Einstein/Montefiore Department of Medicine

WTC Cough Syndrome Update

Seven Years Later, a Cough and a Covenant

By Julia Hess
Published September 10, 2008

Image: David Prezant (Pulmonary Medicine), Co-Director, FDNY World Trade Center Monitoring and Treatment Program and Chief Medical Officer, FDNY Office of Medical Affairs.

For many 9/11 firefighters and other rescue workers, sinus sprays, asthma inhalers, and heartburn medications have become as routine as morning coffee. Seven years later, the chronic cough resulting from asthmatic bronchitis, acid reflux, and sinusitis, a blend now known as the “WTC Cough Syndrome,” continues to plague these first responders. With lives and health altered as indelibly as the face of Ground Zero, New York City firefighters and EMS rescue workers have become the primary focus of investigators like Dr. David Prezant, Einstein-Montefiore Professor of Pulmonary Medicine, Co-Director of the Fire Department’s (FDNY) World Trade Center Monitoring and Treatment Program and Chief Medical Officer at the FDNY Office of Medical Affairs.

“When I see these guys, the first thing they ask is, ‘How am I doing?’ Then they ask, ‘How are my buddies doing?’ They’re willing to participate in our monitoring and treatment programs. They don’t want to be guinea pigs, but they do want people to learn from them and from their diseases. They want what we want—to prevent the next generation from being exposed and affected,” said Prezant.

Along with partners Dr. Thomas Aldrich (Einstein-Montefiore Professor of Pulmonary Medicine), Dr. Kerry Kelly (Co-Director of the FDNY World Trade Center Monitoring and Treatment Program and Chief Medical Officer, FDNY Bureau of Health Services), and the rest of their group, Dr. Prezant was the first to describe WTC Cough Syndrome (New England Journal of Medicine 2002), and he has published extensively on this subject in publications including the Center for Disease Control Morbidity and Mortality Weekly Report (CDC MMWR), the American Journal of Respiratory and Critical Care Medicine, and Chest and Environmental Health Perspectives. Known as “The Lung Specialist Who Answered the 9/11 Call,” Prezant has a mission to determine the mechanisms responsible for firefighters’ post-exposure pulmonary decline and abnormality.

During and after the towers collapsed, the enormous volume of pulverized building materials—masonry, painted surfaces, office flooring, window glass, and elevators—combined with fires to create an intensity of toxic airborne contaminants including asbestos, hydrochloric acid, silica, heavy metals, and other known carcinogenic compounds. Many of the 12,000+ FDNY rescue workers who responded to the attacks developed a substantial accelerated decline in pulmonary function, including decreased lung capacity, airway narrowing, asthma and chronic sinusitis. Firefighters who responded within 48 hours showed more severe symptoms, though complications also emerged in rescue workers and volunteers who had repeated low-level exposure to dust disturbances and enclosed, poorly ventilated areas at the site. In a minority of workers, more advanced issues of interstitial lung disease such as sarcoidosis, pulmonary fibrosis, and bronchiolitis obliterans have also been detected.

“These people handled a disaster of unimaginable proportions, and yet every patient tells me they’d do it again,” said Prezant.

The collapse of the World Trade Center presented firefighters with every possible danger, which they handled equipped with respirators designed for fires but not for terrorist attacks and prolonged rescue/recovery efforts. Inhalation exposure was inevitable, but still they worked long hours, repeatedly returning to rescue those they could and recover those they could not. The impact of 9/11 on firefighters’ health is a puzzle that will continue to unfold. Over the next decade, Prezant and his group will study whether their pulmonary function improves, stabilizes, or declines, conduct a formal disease surveillance program, and make every effort to determine which clinical factors might predict the most favorable outcome.

Seven years later, he still believes that he has the greatest job on Earth. “Every day, I get to identify with these phenomenal workers, to monitor and treat them and help them deal with the consequences they’re living with. We’re fulfilling a unspoken covenant—they’ll go into the most dangerous situation imaginable to save someone like me or you, and all they ask in return is that we will be there to medically treat and care for them when they come out. Hopefully at the same time, what we are learning and understanding will help the medical profession be more proactive should a situation like this ever happen again,” he said. “It’s an immense opportunity for the nerds of this world like me to thank these guys for the heroism they display every day.”

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