WTC Cough May Have Long-term Sequelae in Hundreds

Laurie Barclay, MD

November 06, 2002

Nov. 6, 2002 (San Diego) — The "World Trade Center cough" continues to affect several hundred New York City firefighters, police, and emergency workers, but little is known about the long-term effects of the condition, according to a panel of experts assembled here at CHEST 2002, the 68th annual meeting of the American College of Chest Physicians. Moreover, it is likely that people who live and work in the area are similarly affected.

David J. Prezant, MD, professor of medicine at Albert Einstein College of Medicine in New York, estimated that "300 to 500 New York City firemen will have long-term symptoms and impairment" as a result of days spent in the rubble of the fallen towers.

In the first six months after the World Trade Center (WTC) attack, 301 firefighters developed "WTC cough." Dyspnea (94%), chest discomfort (85%), gastroesophageal reflux disease ([GERD] 87%), and nasal congestion (54%) were reported by most. Fifty-four percent had significant, nearly equal reductions in FVC and FEV1, with more than 500 mL declines from pre-WTC levels. Patients had almost exclusively airway pathology.

Physiologically, subjects had bronchodilator response (63%) and hyperreactivity (23%); radiographically, there was air trapping (51%) and bronchial wall thickening (30%). Little evidence for parenchymal lung disease was seen on chest X-ray, high-resolution chest computed tomography, lung volumes, and diffusion capacity.

New York firefighters are "in excellent, superior physical condition," said Prezant, and that conditioning protected them from disability. Because many firefighters have better than expected lung function, "losing 40% might bring them down to 80%," he said. Asked if a history of smoking increased risk for WTC cough, Prezant said there was no relation between smoking and WTC cough but he added that there is concern about smoking and long-term effects because smoking "decreases repair function."

In a separate study, Farid Moosavy, MD, of the division of pulmonary and critical care medicine at Beth Israel Medical Center in Boston, Massachusetts, studied WTC cough in 240 members of the NYC Police Department Emergency Services Unit and found that officers who "were first on the scene and who were least prepared" and those who spent long periods at the site during the month after Sept. 11, 2001, were most likely to have respiratory symptoms.

Although much attention has been focused on WTC exposure among NYC firefighters, police, and emergency workers, there has been little formal study of other workers or residents who live in lower Manhattan, said Alvin Teirstein, MD, professor of medicine at Mount Sinai School of Medicine and director of the Richenthal Institute, in New York, who is coauthor of a third study.

Dr. Teirstein told Medscape that he expects similar effects to be seen in area residents. He and his colleagues conducted a pilot study of 96 ironworkers who were at the WTC site between Sept. 11, 2001, and February 2002. Seventy-seven percent of those workers had more than one respiratory symptom and 31% had spirometric obstruction. Twelve workers had radiographic abnormalities consistent with pneumoconiosis.

Based on that pilot study, "we have been funded to conduct a study of 8,000 workers," Dr. Teirstein told Medscape. He said that Mount Sinai is also attempting a study of women who live in lower Manhattan and who were pregnant at the time of the collapse. "We want to find out the outcome of those pregnancies," he said.

CHEST 2002: Abstracts S82,S83, S85. Presented Nov. 5, 2002.

Reviewed by Gary D. Vogin, MD