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Published ahead of print on February 25, 2003, doi:10.1164/rccm.200211-1329OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 1, July 2003, 54-62

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Submitted on November 21, 2002
Accepted on February 20, 2003

PERSISTENT HYPERREACTIVITY AND REACTIVE AIRWAYS DYSFUNCTION IN WORLD TRADE CENTER FIREFIGHTERS

Gisela I Banauch1, Dawn Alleyne1, Raoul Sanchez1, Kattia Olender2, Hillel W Cohen3, Michael Weiden4, Kerry J Kelly2, and David J Prezant5*

1 New York City Fire Department, Bureau of Health Services, Brooklyn, NY, USA, 2 Pulmonary Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA, 3 Pulmonary Division, New York University School of Medicine, New York, NY, USA, 4 Pulmonary Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA, 5 Pulmonary Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; New York City Fire Department, Bureau of Health Services, Brooklyn, NY, USA

* To whom correspondence should be addressed. 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 reactive airways dysfunction (RADS) 6-months post-collapse. A representative sample of 179 FDNY rescue workers stratified by exposure intensity (high, moderate, control) without current smoking or prior respiratory disease was enrolled. Highly exposed workers arrived within 2 hours of collapse, moderately exposed later day 1-2; controls were not exposed. Hyperreactivity at 1-, 3-, 6-months post-collapse was associated with exposure intensity independent of ex-smoking and airflow obstruction. Six months post-collapse, highly exposed were 6.8 times more likely than moderately exposed and controls to be hyperreactive (95%CI, 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 RADS(p=0.021). In conclusion, development and persistence of hyperreactivity and RADS were strongly and independently associated with exposure intensity. Hyperreactivity shortly post-collapse predicted RADS at 6-months in highly exposed workers; this has important implications for disaster management plans.
Key words: inorganic particulate matter, nonspecific bronchial hyperreactivity, reactive airways dysfunction syndrome, World Trade Center collapse, firefighters, smoke inhalation




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