title: World Trade Center dyspnea: bronchiolitis obliterans with functional improvement: a case report.
abstract: BACKGROUND
  Bronchiolitis obliterans is a severe, often progressive, lung disease characterized by cough, exertional dyspnea, and airflow obstruction. It has been ascribed to specific causes such as lung or bone marrow transplant, medications for rheumatoid disease, and most recently in association with exposure to environmental agents.
  
  
  METHODS
  A 42-year-old, previously healthy New York City Highway Patrol officer who arrived at the World Trade Center (WTC), "ground zero," early on September 11, 2001 was evaluated. He has been followed for over 2 years with serial chest radiographs, CT scans, and pulmonary function studies. He eventually underwent an open lung biopsy.
  
  
  RESULTS
  His dyspnea started on September 12, 2001 and progressed despite aggressive therapy with inhaled bronchodilator as well as oral and inhaled corticosteroids. At no time did he have any radiographic evidence of pulmonary disease. His forced vital capacity (FVC) decreased from 5.32 L in October 2001 to 2.86 L in January 2003. He underwent an open lung biopsy because of the persistent exertional dyspnea coupled with the loss of over 2 L of lung volume. The pathological findings were chronic bronchiolitis with focal obliterative bronchiolitis and rare non-necrotizing granuloma. Symptoms and pulmonary function improved after therapy with Azithromycin was added to his treatment.
  
  
  CONCLUSIONS
  This process is believed to be secondary to his massive exposure to the cloud of dust that followed the collapse of the WTC. It is our conviction that many of those present at the WTC on September 11 who have persistent dyspnea and deterioration of pulmonary function may have a similar pathologic process despite absence of abnormalities on CT of the chest.
  
  
  CONCLUSIONS
  In view of the many signs and symptoms seen in first responders we feel that these findings provide important information about the pathophysiology and treatment of progressive disease resulting from this exposure.
authors.affiliation: Weill Medical College of Cornell University, Attending Physicians in the Division of Pulmonary Medicine, New York Hospital Queens, Flushing, New York, USA. lungjack@pol.net
authors.forename: Jack M
authors.initials: JM
authors.lastname: Mann
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Sha
authors.forename: Gary
authors.initials: G
authors.lastname: Kline
authors.forename: Frank-Uwe
authors.initials: FU
authors.lastname: Breuer
authors.forename: Albert
authors.initials: A
authors.lastname: Miller
mesh_terms: D000328:Adult; D001989:Bronchiolitis Obliterans / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D004391:Dust; D006801:Humans; D008297:Male; D009519:New York City; D009784:Occupational Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D016273:Occupational Exposure; D016495:Police; D047851:September 11 Terrorist Attacks
chemical_list: D004391:Dust