# Treatment response of WTC related airway injury

> **NIH ALLCDC U01** · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2020 · $794,957

## Abstract

Project Summary
Rescue/recovery work at the World Trade Center (WTC) disaster site caused a decline in lung function in Fire
Department of the City of New York (FDNY) firefighters. Over 15 years of post-exposure follow-up, 1 in 8 WTC-
exposed firefighters experienced accelerated FEV1 decline, a FEV1 loss >64 ml/year. Accelerated FEV1 decline
is associated with chronic obstructive pulmonary disease (COPD) and asthma. Despite the high burden of
respiratory diseases there are no evidence-based indications for inhaled corticosteroid (ICS) combined with
long-acting beta-agonist (LABA) treatment in patients whose only defining characteristic is accelerated FEV1
decline. Only 35% of WTC-exposed FDNY firefighters with accelerated FEV1 decline have been treated with
ICS/LABA. If the rapid rate of FEV1 loss in the accelerated FEV1 decline population is not reduced, patients
with accelerated FEV1 decline will likely develop COPD, the fourth leading cause of death in the United States.
Determining if ICS/LABA treatment is effective in blunting FEV1 decline in these patients would have important
implications not only for WTC-exposed cohorts, but also for other workplace respiratory disease surveillance.
In preliminary analyses, we found that ICS/ LABA use is associated with worse lung function and reduced
quality of life. This observation is consistent with selection by indication bias, whereby sicker individuals are the
ones who are treated. To mitigate the effects of this bias, we used treated patients as their own controls,
examining FEV1 trajectory prior to and after initiation of ICS/LABA therapy. After ICS/LABA initiation, FEV1
trajectory improved by 9.9±1.1 ml/year (mean±SEM). This grant will explore heterogeneity in ICS/LABA
response. The current multi-center collaboration aims to estimate how many in the untreated accelerated
decline group have a pretreatment phenotype predictive of significant ICS/LABA benefit. This proposal tests
the overall hypothesis that ICS/LABA treatment improves FEV1 trajectory in accelerated FEV1 decline patients,
and that specific patient characteristics, including elevated blood eosinophils, will be associated with a
favorable response to ICS/LABA treatment. Specific Aim 1 will use ICS/LABA-treated patients as their own
controls, assessing FEV1 trajectory before and after ICS/LABA initiation, and testing whether inflammatory
biomarkers (notably, blood eosinophils), pulmonary physiology and demographic factors are predictors of
response to therapy. Specific Aim 2 will adjust for selection by indication bias to identify untreated individuals
most likely to respond to treatment, using data from the full cohort of treated and untreated WTC-exposed
rescue and recovery workers. These data will enable the development of models that predict ICS/LABA
treatment response in untreated individuals. When modeling the effect of ICS/LABA on the FEV1 trajectory of
the untreated workers with accelerated FEV1 decline, we will identify those ...

## Key facts

- **NIH application ID:** 9982719
- **Project number:** 5U01OH011682-02
- **Recipient organization:** NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- **Principal Investigator:** Michael D. Weiden
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** ALLCDC
- **Fiscal year:** 2020
- **Award amount:** $794,957
- **Award type:** 5
- **Project period:** 2019-07-01 → 2021-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9982719

## Citation

> US National Institutes of Health, RePORTER application 9982719, Treatment response of WTC related airway injury (5U01OH011682-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/9982719. Licensed CC0.

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