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Low serum IgA and airway injury in World Trade Center-exposed firefighters: a 17-year longitudinal study
  1. Barbara Putman1,2,
  2. Lies Lahousse2,
  3. Rachel Zeig-Owens3,4,
  4. Ankura Singh3,5,
  5. Charles B Hall4,
  6. Yang Liu3,5,
  7. Theresa Schwartz3,5,
  8. David Goldfarb3,5,
  9. Mayris P Webber3,4,
  10. David J Prezant3,5,
  11. Michael D Weiden1,3
  1. 1 Department of Medicine, New York University School of Medicine, New York, New York, USA
  2. 2 Department of Bioanalysis, Ghent University, Gent, Belgium
  3. 3 The Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
  4. 4 Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
  5. 5 Department of Medicine, Montefiore Medical Centre, Bronx, New York, USA
  1. Correspondence to Dr Michael D Weiden, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA; Michael.Weiden{at}


Serum IgA ≤70 mg/dL (low IgA) is associated with exacerbations of chronic obstructive pulmonary disease. The association of low IgA with longitudinal lung function is poorly defined. This study included 917 World Trade Center (WTC)-exposed firefighters with longitudinal spirometry measured between September 2001 and September 2018 and IgA measured between October 2001 and March 2002. Low IgA, compared with IgA >70 mg/dL, was associated with lower forced expiratory volume in 1 s (FEV1) % predicted in the year following 11 September 2001 (94.1% vs 98.6%, p<0.001), increased risk of FEV1/FVC <0.70 (HR 3.8, 95% CI 1.6 to 8.8) and increased antibiotic treatment (22.5/100 vs 11.6/100 person-years, p=0.002). Following WTC exposure, early IgA ≤70 mg/dL was associated with worse lung function and increased antibiotic treatment.

  • occupational lung disease
  • COPD Exacerbations

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  • Contributors MDW had full access to all of the data in the study and agrees to be accountable for all aspects of the work so that questions related to the accuracy and integrity of the research are appropriately investigated and resolved. MDW conceived of the study, and designed it in conjunction with BP, LL, RZ-O, CBH and DJP. MDW, BP, AS, RZ-O, TS, YL and DG analysed and interpreted the data. MDW and BP drafted the first manuscript with critical revisions from LL, AS, RZ-O, CBH, DJP, MPW and TS. All authors approved the final manuscript.

  • Funding This research was funded by National Institute for Occupational Safety and Health, grant number U01 OH011302, U01OH011682 and contracts #200-2011-39383, #200-2011-39378, #200-2017-93426 and #200-2017-93326.

  • Competing interests BP, RZ-O, AS, CBH, YL, TS, DG, MPW, DJP and MDW report grants and/or contracts from the National Institute of Occupational Safety and Health, during the conduct of the study and outside the submitted work. LL reports grants from AstraZeneca and Chiesi (both awards), and expert consultation for Boehringer Ingelheim GmbH and Novartis outside the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval The Montefiore Medical Center/Albert Einstein College of Medicine Institutional Review Board approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note The sponsors had no role in the design and conduct of the study, the collection, management, analysis and interpretation of the data, the preparation, review and approval of the manuscript, or the decision to submit the manuscript for publication.