Air Today . . . Gone Tomorrow Article|
CT helps find cause of
puzzling cough in WTC rescue workers
Public release date: 30-Nov-2004
CHICAGO Radiologists are one step closer to solving a mysterious condition
affecting World Trade Center (WTC) rescue and recovery workers.
Air trapping, a manifestation of obstructed lung airways often seen in smokers and the
elderly, was identified in 25 of 29 rescue and recovery workers suffering from "WTC
cough," according to early research results presented today at the annual meeting of
the Radiological Society of North America (RSNA).
"Our research further corroborates that people at the World Trade Center site on
Sept. 11, 2001, and the days after were exposed to environmental toxins that initiated
airway problems," said lead author David S. Mendelson, M.D., associate professor of
radiology at the Mount Sinai School of Medicine in New York City.
The diagnosis was made using end-expiratory high-resolution CT, a rarely used test that is
performed after patients have expelled their breath. In a typical chest CT, the scan is
performed during a deep breath hold.
Twenty-nine rescue and recovery workers whose respiratory complaints could not be clearly
characterized by routine pulmonary function tests were evaluated with standard CT and
end-expiratory CT. The end-expiratory CT revealed abnormalities not detected on the
These patients had been referred by the WTC Health Effects Treatment Program, a dedicated
clinical effort for World Trade Center rescue and cleanup workers that has evaluated about
900 patients since January 2003. Approximately 40 percent of these patients have been
identified as having new or exacerbated respiratory problems since their work at Ground
Zero. Researchers speculate that small-airway disease has resulted from exposure to large
amounts of toxic dust particles found at the WTC site.
Many of the impairments are clearly obstructive, but there also appears to be a patient
subgroup with definite symptoms in whom conventional tests fail to show the nature and
extent of the obstruction. The term "WTC cough" was coined to describe ailments
that could not be clearly characterized in this group, but the addition of end-expiratory
CT revealed abnormalities beyond the mild changes that can be seen in smokers and the
Although thought to be benign, air trapping is symptomatic causing shortness of
breath, dry cough or wheezing and is treated as a variant of asthma, with inhaled
steroids and bronchodilators.
"We remain attentive to the possibility of other adverse health effects that still
may occur," said co-author Rafael de la Hoz, M.D. "We have seen evidence of
improvement in some patients, but certainly not in all. We are hoping to secure enough
funding to systematically continue the characterization and treatment of these
The U.S. Centers for Disease Control and Prevention (CDC) estimates that 10,000 Fire
Department of New York personnel and 30,000 other workers and volunteers were exposed to
environmental stress, toxins and other physical hazards during rescue and recovery
Co-authors of the paper being presented by Dr. Mendelson are Dr. de la Hoz, Mark
Roggeveen, M.D., Stephen Levin, M.D., and Robin Herbert, M.D.
Note: Copies of RSNA 2004 news releases and electronic images will be available online at
RSNA.org/press04 beginning Monday, Nov. 29.
RSNA is an association of more than 37,000 radiologists, radiation oncologists and related
scientists committed to promoting excellence in radiology through education and by
fostering research, with the ultimate goal of improving patient care. The Society is based
in Oak Brook, Ill.
Editor's note: The data in these releases may differ from those in the printed abstract
and those actually presented at the meeting, as researchers continue to update their data
right up until the meeting. To ensure you are using the most up-to-date information,
please call the RSNA Newsroom between Nov. 27 and Dec. 3 at 312-949-3233.
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