Inhaled Steriods Used As Preventive Treatment Post 9/11

Inhaled corticosteroids (ICS),
antiinflammatory 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 chestnet.


American College of Chest Physicians

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