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
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
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
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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