Chest
Volume 125, Issue 4, April 2004, Pages 1248-1255
Journal home page for Chest

Clinical Investigations
WORLD TRADE CENTER
Respiratory Symptoms and Physiologic Assessment of Ironworkers at the World Trade Center Disaster Site

https://doi.org/10.1378/chest.125.4.1248Get rights and content

Study objectives

To characterize respiratory abnormalities in a convenience sample of ironworkers exposed at the World Trade Center (WTC) disaster site for varying lengths of time between September 11, 2001, and February 8, 2002.

Design

Cross-sectional study.

Setting

The Mount Sinai Medical Center, a large tertiary hospital.

Participants

Ninety-six ironworkers engaged in rescue and recovery with exposure onset between September 11, 2001, and September 15, 2001, who responded to an invitation to undergo respiratory evaluation.

Measurements

Medical and exposure history, physical examination, spirometry, forced oscillation (FO), and chest radiographs. The relationships of prevalence of respiratory symptoms and presence of obstructive physiology to smoking, exposure on September 11, duration of exposure, and type of respiratory protection were examined using univariate and linear and logistic regression analyses.

Results

Seventy-four of 96 workers (77%) had one or more respiratory symptoms (similar in smokers [49 of 63 subjects, 78%] and nonsmokers [25 of 33 subjects, 76%]). Cough was the most common symptom (62 of 96 subjects, 65%), and was associated with exposure on September 11. Chest examination and radiograph findings were abnormal in 10 subjects (10%) and 19 subjects (20%), respectively. FO revealed dysfunction in 34 of 64 subjects tested (53%), while spirometry suggested obstruction in only 11 subjects (17%). Lack of a respirator with canister was a risk factor for large airway dysfunction, and cigarette smoking was a risk factor for small airway dysfunction. No other relationships reached statistical significance.

Conclusions

Respiratory symptoms occurred in the majority of ironworkers at the WTC disaster site and were not attributable to smoking. Exposure on September 11 was associated with a greater prevalence of cough. Objective evidence of lung disease was less common. Spirometry underestimated the prevalence of lung function abnormalities in comparison to FO. Continuing evaluation of symptoms, chest radiographs, and airway dysfunction should determine whether long-term clinical sequelae will exist.

Section snippets

Subjects

One hundred four male ironworkers involved in rescue and recovery efforts and prolonged cleanup of the WTC site were recruited via distribution of an exposure questionnaire to union members. Subjects were > 18 years old and had spent at least 3 days at the disaster site with a start date between September 11, 2001, and September 15, 2001. Many were still working at the site at the time of this evaluation. Eight individuals were excluded due either to a shorter duration of exposure or to a start

Results

Table 2 summarizes the medical history and exposure data. Seventy-four of the 96 ironworkers had one or more respiratory complaints. The most common symptom was cough (n = 62), followed by dyspnea (n = 48) and chest tightness and wheezing (n = 44 each). Sinus complaints occurred in 50 individuals. Upper and lower respiratory symptoms were present concurrently in almost half the cohort (n = 45). Few subjects had prior self-reported asthma (n = 7) or sinus disease (n = 1). More than half of the

Discussion

The initial goal of the present study was to characterize the extent of pulmonary disease in a convenience sample of ironworkers who responded to an invitation to undergo medical evaluation 5 months after the disaster. A second important goal was to compare the techniques of FO and routine spirometry as screening modalities for airways dysfunction in this cohort. Our results demonstrate a high prevalence of respiratory symptoms in exposed workers with fewer abnormalities on physical

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    This work was performed at The Mount Sinai School of Medicine and was supported by grants from the Vivian Richenthal Institute of Pulmonary and Critical Care Medicine and The Catherine and Henry J. Gaisman Foundation.

    Dr. Michael Goldman is a paid consultant to Jaeger, the company that manufactures the oscillation spirometry equipment.

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