Abstract
BackgroundDespite the known occupational hazards, it is not yet clear whether long-term career firefighting leads to a greater rate of decline in lung function than would normally be expected, and how this rate of change is affected by firefighting exposures and other risk/protective factors.MethodsA systematic search of online electronic databases was conducted to identify longitudinal studies reporting on the rate of change in the forced expiratory volume in one second (FEV1) of forced vital capacity (FVC). Included studies were critically appraised to determine their risk of bias using the Research Triangle Institute Item Bank (RTI-IB) on Risk of Bias and Precision of Observational Studies.ResultsTwenty-two studies were identified for inclusion, from four different countries, published between 1974 and 2016. Examined separately, studies were categorised by the type of firefighting exposure. Firefighters experienced variable rates of decline in lung function, which were particularly influenced by cigarette smoking. The influence of routine firefighting exposures is unclear and limited by the methods of measurement, while firefighters exposed to ‘non-routine’ severe exposures unanimously experienced accelerated declines.ConclusionsThe data provided by longitudinal studies provide an unclear picture of how the rate of change in lung function of firefighters relates to routine exposures and how it compares to the rate of change expected in a working-age population. Non-smoking firefighters who routinely wear respiratory protection are more likely than otherwise to have a normal rate of decline in lung function. Exposure to catastrophic events significantly increases the rate of decline in firefighter lung function but there is limited evidence detailing the effect of routine firefighting. Future studies will benefit from more robust methods of measuring exposure.Trial registrationInternational Prospective Register of Systematic Reviews (PROSPERO), registration number (CRD42017058499).
Highlights
Despite the known occupational hazards, it is not yet clear whether long-term career firefighting leads to a greater rate of decline in lung function than would normally be expected, and how this rate of change is affected by firefighting exposures and other risk/protective factors
This review aims to answer the following questions: 1) What is the rate of change of lung function in professional urban firefighters? 2) How is this rate of change influenced by level of exposure to routine firefighting and non-routine firefighting and protective or deleterious factors? 3) How is the rate of change in lung function measured/calculated and reported in studies of professional firefighters?
Characteristics of included studies Descriptive information about the included studies is summarised in Table 1 and includes study location and dates, the baseline characteristics of the study population and the methods of conducting spirometry and measuring exposure
Summary
Despite the known occupational hazards, it is not yet clear whether long-term career firefighting leads to a greater rate of decline in lung function than would normally be expected, and how this rate of change is affected by firefighting exposures and other risk/protective factors. Other reports indicate that firefighters have better lung function than the general population in both FEV1 and FVC: likely due to a strong healthy worker effect [7,8,9,10]. This makes the routine comparison of these values to a reference standard following a single pulmonary function test more challenging, and may serve to misclassify some firefighters’ lung function.
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