NYU, World Trade Ctr, Hlth Program, Clin Ctr Excellence, New York, NY 10016 USA
[5] St Georges Healthcare Natl Hlth Serv Trust, Dept Radiol, London, England
关键词
TOTAL RESPIRATORY RESISTANCE; FREQUENCY-DEPENDENCE; CENTER DUST; BRONCHIOLITIS OBLITERANS; FORCED OSCILLATION; WORKING COMMUNITY; AREA RESIDENTS; LUNG-FUNCTION; STANDARDIZATION; FIREFIGHTERS;
D O I
10.1378/chest.12-1411
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
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 H2O) 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.
引用
收藏
页码:249 / 257
页数:9
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