Bronchial hyperreactivity and other inhalation lung injuries in rescue/recovery workers after the World Trade Center collapse.
BACKGROUND
The collapse of the World Trade Center (WTC) on September 11, 2001 created a large-scale disaster site in a dense urban environment. In the days and months thereafter, thousands of rescue/recovery workers, volunteers, and residents were exposed to a complex mixture of airborne pollutants.


METHODS
We review current knowledge of aerodigestive inhalation lung injuries resulting from this complex exposure and present new data on the persistence of nonspecific bronchial hyperreactivity (methacholine PC20 < or =8 mg/mL) in a representative sample of 179 Fire Department of the City of New York (FDNY) rescue workers stratified by exposure intensity (according to arrival time) who underwent challenge testing at 1, 3, 6, and 12 months post-collapse.


RESULTS
Aerodigestive tract inflammatory injuries, such as declines in pulmonary function, reactive airways dysfunction syndrome (RADS), asthma, reactive upper airways dysfunction syndrome (RUDS), gastroesophageal reflux disease (GERD), and rare cases of inflammatory pulmonary parenchymal diseases, have been documented in WTC rescue/recovery workers and volunteers. In FDNY rescue workers, we found persistent hyperreactivity associated with exposure intensity, independent of airflow obstruction. One year post-collapse, 23% of highly exposed subjects were hyperreactive as compared with only 11% of moderately exposed and 4% of controls. At 1 yr, 16% met the criteria for RADS.


CONCLUSIONS
While it is too early to ascertain all of the long-term effects of WTC exposures, continued medical monitoring and treatment is needed to help those exposed and to improve our prevention, diagnosis, and treatment protocols for future disasters.
Banauch
Gisela I
GI
Albert Einstein College of Medicine, New York, NY, USA.
Dhala
Atiya
A
Alleyne
Dawn
D
Alva
Rakesh
R
Santhyadka
Ganesha
G
Krasko
Anatoli
A
Weiden
Michael
M
Kelly
Kerry J
KJ
Prezant
David J
DJ
D000393:Air Pollutants / Q000009:adverse effects; D016535:Bronchial Hyperreactivity / Q000453:epidemiology / Q000209:etiology*; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D009519:New York City; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology*; D016273:Occupational Exposure / Q000009:adverse effects; D018635:Rescue Work; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology*; D047851:September 11 Terrorist Attacks; D014838:Volunteers
D000393:Air Pollutants