First responders and construction crews toiled at dusty Ground Zero amid a sea of toxic pollutants from the World Trade Center collapse on 9/11. Now clinicians have noted these workers are twice as likely to develop asthma as the general population.
This was a healthier population before 9/11, and they had a dramatic increase in asthma after 9/11, says Jacqueline Moline, MD, MPH, associate professor of preventive and internal medicine at the Mount Sinai School of Medicine and director and principal investigator of the World Trade Center Medical Monitoring and Treatment Program Clinical Center at Mount Sinai. That is one of the stark findings from the monitoring.
Before the buildings collapse, the rate of asthma among WTC responders was 3%, compared to a national average of 4%. Less than 1% of the more than 20,000 individuals presenting to the program reported having an asthma episode in the year before the terrorist attack.
The number of responders and recovery workers with asthma keeps increasing, with 3% reporting episodes of the disease in 2002, 5% in 2003, 7% in 2004 and 8% in 2005, the last year the WTC Program researchers included in their presentation about their findings at the American College of Chest Physicians CHEST 2009 conference in November.
The study reported on data collected while monitoring law enforcement and protective service workers, construction workers and other responders who had engaged in paid and volunteer WTC rescue, recovery and cleanup efforts. It does not include firefighters who have their own monitoring program. Males represented 86% of the survey population, and the average duration of work at WTC sites was 80 days.
Moline says she is not surprised by the findings because the statistics reveal what she and other members of the WTC Monitoring Program clinical team see every day.
In addition to developing asthma at a greater rate, people with WTC-related asthma tend to have a more severe form of the disease. Although treated with the same pharmaceuticals as used with traditional asthma, WTC patients often require more medication to control the symptoms. They use their rescue inhalers more often than patients with standard asthma.
We dont know why, Moline says. Future research will look at how patients react to treatment and what different treatments are needed with WTC- or non-WTC-exposed patients with similar issues.
Monitoring ProgramJessy Thomas, RN
The WTC Medical Monitoring and Treatment Program offers free medical surveillance exams and treatment for WTC-related health conditions to people who worked at the WTC site, morgue, Fresh Kills Landfill and on barges. The National Institute for Occupational Safety and Health and the Centers for Disease Control and Prevention support the program. The James Zadroga 9/11 Health and Compensation Act, pending in Congress, would provide long-term comprehensive healthcare and compensation for those sickened or injured in the aftermath of 9/11.
The goal of the program is to find out what happened to their health as a result of the exposure at Ground Zero and treat them for whatever condition resulted, Moline says. A broader goal is to understand what happens after a disaster, but it is primarily a clinical program to provide optimal care for the workers at the WTC site.
More than 27,000 responders have received screening at one of seven sites in New York and New Jersey. When we see patients, we do a screening with a history, says Jessy Thomas, NP, MPH, MSN, a nurse practitioner for the WTC Medical Monitoring and Treatment Program Clinical Center at Mount Sinai. Then a clinician performs a physical exam and determines if we want to initiate follow-up and a treatment program.
Treatment, if indicated, can begin at that first visit, and follow-up will continue for years to come at a visit frequency indicated by the persons clinical condition. At a minimum, patients return annually for a monitoring exam.
We also stress to them to see a primary care provider for other preventive care, Thomas says.
The medical team frequently encounters WTC-related sinus ailments, gastroesophageal reflux disorder and post-traumatic stress disorder. Prior research papers have reported WTC workers are more likely than people in the general population to experience PTSD, panic disorder, increased drinking and other mental health problems and that they suffer from persistent physical ailments, especially respiratory conditions. Clinicians also have noted a small but significant number of responders younger than 45 have developed multiple myeloma, but researchers say it is too early to know if an increased cancer risk is associated with the WTC work.
The study authors concluded that workers should be protected from exposures to massive and complex hazards, and those who have toiled in a mix of toxic pollutants will require long-term medical follow-up.
The basic tenet of occupational health is that personal protective equipment needs to be used and mandated, Moline says. But when there is chaos, all bets are off.
However, Moline explains, first responders could carry respirators and their use could become second nature, just as healthcare workers now immediately don gloves when they might encounter body fluids.
Thomas says that change will require education about the risks and what clinicians have learned about what can go wrong and the long-term consequences of exposures.
We dont know all of the health effects, Moline says. Some conditions may have a long latency. These individuals will need to be followed for decades to understand the magnitude of the World Trade Center disaster.