In a study of rescue/recovery workers exposed to the toxic dust created by the collapse of the World Trade Center (WTC) buildings in the September 2011 terrorist attacks, a team of researchers assessed how a diagnosis of obstructive airways disease (OAD) affected the likelihood of a subsequent diagnosis of chronic rhinosinusitis (CRS) or gastroesophageal reflux disease (GERD).
The researchers analyzed diagnoses of OAD, CRS, and GERD made by Fire Department of the City of New York doctors between September 11, 2001, and September 10, 2011. An OAD diagnosis significantly increased the risks for subsequent CRS diagnosis. The study concluded that individuals with an OAD diagnosis had elevated risks for subsequent diagnoses of CRS or GERD.
The research team was drawn from Albert Einstein College of Medicine, New York University School of Medicine, Montefiore Medical Center, and the Bureau of Health Services of the Fire Department of New York (FDNY).
National law firm Parker Waichman has spent many years fighting to ensure that first responders and rescue/recover workers of the 9/11 attacks receive the medical care and compensation they deserve. Members of the firm worked for the 2015 reauthorization of the James Zadroga 9/11 Health and Compensation Act.
World Trade Center Toxic Exposure
The destruction of the twin towers and other buildings at the World Trade Center site on September 11, 2001 produced a massive dust cloud containing partially combusted and/or pulverized wood, paper, and jet fuel; pulverized construction materials including asbestos, glass, silica, fiberglass, and concrete; complex organic chemicals; lead and other metals; and other potentially hazardous materials.
The adverse respiratory effects of WTC exposure have shown consistent dose–response relationships. The authors of the new study say they and others “have found a high postexposure health burden of aerodigestive conditions, a category that includes lower respiratory diseases such as asthma, chronic bronchitis, and COPD/emphysema, which together are categorized as obstructive airways disease (OAD); upper respiratory diseases that were predominantly chronic rhinosinusitis (CRS); and gastroesophageal reflux disease (GERD).”
Increased Risk of Multiple Diagnoses
In the 15 years since the disaster, some workers have experienced “chronic inflammation of mucosal surfaces in the nose, sinuses, and lungs, producing CRS, reactive airway disease, and GERD, which may be due to caustic esophageal exposure in the context of accidental ingestion.” By 2015, the authors say, nearly 30 percent of FDNY WTC rescue/recovery workers had a physician diagnosis of CRS, 28% GERD, and 24 percent OAD.
The researchers report high comorbidity rates—the presence of two or more chronic diseases or conditions in a patient—of WTC-related aerodigestive conditions. Some rescue/recovery workers have been diagnosed with all three aerodigestive conditions. The researchers say the clinical reasons for the co-occurrences remain unknown. But GERD may cause lower and upper respiratory diseases or exacerbate persistent airway irritation. Or, perhaps, OAD or CRS might cause or exacerbate GERD through mechanically induced inflammation, for example, cough, postnasal drip, mucous), drug effects (theophylline, corticosteroids), or shared neurological pathways.
The researchers previously reported that FDNY WTC rescue/recovery workers were more frequently diagnosed with OAD than CRS in the months and years after exposure, but over time, CRS diagnoses increased. About six years after their exposure, , GERD diagnoses started to increase. The role, if any, of an early OAD diagnosis in subsequent diagnoses of CRS and/or GERD was unclear.
The population studied consisted of FDNY male firefighters who were active on September 11, 2001 and who arrived at the WTC site to participate in the rescue/recovery effort on or before September 24, 2001. They all had at least one visit to the FDNY Bureau of Health Services (FDNY-BHS) for treatment of any medical condition after exposure. After excluding firefighters with pre-WTC exposure evidence of OAD, CRS, or GERD, the final cohort studied consisted of 8,968 participants.
Demographic information such as age, race, and retirement status was obtained from the FDNY employee database. WTC exposure intensity was obtained from participants’ first post-9/11 health questionnaire. Since 1996, FDNY-BHS has used an electronic medical record system, which contains in-house physician diagnoses and information from diagnostic tests such as endoscopy, spirometry, methacholine challenge tests, and chest CT scans.
The researchers characterized WTC exposure intensity by time of first arrival to the WTC site. These times ranged from arrival on the morning of September 11, 2001 (high); afternoon of September 11, 2001 and anytime on September 12, 2001 (moderate); and any day between September 13, 2001, and September 24, 2001 (low).
The analysis showed that WTC-exposed firefighters with an OAD diagnosis had more than four times the risk of subsequently being diagnosed with CRS and three times the risk of being subsequently diagnosed with GERD. Further, an OAD diagnosis partially mediates the association between WTC exposure and GERD and between WTC exposure and CRS. There are at least two explanations of our findings: biologic, meaning vulnerability of individuals with OAD; and structural, meaning health care practices of physicians at FDNY and elsewhere.
Possible biologic explanations include the hypothesis that OAD, CRS, and GERD are all a consequence of non-resolving inflammation at aerodigestive mucosal surfaces exposed to caustic WTC dust. Thus, the association of OAD with CRS and with GERD could demonstrate elevated individual risk for mucosal injury due to exposure conditions or patient intrinsic vulnerability. Another explanation is that OAD or CRS may cause or exacerbate GERD through mechanically induced inflammation—through cough, postnasal drip, or mucous. A third explanation is that individuals with an OAD diagnosis have diminished capacity for physical activity, possibly leading to reduced fitness and substantial weight gain, which is a risk factor for GERD. Finally, OAD medications such may also lead directly to GERD. Non-biologic explanations include the likelihood that individuals with an OAD diagnosis are regularly seen for treatment at FDNY-BHS, which increases the opportunity for those individuals to receive additional diagnoses, including CRS or GERD.
Study findings support the need continued medical monitoring of WTC-exposed individuals as well as long-term monitoring and treatment for future disasters with high-intensity exposures.
Legal Help for Those with WTC-Related Health Conditions
If you or someone you know has OAD, CRS, or GERD as a result of 9/11 toxic exposure, the attorneys at Parker Waichman LLP can offer a free, no obligation consultation your right to compensation. To reach the firm, fill out the contact form or call 1-800-YOURLAWYER (1-800-968-7529).