World Trade Center firefighters using inhaled medication, steroids at risk for GERD

Key takeaways:

• The odds for developing GERD or Barrett’s esophagus went up among firefighters using short-acting beta agonists or steroids.
• Firefighters who arrived in the morning vs. afternoon of 9/11 had heightened risks.

HONOLULU — Use of short-acting beta agonists and steroids each raised the likelihood for gastroesophageal reflux disease among firefighters exposed to 9/11 particulate matter, according to a presentation at the CHEST Annual Meeting.

Notably, a pilot study conducted before this study found a link between SABA use and GERD, according to researchers.

“These firefighters have been followed longitudinally since their exposure in 2001 as a part of a multicenter health program,” Sanjiti Podury, MD, post-doctoral research fellow at NYU Grossman School of Medicine, said during her presentation. “By 2005, almost 44% of these rescue workers had developed GERD, which is 8.2 times its pre-9/11 prevalence and 2.2 times the prevalence when compared to the general U.S. population.”

Podury and colleagues assessed 4,151 firefighters (mean age at 9/11, 39 years; 100% men; 94% white) who had been exposed to World Trade Center-particulate matter within 2 weeks of 9/11 to further validate whether medication use, including SABA and steroids, increased risk for GERD or Barrett’s esophagus (BE).

To be included, firefighters needed to have normal lung function prior to 9/11, their first serum drawn since 9/11 before the site closed (July 24, 2002) and all serum variables measured, according to researchers.

“A lot of our firefighters were predisposed to a bunch of conditions after their exposure to the World Trade Center particulate matter,” Podury said. “These include airway hyperreactivity, cancer, GERD, rhinosinusitis and other mental health conditions.”

Noting that some firefighters had overlapping conditions, researchers identified 429 (10%) firefighters with BE based on electronic medical records; 2,539 (60.5%) with GERD based on EMRs and proton pump inhibitor, H₂ blockers, antacids or surface agent use; and 333 (8%) with airway hyperreactivity based on EMRs and positive methacholine or bronchodilator testing.

Among the 1,309 firefighters who reported cigarette use, 783 had GERD and 150 had BE, according to researchers.

Compared with steroid use (either prednisone or dexamethasone), SABA use was more prevalent in both patients with GERD (44% vs. 24%) and patients with BE (47% vs. 29%).

In a logistic regression model adjusted for age and smoking, researchers found those using SABA had higher odds for developing GERD (OR = 4.08; 95% CI, 3.5-4.75) and BE (OR = 1.97; 95% CI, 1.61-2.41).

Similar to the above finding, steroid use also raised the likelihood for GERD (OR = 4.65; 95% CI, 3.74-5.78) and BE (OR = 2.27; 95% CI, 1.81-2.86) in this patient population.

Notably, researchers found that the time of arrival at the Word Trade Center on 9/11 altered risk. In the SABA cohort, those who arrived in the morning had a 36% higher risk than those who got to the area in the afternoon. Morning arrival among those using steroids also raised the chances for GERD/BE by 40.8%.

“We’re trying to study further into this overlap between GERD/Barrett’s and airway hyperreactivity and trying to distinguish different phenotypes of these diseases,” Podury said during her presentation. “Future studies will also include an assessment ... of inhaler use and its role in aerodigestive diseases and an analysis of noninvasive biomarkers that can predict GERD and Barrett’s. We are currently enrolling a sub-cohort into our observational study that is investigating noninvasive biomarkers of GERD/Barrett’s and airway hyperreactivity.”