title: Occupational toxicant inhalation injury: the World Trade Center (WTC) experience.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Community and Preventive Medicine, and Medicine, The Mount Sinai School of Medicine, WTC Health Effects Treatment Program, New York, NY 10029, USA. Rafael.delaHoz@mssm.edu
authors.forename: Rafael E
authors.initials: RE
authors.lastname: de la Hoz
authors.forename: Michael R
authors.initials: MR
authors.lastname: Shohet
authors.forename: Rachel
authors.initials: R
authors.lastname: Chasan
authors.forename: Laura A
authors.initials: LA
authors.lastname: Bienenfeld
authors.forename: Aboaba A
authors.initials: AA
authors.lastname: Afilaka
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Levin
authors.forename: Robin
authors.initials: R
authors.lastname: Herbert
mesh_terms: D000395:Air Pollutants, Occupational / Q000633:toxicity*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects*; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000209:etiology / Q000503:physiopathology; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D009784:Occupational Diseases / Q000209:etiology* / Q000503:physiopathology; D016273:Occupational Exposure / Q000009:adverse effects*; D018635:Rescue Work; D012140:Respiratory Tract Diseases / Q000150:complications / Q000209:etiology / Q000503:physiopathology; D047851:September 11 Terrorist Attacks; D014838:Volunteers