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Occupational toxicant inhalation injury: the World Trade Center (WTC) experience

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Abstract

Objective and methods

Clinical descriptive data is presented on a group of 554 former workers and volunteers (with more than 90 different occupations) at the World Trade Center (WTC) disaster site. A subsample of 168 workers (30% of the group) was selected to examine lower airway disease risk in relation to smoking and WTC exposure variables.

Results

Five diagnostic categories clearly predominate: upper airway disease (78.5%), gastroesophageal reflux disease (57.6%), lower airway disease (48.9%), psychological (41.9%) and chronic musculoskeletal illnesses (17.8%). The most frequent pattern of presentation was a combination of the first three of those categories (29.8%). Associations were found between arrival at the WTC site within the first 48 h of the terrorist attack and lower airway and gastroesophageal reflux disease, and between past or present cigarette smoking and lower airway disease.

Conclusion

Occupational exposures at the WTC remain consistently associated with a disease profile, which includes five major diagnostic categories. These conditions often coexist in different combinations, which (as expected) mutually enhances their clinical expression, complicates medical management, and slows recovery. Cigarette smoking and early arrival at the WTC site appear to be risk factors for lower airway disease diagnosis.

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Notes

  1. Subsequent to the review and acceptance of this article, two patients suspected to have small airway disease (as described in “Methods” and “Results”), underwent thoracoscopic open lung biopsy, in view of their lack of adequate response to inhaled medications. The histology revealed constrictive bronchiolitis in one of the cases, which would lend support to the preliminary classification presented in this article. This patient (whose end-expiratory chest CT scan showed severe air trapping but no interstitial changes, and his pulmonary function tests borderline decreases in both total lung capacity and diffusion capacity) had, however, mild and patchy but definite focal lymphoid aggregates, areas of alveolar–capillary membrane thickening, and mild subpleural distal air space dilatation, but no honeycombing or fibroblastic foci. In the second case, the chest CT scan showed equally severe air trapping and interstitial changes, but the restriction and decreased diffusion were severe. The histologic features just described for the first case were similar but clearly more severe in the second case. Pending further characterization, the latter findings would add a new category of lung disease or broaden the spectrum or our understanding of the nature of the small airway disease category.

  2. See footnote 1.

References

  • Al Neaimi YI, Gomes J, Lloyd OL (2001) Respiratory illnesses and ventilatory function among workers at a cement factory in a rapidly developing country. Occup Med 51:367–373

    Article  CAS  Google Scholar 

  • American Thoracic Society (1978) Epidemiology standardization project. Am Rev Respir Dis 118:1–120

    Google Scholar 

  • American Thoracic Society (1991) Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis 144:1202–1218

    Google Scholar 

  • Banauch GI, Alleyne D, Sánchez R, Olender K, Cohen HW, Weiden M, Kelly KJ, Prezant DJ (2003) Persistent hyperreactivity and reactive airway dysfunction in firefighters at the World Trade Center. Am J Respir Crit Care Med 168:54–62

    Article  PubMed  Google Scholar 

  • Belafsky PC, Postma GN, Koufman JA (2001) The validity and reliability of the Reflux Finding Score (RFS). Laryngoscope 111:1313–1317

    Article  PubMed  CAS  Google Scholar 

  • Berríos-Torres SI, Greenko JA, Phillips M, Miller JR, Treadwell T, Ikeda RM (2003) World Trade Center rescue worker injury and illness surveillance, New York, 2001. Am J Prev Med 25:79–87

    Article  PubMed  Google Scholar 

  • Brightling CE, Ward R, Goh KL, Wardlaw AJ, Pavord ID (1999) Eosinophilic bronchitis is an important cause of chronic cough. Am J Respir Crit Care Med 160:406–410

    PubMed  CAS  Google Scholar 

  • Buyantseva LV, Tulchinsky M, Kapalka GMP, Chinchilli VM, Qian Z, Gillio R, Roberts A, Bascom R (2007) Evolution of lower respiratory symptoms in New York police officers after 9/11: a prospective longitudinal study. J Occup Environ Med 49:310–317

    Article  PubMed  Google Scholar 

  • Centers for Disease Control, Prevention (2002) Injuries and illnesses among New York City Fire Department rescue workers after responding to the World Trade Center attacks. MMWR 51:1–20

    Google Scholar 

  • Crapo RO, Morris AH, Clayton PD, Nixon CR (1982) Lung volumes in healthy nonsmoking adults. Bull Eur Physiopathol Respir 18:419–425

    Google Scholar 

  • DeVault KR, Castell DO (1999) Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 94:1434–1442

    Article  PubMed  CAS  Google Scholar 

  • Feldman DM, Baron SL, Bernard BP, Lushniak BD, Banauch G, Arcentales N, Kelly KJ, Prezant DJ (2004) Symptoms, respiratory use, and pulmonary function changes among New York City firefighters responding to the World Trade Center disaster. Chest 125:1256–1264

    Article  PubMed  Google Scholar 

  • Fireman EM, Lerman Y, Ganor E, Greif J, Fireman-Shoresh S, Lioy PJ, Banauch GI, Weiden M, Kelly KJ, Prezant DJ (2004) Induced sputum assessment in New York Ctiy firefighters exposed to World Trade Center dust. Environ Health Perspect 112:1564–1569

    Article  PubMed  CAS  Google Scholar 

  • Gavett SH, Haykal-Coates N, Highfill JW, Ledbetter AD, Chen LC, Cohen MD, Harkema JR, Wagner JG, Costa DL (2003) World Trade Center fine particulate matter causes respiratory tract hyperresponsiveness in mice. Environ Health Perspect 111:981–991

    Article  PubMed  Google Scholar 

  • Ghanei M, Hosseini AR, Arabbaferani Z, Shahkarami E (2005) Evaluation of chronic cough in chemical chronic bronchitis patients. Envrion Toxicol Pharmacol 20:6–10

    Article  CAS  Google Scholar 

  • Ghanei M, Khedmat H, Mardi F, Hosseini A (2006) Distal esophagitis in patients with mustard-gas induced chronic cough. Dis Esophagus 19:285–288

    Article  PubMed  CAS  Google Scholar 

  • Gibbons WJ, Sharma A, Lougheed D, Macklem PT (1996) Detection of excessive bronchoconstriction in asthma. Am J Respir Crit Care Med 153:582–589

    PubMed  CAS  Google Scholar 

  • Guerry-Force ML, Müller NL, Wright JL, Wiggs B, Coppin C, Paré PD, Hogg JC (1987) A comparison of bronchiolitis obliterans with organizing pneumonia, usual interstitial pneumonia, and small airways disease. Am Rev Respir Dis 135:705–712

    PubMed  CAS  Google Scholar 

  • Hankinson JL, Odencratz JR, Fedan KB (1999) Spirometric reference values from a sample of the general US population. Am J Respir Crit Care Med 159:179–187

    PubMed  CAS  Google Scholar 

  • Kempainen RR, Savik K, Whelan TP, Dunitz JM, Herrington CS, Billings JL (2007) High prevalence of proximal and distal gastroesophageal reflux disease in advanced COPD. Chest 131:1666–1671

    Article  PubMed  Google Scholar 

  • Levin SM, Herbert R, Moline JM, Todd AC, Stevenson L, Landsbergis P, Jiang S, Skloot G, Baron S, Enright P (2005) Physical health status of World Trade Center rescue and recovery workers and volunteers––New York City, July 2002–August 2004. MMWR 53:807–812

    Google Scholar 

  • Lioy PJ, Weisel C, Millette JR, Eisenreich SJ, Vallero D, Offenberg J, Buckley B, Turpin B, Zhong M, Cohen MD, Prophete C, Yang I, Stiles R, Chee G, Johnson W, Porcia R, Alimokhtari S, Hale RC, Weschler C, Chen LC (2002) Characterization of the dust/smoke aerosol that settled east of the World Trade Center (WTC) in Lower Manhattan after the collapse of the WTC 11 September 2001. Environ Health Perspect 110:703–714

    Article  PubMed  CAS  Google Scholar 

  • Malo JM, Ghezzo H (2004) Recovery of methacholine responsiveness after end of exposure in occupational asthma. Am J Respir Crit Care Med 169:1304–1307

    Article  PubMed  Google Scholar 

  • Mann JM, Sha KK, Kline G, Breuer F-U, Miller A (2005) World Trade Center dyspnea: bronchiolitis obliterans with functional improvement: a case report. Am J Ind Med 48:225–229

    Article  PubMed  Google Scholar 

  • Mendelson DS, Roggeveen M, Levin SM, Herbert R, de la Hoz RE (2007) Air trapping detected on end-expiratory high resolution CT in symptomatic World Trade Center rescue and recovery workers. J Occup Environ Med 49:840–845

    Article  PubMed  Google Scholar 

  • Miller A, Thornton JC, Warshaw R, Anderson H, Teirstein AS, Selikoff IJ (1983) Single breath diffusing capacity in a representative sample of the population of Michigan, a large industrial state, predicted values, lower limits of normal, and frequencies of abnormality by smoking history. Am Rev Respir Dis 127:270–277

    PubMed  CAS  Google Scholar 

  • Mwaiselage J, Brätveit M, Moen B, Mashalla Y (2004) Cement dust exposure and ventilatory function impairment: an exposure-response study. J Occup Environ Med 46:658–667

    Article  PubMed  Google Scholar 

  • Payne JP, Kemp SJ, Dewar A, Goldstraw P, Kendall M, Chen LC, Tetley TD (2004) Effects of airborne World Trade Center dust on cytokine release by primary human lung cells in vitro. J Occup Environ Med 46(5):420–427

    Article  PubMed  CAS  Google Scholar 

  • Prezant DJ, Weiden M, Banauch GI, McGuinness G, Rom WN, Aldrich TK, Kelly KJ (2002) Cough and bronchial responsiveness in firefighters at the World Trade Center site. N Engl J Med 347:806–815

    Article  PubMed  Google Scholar 

  • Ruigómez A, García Rodríguez LA, Wallander M-A, Johansson S, Thomas M, Price D (2005) Gastroesophageal reflux disease and asthma––a longitudinal study in UK general practice. Chest 128:85–93

    Article  PubMed  Google Scholar 

  • Salzman SH, Moosavy FM, Miskoff JA, Friedmann P, Fried G, Rosen MJ (2004) Early respiratory abnormalities in emergency services police officers at the World Trade Center site. J Occup Environ Med 46:113–122

    Article  PubMed  Google Scholar 

  • Smith RP, Katz CL, Holmes A, Herbert R, Levin SM, Moline J, Landsbergis P, Stevenson L, North CS, Larkin GL, Baron S, Hurrell JJ (2004) Mental health status of World Trade Center rescue and recovery workers and volunteers––New York City, July 2002–August 2004. MMWR 53:812–815

    Google Scholar 

  • SPSS Inc. (2003) SPSS for Windows ver. 12.0, Chicago

  • Storaas T, Steinsvag SK, Florvaag E, Irgens A, Aasen TB (2005) Occupational rhinitis: diagnostic criteria, relation to lower airway symptoms and IgE sensitization in bakery workers. Acta Otolaryngol 125:1211–1217

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was made possible by the support of the American Red Cross, the 11 September Fund, the Robin Hood Foundation, and the Bear Stearns Charitable Foundation. Part of this work was presented in abstract form at the 2004 annual meetings of the American Thoracic Society, the American Rhinologic Society/COSM, and Radiologic Society of North America. Part of this work was presented in May of 2006 by Dr. Rachel Chasan in partial fulfillment of the requirements for her master of public health degree at The Mount Sinai School of Medicine. We acknowledge the contributions of Mr. Diego Levy and Mr. Oscar Castillo to the process of data gathering, entry, and data base management. We thank Drs. Benoit Nemery, Paul Landsbergis, Carrie Redlich, and Peter D. Paré for their critical review of the manuscript and their suggestions. In November of 2006, after almost 4 years of operation, the WTC Health Effects Treatment Program received governmental funding, became fully sponsored by the United States federal government, and merged with the pre-existing (since July of 2002) WTC Screening and Monitoring Program into the WTC Medical Monitoring and Treatment Program.

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Correspondence to Rafael E. de la Hoz.

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de la Hoz, R.E., Shohet, M.R., Chasan, R. et al. Occupational toxicant inhalation injury: the World Trade Center (WTC) experience. Int Arch Occup Environ Health 81, 479–485 (2008). https://doi.org/10.1007/s00420-007-0240-x

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