Disaster Medicine and Public Health Preparedness

Research Article

Trial of Prophylactic Inhaled Steroids to Prevent or Reduce Pulmonary Function Decline, Pulmonary Symptoms, and Airway Hyperreactivity in Firefighters at the World Trade Center Site

Gisela I. Banauch, Gabriel Izbicki, Vasilios Christodoulou, Michael D. Weiden, Mayris P. Webber, Hillel Cohen, Jackson Gustave, Robert Chavko, Thomas K. Aldrich, Kerry J. Kelly and David J. Prezant c1

ABSTRACT

Background: Inhaled corticosteroids (ICS) are the most effective anti-inflammatory treatment for asthmatics. This trial evaluated the effects of prophylactic ICS in firefighters exposed to the World Trade Center disaster.

Methods: Inhaled budesonide via a dry powder inhaler (Pulmicort Turbuhaler, AstraZeneca, Wilmington, DE) was offered on-site to New York City firefighters between September 18 and 25, 2001. One to 2 years later, firefighters (n = 64) who completed 4 weeks of daily ICS treatment were evaluated and compared with an age- and exposure-matched comparison group (n = 72) who did not use ICS.

Results: When spirometry results at the final visit were compared with those from the weeks following the 9/11 disaster, the treatment group had a greater increase in forced vital capacity (P = .009) and possibly a slower decline in forced expiratory volume at 1 second (P = .11), as well as a greater improvement in perceived well-being as assessed by the St George's Respiratory Questionnaire (P < .01). There was no difference in airway hyperreactivity and no evidence of adverse effects from ICS.

Conclusions: Because the potential for hazardous exposures is great at many disasters, disease prevention programs based on environmental controls and respiratory protection are warranted immediately. Our results suggest that, pending further study with a larger sample, prophylactic ICS should be considered, along with respiratory protection, to minimize possible lung insult. (Disaster Med Public Health Preparedness. 2008;2:33–39)

(Received November 15 2007)

(Accepted December 11 2007)

Key Words

  • World Trade Center;
  • inhaled corticosteroid;
  • firefighters;
  • pulmonary disease;
  • preventive medicine

Correspondence

c1 Address correspondence and reprint requests to David J. Prezant, MD, FCCP, New York City Fire Department, Office of Medical Affairs (Room 4w-1), Brooklyn, NY 11201 (e-mail: prezand@fdny.nyc.gov).

Drs Banauch, Aldrich, and Chavko are with the Pulmonary Division, Montefiore Medical Center; Dr Izbicki is with the Pulmonary Institute, Shaare Zedek Medical Center; Mr Christodoulo, Mr Gustave, and Drs Kelly and Prezant are with the New York City Fire Department; Dr Weiden is with the Pulmonary Division, New York University College of Medicine; Dr Webber is with the Department of Epidemiology and Population Health, Montefiore Medical Center; and Dr Cohen is with the Department of Epidemiology and Population Health, Albert Einstein College of Medicine.

Presented, in part, at the American College of Chest Physicians annual meeting, Chicago, October 2007.