Abstract
The aim of this study was to evaluate whether underlying respiratory disease may be revealed by offline fractional exhaled nitric oxide (FENO) testing among a cohort of New York State (NYS) World Trade Center (WTC) responders in comparison with a control group of similar but unexposed NYS employees, 6 years post-9/11. Participants (92 exposed, 141 unexposed) provided two breath samples that were collected in Mylar bags and sent to a central laboratory for FENO testing. Participants also completed a brief questionnaire. Ambient air pollution was characterized using particulate matter (PM2.5) and ozone concentration data from the NYS Department of Environmental Conservation air-monitoring sites closest to each testing site for each day of sample collection. WTC exposure did not appear to be associated with elevated FENO concentrations. FENO concentrations were higher on days with elevated levels of PM2.5 (≥35 μg/m³) and ozone (≥0.08 ppm). FENO concentrations were higher in men and lower in smokers. Our results do not suggest an association between WTC exposure and elevated FENO concentrations, 6 years post-9/11, in this moderately exposed cohort of responders. Results do suggest that FENO concentrations were elevated in relation to higher levels of ambient air pollutants. Our results also offer useful reference values for future research involving FENO testing. This study demonstrates that offline FENO testing is a useful method for epidemiological studies requiring collection of samples in the field, potentially over a broad geographic area.
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References
Prezant DJ, Weiden M, Banauch GI et al (2002) Cough and bronchial responsiveness in firefighters at the World Trade Center site. N Engl J Med 347:806–815
Salzman SH, Moosavy FM, Miskoff JA et al (2004) Early respiratory abnormalities in emergency services police officers at the World Trade Center site. J Occup Environ Med 46:113–122
Skloot G, Goldman M, Fischler D et al (2004) Respiratory symptoms and physiologic assessment of ironworkers at the World Trade Center disaster site. Chest 125:1248–1255
Herbert R, Moline J, Skloot G et al (2006) The World Trade Center disaster and the health of workers: five-year assessment of a unique medical screening program. Environ Health Perspect 114(12):1853–1858
Reibman J, Lin S, Hwang SA et al (2005) The World Trade Center residents’ respiratory health study: new onset respiratory symptoms and pulmonary function. Environ Health Perspect 113:406–411
Lin S, Reibman J, Bowers JA et al (2005) Upper respiratory symptoms and other health effects among residents living near the World Trade Center site after September 11, 2001. Am J Epidemiol 162:499–507
Trout D, Nimgade A, Mueller C et al (2002) Health effects and occupational exposures among office workers near the World Trade Center disaster site. J Occup Environ Med 44:601–605
Farfel M, DiGrande L, Brackbill R et al (2008) An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center health registry enrollees. J Urban Health 85(6):880–909
Mauer MP, Cummings KR, Carlson GA (2007) Health effects in New York State personnel who responded to the World Trade Center disaster. J Occup Environ Med 49:1197–1205
Mauer MP, Herdt-Losavio ML, Carlson GA (2010) Asthma and lower respiratory symptoms in New York State employees who responded to the World Trade Center disaster. Int Arch Occup Environ Health 83(1):21–27
Mauer MP, Cummings KR, Hoen R (2010) Long-term respiratory symptoms in World Trade Center responders. Occup Med (Lond) 60(2):145–151
Mauer MP, Cummings KR (2010) Impulse oscillometry and respiratory symptoms in World Trade Center responders, 6 years post-9/11. Lung 188(2):107–113
Lioy PJ, Weisel CP, Millette JR et al (2002) Characterization of the dust/smoke aerosol that settled east of the World Trade Center (WTC) in lower Manhattan after the collapse of the WTC 11 September 2001. Environ Health Perspect 110:703–714
Cahill TA, Cliff SS, Perry KD et al (2004) Analysis of aerosols from the World Trade Center collapse site, New York, October 2 to October 30, 2001. Aerosol Sci Technol 38:165–183
Centers for Disease Control, Prevention (CDC) (2002) Occupational exposures to air contaminants at the World Trade Center disaster site—New York, September–October, 2001. MMWR Morb Mortal Wkly Rep 51:453–456
Centers for Disease Control, Prevention (CDC) (2003) Potential exposures to airborne and settled surface dust in residential areas of lower Manhattan following the collapse of the World Trade Center—New York City, November 4–December 11, 2001. MMWR Morb Mortal Wkly Rep 52:131–136
McGee JK, Chen LC, Cohen MD et al (2003) Chemical analysis of World Trade Center fine particulate matter for use in toxicologic assessment. Environ Health Perspect 111:972–980
Offenberg JH, Eisenreich SJ, Gigliotti CL et al (2004) Persistent organic pollutants in dusts that settled indoors in lower Manhattan after September 11, 2001. J Expo Anal Environ Epidemiol 14:164–172
Landrigan PJ, Lioy PJ, Thurston G et al (2004) Health and environmental consequences of the World Trade Center disaster. Environ Health Perspect 112:731–739
Mendelson DS, Roggeveen M, Levin SM et al (2007) Air trapping detected on end-expiratory high-resolution computed tomography in symptomatic World Trade Center rescue and recovery workers. J Occup Environ Med 49:840–845
American Thoracic Society (2005) ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med 171:912–930
American Thoracic Society (2006) ATS Workshop proceedings: exhaled nitric oxide and nitric oxide oxidative metabolism in exhaled breath condensate. Proc Am Thorac Soc 3:131–145
Herdt-Losavio ML, Mauer MP, Carlson GA (2008) Development of an exposure assessment method for epidemiologic studies of New York State personnel who responded to the World Trade Center disaster. Ann Occup Hyg 52:83–93
NYS Department of Environmental Conservation Ambient Air Quality Standards. http://www.dec.ny.gov/chemical/8542.html. Accessed Jan 2009
Silkoff PE, Stevens A, Pak J, Bucher-Bartelson B, Martin RJ (1999) A method for the standardized offline collection of exhaled nitric oxide. Chest 116(3):754–759
Bodini A, Pijnenburg MW, Boner AL, de Jongste JC (2003) Exhaled nitric oxide in mylar balloons: influence of storage time, humidity and temperature. Mediators Inflamm 12(1):47–49
Barreto M, Villa MP, Martella S et al (2001) Off-line exhaled nitric oxide measurements in children. Pediatr Pulmonol 32(2):159–167
Deykin A, Massaro A, Drazen J, Israel E (2002) Exhaled nitric oxide as a diagnostic test for asthma: online versus offline techniques and effect of flow rate. Am J Respir Crit Care Med 165(12):1597–1601
Renzetti G, Silvestre G, D’Amario C et al (2009) Less air pollution leads to rapid reduction of airway inflammation and improved airway function in asthmatic children. Pediatrics 123(3):1051–1058
Dales R, Wheeler A, Mahmud M et al (2008) The influence of living near roadways on spirometry and exhaled nitric oxide in elementary schoolchildren. Environ Health Perspect 116:1423–1427
Mar TF, Jansen K, Shepherd K et al (2005) Exhaled nitric oxide in children with asthma and short-term PM2.5 exposure in Seattle. Environ Health Perspect 113:1791–1794
Adamkiewicz G, Ebelt S, Syring M et al (2004) Association between air pollution and exhaled nitric oxide in an elderly population. Thorax 59:204–209
Koenig JQ, Jansen K, Mar TF et al (2003) Measurement of offline exhaled nitric oxide in a study of community exposure to air pollution. Environ Health Perspect 111:1625–1629
Steerenberg PA, Nierkens S, Fischer PH et al (2001) Traffic-related air pollution affects peak expiratory flow, exhaled nitric oxide, and inflammatory nasal markers. Arch Environ Health 56(2):167–174
Van Amsterdam JG, Verlaan BP, Van Loveren H et al (1999) Air pollution is associated with increased level of exhaled nitric oxide in nonsmoking healthy subjects. Arch Environ Health 54(5):331–335
van Amsterdam JGC, Hollander A, Snelder JD et al (1999) The effect of air pollution on exhaled nitric oxide of atopic and nonatopic subjects. Nitric Oxide 3(6):492–495
Steerenberg PA, Snelder JB, Fischer PH et al (1999) Increased exhaled nitric oxide on days with high outdoor air pollution is of endogenous origin. Eur Respir J 13:334–337
Olivieri M, Talamini G, Corradi M et al (2006) Reference values for exhaled nitric oxide (REVENO) study. Respir Res 7:94
Bruce C, Yates DH, Thomas PS (2002) Caffeine decreases exhaled nitric oxide. Thorax 57:361–363
Kharitonov SA, Barnes PJ (2001) Exhaled markers of pulmonary disease. Am J Respir Crit Care Med 163:1693–1722
Verleden GM, Dupont LJ, Verpeut AC et al (1999) The effect of cigarette smoking on exhaled nitric oxide in mild steroid-naive asthmatics. Chest 116:59–64
Kharitonov SA, Yates D, Barnes PJ (1995) Increased nitric oxide in exhaled air of normal human subjects with upper respiratory tract infections. Eur Respir J 8:295–297
van Amsterdam JGC, Verlaan APJ, van Loveren H et al (1999) The balloon technique: a convenient method to measure exhaled NO in epidemiological studies. Int Arch Occup Environ Health 72:404–407
Acknowledgments
The authors thank Janine Palome and Frances Jourd’heuil for their valuable contributions to the data collection and measurements for this study, and Russ Twadell with the NYSDEC for his contributions. They also thank Karen Cummings for her assistance. This work was supported by the Centers for Disease Control and Prevention (CDC) [Cooperative Agreement Number U1Q/CCU221059]. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.
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Mauer, M.P., Hoen, R. & Jourd’heuil, D. FENO Concentrations in World Trade Center Responders and Controls, 6 Years Post-9/11. Lung 189, 295–303 (2011). https://doi.org/10.1007/s00408-011-9307-2
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DOI: https://doi.org/10.1007/s00408-011-9307-2