Respiratory Related Issues in Firefighters

Although in recent years improved respiratory protection has become available to protect firefighters from the fire environment, weight and bulk limitations still make adequate protection difficult.1 Numerous investigations and case reports have identified the potential for chronic pulmonary dysfunction to follow single episodes of smoke inhalation among firefighters. The sometimes-delayed respiratory sequelae of acute smoke inhalation have been attributed not only to thermal injury but also to toxic exposures of the tracheobronchial tree with, for example, resultant tracheobronchitis, bronchiolitis obliterans, bronchial stenosis, and bronchiectasis.2

Firefighters can inhale smoke and a wide range of chemicals that may be present in a burning building. Although the breathing apparatus does a good job of protecting them, it isn’t always worn, especially during the so-called overhaul phase, when firefighters sift through debris to ensure that the fire doesn’t reignite. Firefighters are occupationally exposed to many irritants of the respiratory tract including ammonia, formaldehyde, isocyanates, sulphides, cyanides, and hydrogen chloride.1

The chronic effects of greatest concern in studies of firefighters have been lung cancer, heart disease, and chronic obstructive pulmonary diseases. Acute pulmonary injury is often associated with inhalation of hot air and toxic constituents of smoke, particularly the combustion products of commonly used plastics.3 The short-term effects of firefighting on the respiratory system have been studied on numerous occasions with varying results. These studies suggest that acute exposure to contaminants during firefighting:

1) May result in hypoxemia due to smoke inhalation.3

2) May cause acute respiratory symptoms and acute decrements in lung function. Persistence of these decrements in some cases suggest decrements are not merely caused by irritant bronchoconstriction.3

3) May cause acute increases in airway responsiveness.3

These changes in lung function occur secondary to a variety of mechanisms which may include reflex bronchoconstriction (constriction of the airways due to lung irritation) and smoke-induced airway hyperresponsiveness.3

The respiratory effects of exposure to smoke and fumes from fires have been a major concern. Acute smoke inhalation carries a high mortality for unprotected victims and is often combined with burns and other trauma. Fatal and overwhelming smoke inhalation has been reviewed extensively in clinical literature.4

Airway responsiveness increases after firefighting exposure. Increased airways reactivity following minor smoke inhalation during routine firefighting is a complex response, more complicated than bronchoconstriction, which results from irritation.2 The response is persistent and is associated with acute but transient increases in airways responsiveness. In at least one case, exposure resulted in airflow obstruction, initially responsive to bronchodilators, that became progressively more severe despite treatment, until the patient died of respiratory failure two years later. In this case, the pathology may have resembled mucoid impaction syndrome.2

Reports of progressive abnormalities in lung function among firefighters have suggested as much as a doubling of the expected rate of decline in lung function that normally affects aging adults, and this difference is associated with an increased frequency of respiratory symptoms. Declines of this magnitude have been associated with an increased risk for chronic obstructive airways disease (emphysema or chronic bronchitis).

According to a joint report by the United States Fire Administration (USFA) and the International Association of Fire Fighters (IAFF), published in 2010, diseases linked to the respiratory system are third among the causes of disease-related deaths in North America alone. This means that one out of six disease-related deaths are because of respiratory disorders.

Declining lung function can manifest itself through shortness of breath, persistent coughing, wheezing, and weight loss. Firefighters need to be on the lookout for any of these symptoms, as well as any sleep disturbances. Chronic obstructive pulmonary disease, pulmonary hypertension, heart disease, interstitial lung disease, lung cancer, tuberculosis, and reactive airways dysfunction syndrome are just a few of the diseases they are susceptible to.3

Given the excessive exposure of firefighters to respiratory irritants and toxicants, it is essential that firefighters recognize the importance of breathing apparatus use, and take steps to minimize their risk of acute and chronic pulmonary disease. It is the position of the IAFF Department of Health and Safety that there is an increased risk among fire fighters of developing acute lung disease during the course of firefighting work. There may also be an increased risk of chronic lung disease in fire fighters, however, more research on chronic exposure is needed. “Respiratory diseases remain a significant health issue for firefighters and other emergency responders,” added IAFF General President Harold A. Schaitberger. “Respiratory effects due to firefighter occupational exposure are a concern affecting the fire service throughout the United States.”

Although it may take years for a lung-related disease to develop, regularity in checkups is important.  Routine follow-ups need to be emphasized, and any change in symptoms need to be reported to the doctor. Apart from regularity in exercise, careful monitoring of the evolution of any other conditions is also important, as smoke inhalation can exacerbate these.

Depending on the diagnosis, treatment options may include antibiotics that reduce inflammation and kill the bacteria infecting the bronchi, manual chest physical therapy and airway clearance devices that loosen and expel any excess mucus from the lungs, or expectorants and prescription drugs that help thin mucus so that it is easier to cough up. Depending on the patient’s condition, a doctor may recommend a bronchodilator, inhaled corticosteroids, airway clearance therapy, or surgery to remove part of the infected airway.

When choosing an airway clearance therapy, it is important to take into consideration both the patient’s and the physician’s suggestions and preferences. An airway clearance regimen should be effective, efficient, easy to use, able to be undertaken independently or with minimal assistance, and should improve lung function. It should also be flexible, comfortable and adaptable to meet the changing needs of the individual patient.

Chest Physiotherapy, also known as chest physical therapy (CPT), is a cornerstone airway clearance therapy used to treat pulmonary disorders by aiding the clearance of mucus from the lungs by moving it into the main larger airways so that it can be coughed out.6 CPT includes postural drainage, chest percussion, chest vibration, deep breathing exercises, and coughing. Respiratory therapists, nurses, and care givers who have been taught the correct procedure may administer manual hand CPT by using cupped hands to percuss and vibrate the chest wall to loosen mucus from the chest wall.6 Percussion and vibration help loosen and move mucus and secretions from the lungs and airways.

A less burdensome, yet effective airway clearance technique is the use of High Frequency Chest Wall Oscillation (HFCWO) therapy vests that apply vibratory forces that oscillate through the chest wall into the lungs to loosen and mobilize secretions. With the use of an HFCWO therapy vest, there is no need for a skilled caregiver and therapy can be easily performed on patients that are not capable of actively participating in therapy.

AffloVest, the first fully mobile during use HFCWO airway clearance therapy, was designed to deliver mobility and freedom. With no bulky hoses or generators, the AffloVest is engineered to encourage treatment adherence and compliance by allowing patients to experience an improved quality of life during airway clearance treatments.

AffloVest has eight mechanical oscillating motors, engineered to mimic manual CPT, the gold standard of airway clearance. AffloVest targets all five lobes of the lungs, front and back, with direct dynamic oscillation which allows patients to be fully mobile during use and Promotes airway clearance and secretion mobilization.

AffloVest offers a great alternative to manual chest physiotherapy (CPT).

 

Advantages:

  • Treatment can be self-administered.
  • Does not require a skilled professional, so every treatment will be done correctly.
  • Freedom to do other things during treatment, because no special position or breathing techniques are required.

References
1. Brandt-Rauf PW, Fallon LF, Jr, Tarontini T, Triema C, Andrews L. Health hazards of firefighters: exposure assessment. Br J Ind Med 1988;45:606-12.
2. Kirkpatrick M, Bass J. Severe obstructive lung disease after smoke inhalation. Chest 1979;76:108-10.
3. Loke J, Farmer W, Matthay R, Putman C, Smith G. Acute and chronic effects of firefighting on pulmonary function. Chest 1980;77:369-73.
4. Guidotti, Tee L, et al Occupational health concerns of firefighting. Annual Rev. Publ. Health. 1992. 13:151-71
5. McIlwaine M, Bradley J, Elborn JS, et al. Personalizing airway clearance in chronic lung disease. Eur Respir Rev 2017; 26: 16008
6. Faling L, Chest physical therapy. Philadelphia: Lippincott; 1991:625–654