Document Detail

Lessons from the World Trade Center disaster: airway disease presenting as restrictive dysfunction.
MedLine Citation:
PMID:  23392588     Owner:  NLM     Status:  MEDLINE    
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), FEV1/VC>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.
Kenneth I Berger; Joan Reibman; Beno W Oppenheimer; Ioannis Vlahos; Denise Harrison; Roberta M Goldring
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Chest     Volume:  144     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-07-24     Completed Date:  2013-09-30     Revised Date:  2014-07-01    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  249-57     Citation Subset:  AIM; IM    
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MeSH Terms
Lung / physiopathology*,  radiography
Lung Diseases, Interstitial / physiopathology,  radiography
Middle Aged
Particulate Matter / adverse effects*
Respiratory Function Tests
Respiratory Tract Diseases / etiology*,  physiopathology*,  radiography
Retrospective Studies
September 11 Terrorist Attacks*
Tomography, X-Ray Computed
Total Lung Capacity
Grant Support
200-2011-39391//PHS HHS; 200-2011-39397//PHS HHS; 200-2011-39413//PHS HHS; 5E11OH009630/OH/NIOSH CDC HHS
Reg. No./Substance:
0/Particulate Matter
Comment In:
Chest. 2013 Dec;144(6):1977-8   [PMID:  24297145 ]
Chest. 2013 Dec;144(6):1978-9   [PMID:  24297146 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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