Elevated Peripheral Eosinophils Are Associated with New-Onset and Persistent Wheeze and Airflow Obstruction in World Trade Center-Exposed Individuals

Abstract

Background Exposure to World Trade Center (WTC) dust and fumes is associated with onset of asthma-like respiratory symptoms in rescue and recovery workers and exposed community members. Eosinophilic inflammation with increased lung and peripheral eosinophils has been described in subpopulations with asthma. We hypothesized that persistent asthma-like symptoms in WTC-exposed individuals would be associated with systemic inflammation characterized by peripheral eosinophils. Methods The WTC Environmental Health Center (EHC) is a treatment program for local residents, local workers, and clean-up workers with presumed WTC-related symptoms. Patients undergo a standardized evaluation including questionnaires and complete blood count. Between 9/2005–3/2009, 2461 individuals enrolled in the program and were available for analysis. Individuals with pre-existing respiratory symptoms or lung disease diagnoses prior to 9/11/2001 and current or significant tobacco use were excluded. Results 1508 individuals met inclusion criteria. These patients had a mean age of 47 years, were mostly female (51%) and had a diverse race/ethnicity. Respiratory symptoms that developed after WTC dust/fume exposure and remained persistent included dyspnea on exertion (68%), cough (57%), chest tightness (46%), and wheeze (33%). A larger percentage of those with wheeze had elevated peripheral eosinophils compared to those without wheeze (21% vs. 13%, p<0.0001). Individuals with elevated peripheral eosinophils were more likely to have airflow obstruction on spirometry (16% vs. 7%, p = 0.0003). Conclusions Peripheral eosinophils were associated with wheeze and reduced lung function in a diverse WTC-exposed population. These data suggest that eosinophils may participate in lung inflammation in this population with symptoms consistent with WTC-related asthma.

Health effects of World Trade Center (WTC) Dust: An unprecedented disaster with inadequate risk management

“…Kazeros et al (2013) hypothesized that persistent asthma-like symptoms in WTC Dust-exposed individuals would be associated with systemic inflammation characterized by peripheral eosinophils. Their WTC Environmental Health Center (WTCEHC) patients underwent a standardized evaluation including questionnaires and complete blood count.…”

Risk factors for persistence of lower respiratory symptoms among community members exposed to the 2001 World Trade Center terrorist attacks

“…While most participants with post-9/11 LRS experienced symptom resolution during the study period, LRS persisted for a nearly one-third of those with initial symptoms. Most (85%) participants with persistent LRS had normal spirometry at follow-up; however, more than half had abnormal IOS results, including elevated resistance (R 5 ) and frequency dependence of resistance (R [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], suggesting that small airways dysfunction not detected on standard spirometry may underlie symptoms in this group. This was further supported by our finding that higher R 5 and R 5-20 values at exam 1 were associated with an increased odds of persistent LRS at follow-up.…”

FDNY and 9/11: Clinical services and health outcomes in World Trade Center‐exposed firefighters and EMS workers from 2001 to 2016

“…Persistence of disease is likely the result of chronic inflammation initiated by exposure to the dust and potentiated by host characteristics as demonstrated by induced sputum studies showing significantly increased percentages of inflammatory biomarkers, neutrophils, and eosinophils in those with high WTC‐exposure [Fireman et al, ] and by serum studies from blood drawn within 6 months of 9/11 showing elevated levels of known inflammatory biomarkers, such as macrophage derived chemokines, that were associated with increased risk of subsequent abnormal pulmonary function [Nolan et al, ]. The protease/anti‐protease imbalance defined by mild to moderate genetic deficiency of alpha‐1 antitrypsin deficiency [Banauch et al, ] and the elevated set‐points of eosinophils and IgE levels observed in those with non‐resolving upper and lower airways inflammation [Kazeros et al, ; Kwon et al, ] are intrinsic characteristics of patients that can be assessed repeatedly using inexpensive, commercially available techniques. As the association between WTC‐exposure and disease diminishes over time, these and other innate biomarkers of risk for immune injury will become important for stratification of WTC‐exposed rescue/recovery workers.…”