Air Today . . . Gone Tomorrow Article

Assessing The Scope Of WTC Ailments: Experts study how lung ills may worsen
By Delthia Ricks, Newsday Staff Writer, October 1, 2002

A year after the World Trade Center's collapse, doctors have just begun to get a grasp of the scope - and persistence - of respiratory disorders left in the disaster's wake. Many have even begun to wonder whether more serious illnesses, such as heart disease and cancer, await.

In addition to asthma, a new condition called World Trade Center cough and another relatively new medical disorder known as reactive airways dysfunction syndrome - RADS - are the ailments most commonly treated in firefighters, police officers and others who responded to or lived near the site. RADS is a type of occupational asthma, a wheezing condition that occurs usually after exposure to high concentrations of environmental irritants. It can evolve into full-blown episodes of asthma, studies have shown.

Doctors say a rarer condition - hypersensitivity pneumonitis, also known interchangeably as farmer's lung and coffee worker's lung - may yet be established. The cough is the most common of the post-9/11 respiratory illnesses.

Dr. Suhail Raoof, a pulmonary disease specialist at Nassau University Medical Center in East Meadow, said WTC cough is nagging and distinctive. He has examined dozens of police officers in recent months with its symptoms. "It is a dry cough and sometimes it is very profound, very severe," said Raoof, director of pulmonary medicine at the medical center and a professor of medicine at SUNY Stony Brook.

As with all things in medicine there are exceptions, gray zones and mysteries. The case of a Lodi, N.J., truck driver is among them. Terry Algranati, 34, was not in Manhattan on the day of the attack nor did he work on the pile of debris. But he could see smoke rising like a thunderhead over lower Manhattan. He now has a persistent and debilitating cough, and he and his doctors blame the dust from Ground Zero.

On Sept. 12, 2001, Algranati drove to Fort Lee, N.J., to play basketball with friends. His game was cut short by the air's thickness and acrid smell, which caused him to cough. Algranati now has been plagued by the cough for a year. His doctors have no idea whether it will subside, and he now relies on an inhaler. "From that point on I have had trouble breathing," Algranati said. His doctors term the condition pre-asthma. And it worsens in certain positions. "When I lay on my back, I get a hacking cough," he said. Algranati, robust and athletic before 9/11, said he had always been healthy. "I never went to doctors that much; never took any medicine. I'm certainly not a hypochondriac. So this has been a real surprise."

Hardest hit were the hundreds of rescuers at Ground Zero. Medical investigators from New York City's fire department and the Centers for Disease Control and Prevention wrote recently in the New England Journal of Medicine that the "clinical and physiological severity [of the cough] was related to the intensity of exposure."

And the greater the exposure, doctors said, the more intense the aftereffects. Some of the worst symptoms have been detected in firefighters and paramedics. Long-dormant asthma, a distant problem of childhood, has resumed with a vengeance for some rescuers, doctors say.

FDNY officials estimate that 3 percent of the department's workforce has been affected in some way by long-term respiratory disability. "They are a long way from being the physically active firefighters" that they were, said Dr. David Prezant, FDNY's deputy chief medical officer. He and a team of medical investigators examined 10,116 firefighters and paramedics in the months following the disaster. More than 600 remain sidelined because of medical problems, most of them respiratory, Prezant said. "To return to their way of life, they would have to be off medicine," Prezant said during a news conference last month. "They have severe worries about whether their conditions will get better over time." Prezant has further defined WTC cough as being more syndrome than singular medical condition. "It is a combined irritation of the sinuses, throat, lower airways and always involves the esophageal tract," he said.

All of the respiratory disorders - the cough, asthma and RADS - are marked by inflammatory processes in the lungs, bronchial tubes and nasal sinuses. Medical treatment involves anti-inflammatory medications for some patients and the commonly prescribed asthma drugs for others. Pulmonary function tests are conducted as part of the battery of tests needed to make a diagnosis.

Raoof has examined more than 300 police officers with lung disorders in an investigation funded by the Fraternal Order of Police. "Police officers are not routinely exposed to smoke and particulates, so this is a different population of patients that we are looking at with these symptoms," he said. RADS, Raoof explained, was described for the first time in 1988 as a disorder found in those who work in environments with airborne debris. Like WTC cough, it is more syndrome than singular disorder.

The condition consists of wheezing, respiratory tract inflammation, nasal irritation, and for some, asthma attacks. Doctors have learned that WTC cough can evolve into RADS. "After a period of time the cough started showing a progression in a significant number of the people," Raoof said. "We found they had sinusitis and had a postnasal drip or they had RADS." He said the patients Dr. Prezant studied were mainly firefighters "exposed to a lot of smoke. Their symptoms are more profound."

Numerous patients, the doctors found, have experienced more than one respiratory ailment. And, they say, as WTC cough has evolved into RADS for some people, RADS has developed into persistent asthma attacks for others.

Additional studies of people affected by Ground Zero debris are under way at Stony Brook University Hospital and Mount Sinai Medical Center in Manhattan. But while doctors are dealing with respiratory conditions now, they have no idea whether more serious illnesses will develop in the future. "I don't think that we're ever going to know the full scale of what firefighters were exposed to on that day," Prezant said. In very general terms, he and his team defined the particles causing WTC cough as "inorganic dust, products of pyrolysis [burned or scorched airborne particles], and other respirable material."

Though experts such as Dr. Stephen Levin, medical director of Mount Sinai's occupational health center, have said serious medical disorders such as mesothelioma do not appear likely, Prezant still questioned during a recent news conference whether cancer and heart disease might loom for those who responded to the disaster.

Research is only now showing how environmental particulates can lead to heart disease. Dr. Robert D. Brook of the University of Michigan reported earlier this year that particulates from air pollution cause constriction of the blood vessels, setting the stage for heart attacks. No proof exists that a single concentrated exposure, such as that experienced at Ground Zero, can lead to vascular changes profound enough to cause a heart attack.

Dr. David Parkinson, director of the occupational and environmental health center at Stony Brook, said the longer lung conditions persist, the more likely more advanced ailments will be found. He said studies are being expanded to include more patients. One respiratory illness that may be discovered, he said, is hypersensitivity pneumonitis, or farmer's lung. The disorder is typified by cough, wheezing, nausea and labored breathing, occasionally accompanied by pain.

The disease is caused by organic dusts. Cotton mill workers have gotten it, Parkinson said, as have farmers who bale hay. "Theoretically, there might have been something in that dreadful dust that might have produced hypersensitivity pneumonitis. There are people who probably have it" because of Ground Zero exposure, he said.

Prezant and other doctors have vowed to continue studying illnesses wrought by the disaster. "It would have been impossible for anyone to imagine the scope [of the pulmonary disorders] before this disaster," said Dr. Paul Scanlon, a professor of medicine and pulmonary disease specialist at the Mayo Clinic in Rochester, Minn.


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