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Published ahead of print on February 25, 2003, doi:10.1164/rccm.200211-1329OC
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American Journal of Respiratory and Critical Care Medicine Vol 168. pp. 54-62, (2003)
© 2003 American Thoracic Society

Original Article

Persistent Hyperreactivity and Reactive Airway Dysfunction in Firefighters at the World Trade Center

Gisela I. Banauch, Dawn Alleyne, Raoul Sanchez, Kattia Olender, Hillel W. Cohen, Michael Weiden, Kerry J. Kelly and David J. Prezant

Pulmonary Division, Montefiore Medical Center, and Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx; Bureau of Health Services, New York City Fire Department, Brooklyn; and Pulmonary Division, New York University School of Medicine, New York, New York

Correspondence and requests for reprints should be addressed to Dr. David Prezant, M.D., Professor of Medicine, Montefiore Medical Center, Pulmonary Division, Centennial 423, Bronx, NY 10467. E-mail: Prezd{at}dnamail.com

New York City Fire Department rescue workers experienced massive exposure to airborne particulates at the World Trade Center site. Aims of this longitudinal study were to (1) determine if bronchial hyperreactivity was present, persistent, and independently associated with exposure intensity, (2) identify objective measures shortly after the collapse that would predict persistent hyperreactivity and a diagnosis of reactive airways dysfunction 6 months post-collapse. A representative sample of 179 rescue workers stratified by exposure intensity (high, moderate, and control) without current smoking or prior respiratory disease was enrolled. Highly exposed workers arrived within 2 hours of collapse, moderately exposed workers arrived later on Days 1–2; control subjects were not exposed. Hyperreactivity at 1, 3, and 6 months post-collapse was associated with exposure intensity, independent of ex-smoking and airflow obstruction. Six months post-collapse, highly exposed workers were 6.8 times more likely than moderately exposed workers and control subjects to be hyperreactive (95% confidence interval, 1.8–25.2; p = 0.004), and hyperreactivity persisted in 55% of those hyperreactive at 1 and/or 3 months. In highly exposed subjects, hyperreactivity 1 or 3 months post-collapse was the sole predictor for reactive airways dysfunction (p = 0.021). In conclusion, development and persistence of hyperreactivity and reactive airways dysfunction were strongly and independently associated with exposure intensity. Hyperreactivity shortly post-collapse predicted reactive airways dysfunction at 6 months in highly exposed workers; this has important implications for disaster management.

Key Words: inorganic particulate matter • nonspecific bronchial hyperreactivity • reactive airways dysfunction syndrome • firefighters • World Trade Center collapse




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