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Environment
Original Article
Risk factors for persistence of lower respiratory symptoms among community members exposed to the 2001 World Trade Center terrorist attacks
  1. Hannah T Jordan1,
  2. Stephen M Friedman1,
  3. Joan Reibman2,
  4. Roberta M Goldring2,
  5. Sara A Miller Archie1,
  6. Felix Ortega1,
  7. Howard Alper1,
  8. Yongzhao Shao2,
  9. Carey B Maslow1,
  10. James E Cone1,
  11. Mark R Farfel1,
  12. Kenneth I Berger2
  1. 1 World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, New York, USA
  2. 2 Department of Medicine, New York University School of Medicine, New York, New York, USA
  1. Correspondence to Dr Hannah T Jordan, Deputy Medical Director, World Trade Center Health Registry; New York City Department of Health and Mental Hygiene; 125 Worth Street, 10th floor, CN 6W; New York, NY 10013, USA; hjordan1{at}health.nyc.gov

Abstract

Objectives We studied the course of lower respiratory symptoms (LRS; cough, wheeze or dyspnoea) among community members exposed to the 9/11/2001 World Trade Center (WTC) attacks during a period of 12–13 years following the attacks, and evaluated risk factors for LRS persistence, including peripheral airway dysfunction and post-traumatic stress disorder (PTSD).

Methods Non-smoking adult participants in a case-control study of post-9/11-onset LRS (exam 1, 2008–2010) were recruited for follow-up (exam 2, 2013–2014). Peripheral airway function was assessed with impulse oscillometry measures of R5 and R5-20. Probable PTSD was a PTSD checklist score ≥44 on a 2006–2007 questionnaire.

Results Of 785 exam 1 participants, 545 (69%) completed exam 2. Most (321, 59%) were asymptomatic at all assessments. Among 192 participants with initial LRS, symptoms resolved for 110 (57%) by exam 2, 55 (29%) had persistent LRS and 27 (14%) had other patterns. The proportion with normal spirometry increased from 65% at exam 1 to 85% at exam 2 in the persistent LRS group (p<0.01) and was stable among asymptomatic participants and those with resolved LRS. By exam 2, spirometry results did not differ across symptom groups; however, R5 and R5-20 abnormalities were more common among participants with persistent LRS (56% and 46%, respectively) than among participants with resolved LRS (30%, p<0.01; 27%, p=0.03) or asymptomatic participants (20%, p<0.001; 8.2%, p<0.001). PTSD, R5 at exam 1, and R5-20 at exam 1 were each independently associated with persistent LRS.

Conclusions Peripheral airway dysfunction and PTSD may contribute to LRS persistence. Assessment of peripheral airway function detected pulmonary damage not evident on spirometry. Mental and physical healthcare for survivors of complex environmental disasters should be coordinated carefully.

  • Environmental Exposure
  • Signs and Symptoms, Respiratory
  • Lung Function Tests

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/oemed-2016-104157

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    Footnotes

    • Contributors HTJ had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. HTJ, SMF, JR, RMG, JEC, MRF, and KIB contributed substantially to the study design. HTJ, SMF, JR, RMG, SAM, FO, HA, YS, CM, JEC, MRF, and KIB contributed substantially to the data analysis and interpretation, and the writing of the manuscript.

    • Funding This publication was supported by Cooperative Agreement Numbers 2U50/OH009739 and 5U50/OH009739 from the National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC); U50/ATU272750 from the Agency for Toxic Substances and Disease Registry (ATSDR), CDC, which included support from the National Center for Environmental Health, CDC; and by the New York City Department of Health and Mental Hygiene (NYC DOHMH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIOSH, CDC or the Department of Health and Human Services.

    • Competing interests None declared.

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