Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Medline ® Abstracts for References 32,33

of 'Reactive airways dysfunction syndrome and irritant-induced asthma'

Pulmonary disease in rescue workers at the World Trade Center site.
Banauch GI, Dhala A, Prezant DJ
Curr Opin Pulm Med. 2005;11(2):160.
PURPOSE OF REVIEW: The catastrophic collapse of the World Trade Center (WTC) towers on September 11, 2001 created a large-scale disaster site in a densely populated urban environment. Over the ensuing months, tens of thousands of rescue, recovery and cleanup workers, volunteers, and residents of the adjacent community were exposed to a complex mixture of airborne pollutants. This review focuses on currently described respiratory syndromes, symptoms, and physiologic derangements in WTC rescue, recovery, and cleanup workers, discusses potential long-term effects on respiratory health, and draws parallels to community findings.
RECENT FINDINGS: Detailed qualitative and quantitative analyses of airborne pollutants with their changing composition during initial rescue/recovery and subsequent cleanup have been published. Major concerns include persistent aerodigestive tract inflammatory syndromes, such as reactive airways dysfunction syndrome (RADS), reactive upper airways dysfunction syndrome (RUDS), gastroesophageal reflux disease (GERD), and inflammatory pulmonary parenchymal syndromes, as well as respiratory tract and nonrespiratory malignancies. Aerodigestive tract inflammatory syndromes have now been documented in WTC exposed occupational groups, and syndrome incidence has been linked to WTC airborne pollutant exposure intensity. Community based investigations have yielded similar findings.
SUMMARY: While it is too early to ascertain long-term effects of WTC dust exposure, current studies already demonstrate a definite link between exposure to WTC-derived airborne pollutants and respiratory disease, both in the occupational and the community setting. A better understanding of causes and effects of this exposure will help in developing appropriate preventative tools for rescue workers in future disasters.
Albert Einstein College of Medicine, Bronx, New York, USA. hbanauch@montefiore.org
Symptoms, respirator use, and pulmonary function changes among New York City firefighters responding to the World Trade Center disaster.
Feldman DM, Baron SL, Bernard BP, Lushniak BD, Banauch G, Arcentales N, Kelly KJ, Prezant DJ
Chest. 2004;125(4):1256.
CONTEXT: New York City firefighters responding to the World Trade Center (WTC) disaster on September 11, 2001, were exposed to numerous hazards. A medical screening program was conducted 3 weeks after the disaster on a sample of firefighters.
OBJECTIVES: To determine whether arrival time at the WTC and other exposure variables (including respirator use) were associated with symptoms and changes in pulmonary function (after exposure - before exposure).
DESIGN: A cross-sectional comparison of firefighters representing the following groups: (1) firefighters who arrived before/during the WTC collapse, (2) firefighters who arrived 1 to 2 days after the collapse, (3) firefighters who arrived 3 to 7 days after the collapse, and (4) unexposed firefighters.
SETTING: Fire Department of New York City (FDNY) Bureau of Health Services on October 1 to 5, 2001.
POPULATION: A stratified random sample of 362 of 398 recruited working firefighters (91%). Of these, 149 firefighters (41%) were present at the WTC collapse, 142 firefighters (39%) arrived after the collapse but within 48 h, 28 firefighters (8%) arrived 3 to 7 days after the collapse, and 43 firefighters (12%) were unexposed.
MAIN OUTCOME MEASURES: New/worsening symptoms involving the eyes, skin, respiratory system, and nose and throat (NT), and changes in spirometry from before to after exposure.
RESULTS: During the first 2 weeks at the WTC site, 19% of study firefighters reported not using a respirator; 50% reported using a respirator but only rarely. Prevalence ratios (PRs) for skin, eye, respiratory, and NT symptoms showed a dose-response pattern between exposure groups based on time of arrival at the WTC site, with PRs between 2.6 and 11.4 with 95% confidence intervals (CIs) excluding 1.0 for all but skin symptoms. For those spending>7 days at the site, the PR for respiratory symptoms was 1.32 (95% CI, 1.13 to 1.55), compared with those who were exposed for<7 days. Mean spirometry results before and after exposure were within normal limits. The change in spirometry findings (after exposure - before exposure) showed near-equal reductions for FVC and FEV(1). These reductions were greater than the annual reductions measured in a referent population of incumbent FDNY firefighters prior to September 11 (p<or= 0.05). There was a 60% increased risk of a decline of>or= 450 mL in FEV(1) in those arriving during the first 48 h compared to the referent (p<or= 0.05).
CONCLUSIONS: The symptoms and pulmonary function changes following exposure at the WTC demonstrate the need for improvements in respirators and their use, as well as long-term medical monitoring of rescue workers.
National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA.