Study looks at inhaled corticosteroid use post 9/11 in NYC firefighters

Inhaled corticosteroids (ICS), anti-inflammatory treatments often prescribed for asthma, may be beneficial in preventing respiratory illness, according to a new study.

The research, presented at CHEST 2007, the 73rd annual international scientific assembly of the American College of Chest Physicians (ACCP), examined the effectiveness of ICS in preventing asthma and other respiratory illness due to inhalation exposures experienced by NYC firefighters after the World Trade Center (WTC) collapse. Two years post-collapse, those firefighters treated with ICS reported positive feedback.

"Respiratory protection is often needed during disasters, but it is difficult to get it instantly, and many responders, without EMS or fire experience, have not been trained or fit-tested to wear equipment properly. Couple this with a disaster environment that is difficult in which to function, and it leads to exposures that could result in lung damage," said study author David Prezant, MD, FCCP, Chief Medical Officer, Office of Medical Affairs and Co-Director WTC Medical Monitoring and Treatment Programs, New York City Fire Department. "However, our preliminary data suggest that combining prophylactic inhaled corticosteroids with our best attempts to provide proper respiratory protection could reduce declines in lung function."

One week post-WTC attack, Dr. Prezant and his colleagues from the New York City Fire Department offered ICS to NYC firefighters. Participating firefighters were told to use the ICS inhaler daily for 4 weeks. Two years post-WTC collapse, Dr. Prezant and coinvestigators from Montefiore Medical Center, New York University College of Medicine, and the Shaare Zedek Medical Center in Israel, offered free, voluntary evaluations of respiratory symptoms and function to the treated firefighters and a comparison group of firefighters who did not participate in the ICS treatment but who were matched for similar exposures and pretreatment pulmonary function.

A total of 2,708 firefighters agreed to participate, but only 158 completed the 4 weeks of treatment (participant totals have been revised since abstract submission). Those who did not complete the treatment cited fear of steroid use and lack of immediate effect. Despite reporting more unprotected hours without a respirator, results showed that the treated group had significantly greater declines in respiratory symptoms and greater quality of life when compared with the untreated firefighters. In addition, revised data analysis showed a small but significant improvement in the lung function of the treated group, as well.

"In situations like the World Trade Center collapse, significant exposure and symptoms are both risk factors for the development of multiple pulmonary disorders," said Dr. Prezant. "The first line of defense must always be respiratory protection, but ICS are a useful adjunct, and we would encourage their use to be considered during emergency conditions where rescues must be made and respiratory protections may be less than adequate, or when early symptoms occur."

"Respiratory illness continues to plague those who were present when the World Trade Center collapsed," said Alvin V. Thomas, MD, FCCP, President of the American College of Chest Physicians. "It is essential that physicians and researchers work to alleviate and eventually cure those ailments caused by this tragedy, as well as any respiratory diseases that may be acquired in other occupational settings."

While researchers are optimistic about the results, they continue to stress that larger studies are required to substantiate these findings. This study was conducted with support from the Investigator-Sponsored Study Program of AstraZeneca, and the use of inhaled corticosteroids may be considered off- label use. The sponsors had no involvement in the design and conduct of the study, in the collection, management, analysis, and interpretation of the data, or in the preparation of this report.

CHEST 2007 is the 73rd annual international scientific assembly of the American College of Chest Physicians, held October 20-25 in Chicago, IL. The ACCP represents 17,000 members who provide patient care in the areas of pulmonary, critical care, and sleep medicine in the United States and throughout the world. The ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at http://www.chestnet.org/.