Qinyi Cheng

Characteristics of a Residential and Working Community With Diverse Exposure to World Trade Center Dust, Gas, and Fumes

Objective: To describe physical symptoms in those local residents, local workers, and cleanup workers who were enrolled in a treatment program and had reported symptoms and exposure to the dust, gas, and fumes released with the destruction of the World Trade Center (WTC) on September 11, 2001. Methods: Symptomatic individuals underwent standardized evaluation and subsequent treatment. Results: One thousand eight hundred ninety-eight individuals participated in the WTC Environmental Health Center between September 2005 and May 2008. Upper and lower respiratory symptoms that began after September 11, 2001 and persisted at the time of examination were common in each exposure population. Many (31%) had spirometry measurements below the lower limit of normal. Conclusions: Residents and local workers as well as those with work-associated exposure to WTC dust have new and persistent respiratory symptoms with lung function abnormalities 5 or more years after the WTC destruction.

Genetic Variants of TSLP and Asthma in an Admixed Urban Population

Background Thymic stromal lymphopoietin (TSLP), an IL7-like cytokine produced by bronchial epithelial cells is upregulated in asthma and induces dendritic cell maturation supporting a Th2 response. Environmental pollutants, including tobacco smoke and diesel exhaust particles upregulate TSLP suggesting that TSLP may be an interface between environmental pollution and immune responses in asthma. Since asthma is prevalent in urban communities, variants in the TSLP gene may be important in asthma susceptibility in these populations. Objectives To determine whether genetic variants in TSLP are associated with asthma in an urban admixed population. Methodology and Main Results Ten tag-SNPs in the TSLP gene were analyzed for association with asthma using 387 clinically diagnosed asthmatic cases and 212 healthy controls from an urban admixed population. One SNP (rs1898671) showed nominally significant association with asthma (odds ratio (OR) = 1.50; 95% confidence interval (95% CI): 1.09–2.05, p = 0.01) after adjusting for age, BMI, income, education and population stratification. Association results were consistent using two different approaches to adjust for population stratification. When stratified by smoking status, the same SNP showed a significantly increased risk associated with asthma in ex-smokers (OR = 2.00, 95% CI: 1.04–3.83, p = 0.04) but not significant in never-smokers (OR = 1.34; 95% CI: 0.93–1.94, p = 0.11). Haplotype-specific score test indicated that an elevated risk for asthma was associated with a specific haplotype of TSLP involving SNP rs1898671 (OR = 1.58, 95% CI: 1.10–2.27, p = 0.01). Association of this SNP with asthma was confirmed in an independent large population-based cohort consortium study (OR = 1.15, 95% CI: 1.07–1.23, p = 0.0003) and the results stratified by smoking status were also validated (ex-smokers: OR = 1.21, 95% CI: 1.08–1.34, p = 0.003; never-smokers: OR = 1.06, 95% CI: 0.94–1.17, p = 0.33). Conclusions Genetic variants in TSLP may contribute to asthma susceptibility in admixed urban populations with a gene and environment interaction.

Longitudinal Spirometry Among Patients in a Treatment Program for Community Members With World Trade Center-Related Illness

Objective: The course of lung function in community members exposed to World Trade Center (WTC) dust and fumes remains undefined. We studied longitudinal spirometry among patients in the WTC Environmental Health Center (WTCEHC) treatment program. Methods: Observational study of 946 WTCEHC patients with repeated spirometry measures analyzed on the population as a whole and stratified by smoking status, initial spirometry pattern, and WTC-related exposure category. Results: Improvement in forced vital capacity (54.4 mL/yr; 95% confidence interval, 45.0 to 63.8) and forced expiratory volume in 1 second (36.8 mL/yr; 95% confidence interval, 29.3 to 44.3) was noted for the population as a whole. Heavy smokers did not improve. Spirometry changes differed depending on initial spirometry pattern and exposure category. Conclusion: These data demonstrate spirometry improvement in select populations suggesting reversibility in airway injury and reinforcing the importance of continued treatment.

S1937 Post 9/11 GERD-Like Symptoms: Endoscopic and Pathologic Evaluation of a New Entity

Background and Aims: Studies describe adverse pulmonary effects in those who responded to the World Trade Center (WTC) disaster in New York City,with mention of aerodigestive symptoms (sx) described as GERD. Little is known about the mechanism of gastrointestinal sx in the WTC-exposed populations. The WTC Environmental Health Center (WTCEHC) was established to respond to health issues related to the attack on 9/11/01 and serves those exposed to WTC dust or fumes, including local residents, workers, and clean-up workers. We now report biopsy findings of post 9/11 refractory GERD-like sx. Methods: Participants were self-referred for medical sx and WTC exposure within the year after 9/11/2001. A standardized questionnaire was administered, including questions assessing the presence of heartburn and/or “acid indigestion.” Patients with sx were treated with proton pump inhibitors (PPIs); those with refractory sx were referred to a single gastroenterologist. Endoscopic results from patients evaluated between 1/11/07 and 10/23/08 are analyzed. Results: 160 patients were referred for endoscopy for refractory GERD-like symptoms. 33 patients whose sx resolved before their appointment were not endoscoped. 18 patients did not attend their appointment. 109 patients underwent endoscopy (mean age of 49.8, 48.6% male). 41.3% were white, 11.0% black, 8.3% Asian, 0.9% Native American, and 40% were undeclared. 64.2% of patients were Hispanic. Many patients (58.7%) had an income <15K. Visible abnormalities were seen on endoscopic evaluation in most patients (94.5%). On biopsy, 49.5% had reflux esophagitis, 44% had chronic inactive gastritis (CIG) and 43.1% had chronic active gastritis (CAG). 40% had evidence of infection with Helicobacter pylori (HP). CIG and CAG were associated with HP (P<0.0001) and Asian race (p=0.02). In patients who were HP negative, many had CIG (63.5%), CAG (19.1%), and reflux esophagitis (21.7%). Conclusions: GERD-like sx in a WTC exposed population were associated with gastritis as well as reflux esophagitis. Although we identified a high frequency of HP in our population, in patients without HP, gastritis remained common. The high frequency of HP in our population is most likely due to the country of origin of our patients. Further studies are ongoing to characterize the esophageal disease through pH testing and manometry. Biopsy and EGD results