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Previous Volume 347:806-815 September 12, 2002 Number 11 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Appendix 1 Editorial by Scanlon, P. D. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Workers from the Fire Department of New York City were exposed to a variety of inhaled materials during and after the collapse of the World Trade Center. We evaluated clinical features in a series of 332 firefighters in whom severe cough developed after exposure and the prevalence and severity of bronchial hyperreactivity in firefighters without severe cough classified according to the level of exposure.

Methods "World Trade Center cough" was defined as a persistent cough that developed after exposure to the site and was accompanied by respiratory symptoms severe enough to require medical leave for at least four weeks. Evaluation of exposed firefighters included completion of a standard questionnaire, spirometry, airway-responsiveness testing, and chest imaging.

Results In the first six months after September 11, 2001, World Trade Center cough occurred in 128 of 1636 firefighters with a high level of exposure (8 percent), 187 of 6958 with a moderate level of exposure (3 percent), and 17 of 1320 with a low level of exposure (1 percent). In addition, 95 percent had symptoms of dyspnea, 87 percent had gastroesophageal reflux disease, and 54 percent had nasal congestion. Of those tested before treatment of World Trade Center cough, 63 percent of firefighters (149 of 237) had a response to a bronchodilator and 24 percent (9 of 37) had bronchial hyperreactivity. Chest radiographs were unchanged from precollapse findings in 319 of the 332 with World Trade Center cough. Among the cohort without severe cough, bronchial hyperreactivity was present in 77 firefighters with a high level of exposure (23 percent) and 26 with a moderate level of exposure (8 percent).

Conclusions Intense, short-term exposure to materials generated during the collapse of the World Trade Center was associated with bronchial responsiveness and the development of cough. Clinical and physiological severity was related to the intensity of exposure.

Source Information

From the Bureau of Health Services, Fire Department of New York City, New York (D.J.P., M.W., K.J.K.); the Division of Pulmonary Medicine, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, N.Y. (D.J.P., G.I.B., T.K.A.); and the Division of Pulmonary and Critical Care Medicine, Departments of Medicine, Environmental Medicine, and Radiology, New York University School of Medicine, New York (M.W., G.M., W.N.R.).

Address reprint requests to Dr. Prezant at Montefiore Medical Center, Pulmonary Division, Centennial 423, Bronx, NY 10467, or at prezand{at}fdny.nyc.gov.

Full Text of this Article

Related Letters:

Cough and Bronchial Responsiveness in Firefighters at the World Trade Center Site
Hanson B. L., Sztern B., Lange J. H., Prezant D., Weiden M., Kelly K. J.
Extract | Full Text | PDF  
N Engl J Med 2003; 348:76-77, Jan 2, 2003. Correspondence

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