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Thread: Tracing Lung Ailments That Rose With 9/11 Dust

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    Tracing Lung Ailments That Rose With 9/11 Dust

    By ANTHONY DePALMA
    Published: May 13, 2006

    As they push their investigation into the health risks to workers in the recovery and cleanup operations at ground zero, medical detectives are focusing on a group of lung diseases that can lead to long-term disabilities and, in some cases, death.

    After nearly five years, it is still too early for these doctors, scientists and forensic pathologists to say with certainty whether any long-term cancer threat came with exposure to the toxic cloud unleashed by the trade center collapse. But there are already clear signs that the dust, smoke and ash that responders breathed in have led to an increase in diseases that scar the lungs and reduce their capacity to take in and let out air.

    The Fire Department tracked a startling increase in cases of a particular lung scarring disease, known as sarcoidosis, among firefighters, which rose to five times the expected rate in the two years after Sept. 11. Though that rate has declined, doctors worry that the disease may be lurking in other firefighters. Experts who regularly see workers who were at ground zero in the 48 hours after the towers' collapse expect monitoring to show many more cases of lung scarring disorders among that group.

    New evidence also suggests that workers who arrived later or worked on the periphery may also be susceptible to debilitating lung ailments.

    "We have thousands of people who were down there with unprotected exposures," said Dr. Stephen M. Levin, a director of the World Trade Center Worker and Volunteer Medical Screening Program. "Many will develop asthma and a few will develop this terrible lung scarring that leads to disability or death."

    But even in diseases closely related to dust, making a binding connection to ground zero exposure is hard. For instance, the Fire Department has linked sarcoidosis to working at the trade center site, while the Police Department has not.

    The clues that led to this new area of medical investigation were stark reminders of what was lost on Sept. 11. They are drawn from cases of statistically unexpected respiratory disease among young responders.

    The ailments now seen are far more serious than the general hacking and congestion known as "World Trade Center cough" that initially hit most responders. Rather, these are a set of diseases and disorders that typically take a few years to develop, and in some cases get progressively worse.

    The most worrisome to medical experts are granulomatous pulmonary diseases, which show a particular type of swirling marks left on the lungs by foreign matter like dust. Doctors say the severity of the disease is often dictated by an patient's genetic makeup. The diseases include pulmonary fibrosis and sarcoidosis, the sometimes fatal disorder that can be set off when exposure to dust causes the body's immune system to attack itself.

    Some people can live with the scarring if they limit their activities, but in others the exposure to foreign material sets off a cascade of ailments that can lead to more debilitating conditions and, eventually, death. Detective James Zadroga, 34, died in January when his badly scarred lungs weakened and his heart gave out. The coroner's report gave the cause of death as "granulomatous pneumonitis," and the autopsy found swirls throughout his lungs caused by foreign material consistent with dust.

    Detective Zadroga's death was the first to be officially linked by an autopsy report to exposure to the ground zero dust, although the electronmicroscope comparisons that could have proved the match beyond a reasonable doubt were not done by the coroner's office.

    The Uniformed Firefighters Association earlier this year linked the deaths of two firefighters and a battalion chief

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    Tracing Lung Ailments That Rose With 9/11 Dust (continued)

    (Page 2 of 2)

    Although the reported cases of lung disease affect a tiny portion of the 40,000 people who responded to the trade center collapse, they have already caused widespread concern among the survivors, lending urgency to medical efforts to understand the risks and illnesses involved.

    "When these cases come to public attention, every individual down there who has some problem breathing thinks, 'I'm next,' " said Dr. Levin, a professor at Mount Sinai School of Medicine.

    Dr. Levin's screening program offers the most complete picture of the health consequences of Sept. 11, apart from statistics maintained by the Fire Department on the firefighters. Nearly 12,000 union employees and other workers who were exposed to the trade center dust and debris have been examined.

    Dr. Levin said that more than 60 percent of those people developed respiratory problems like sinusitis. He said continued monitoring was beginning to suggest that more serious lung problems might follow; he will complete a new epidemiological study of responders in a few months.

    In testimony before a Congressional committee in February, Dr. Kerry J. Kelly, chief medical officer of the Fire Department, outlined the department's concerns about lung diseases. She said one responder awaiting a lung transplant had died of pulmonary fibrosis. And the department was alarmed to find that 20 firefighters had come down with sarcoidosis in the first two years after Sept. 11, "a substantial increase from prior years" that was believed to be linked to "massive dust inhalation" at ground zero.

    The high rate, five times the expected level, has since returned to the expected range

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    9/11 Sucks 12 Years From Bravest Lungs

    Updated: 05-15-2006 11:29:23 AM



    By CARL CAMPANILE
    Courtesy of New York Post

    FDNY rescuers who sucked in toxic air while working at Ground Zero lost the equivalent of 12 years of lung function after the World Trade Center attacks, a bombshell health study shows.

    "World Trade Center exposure produced a substantial reduction in pulmonary function in New York City Fire Department rescue workers during the first year following 9/11/01," according to the analysis of 12,079 fire and EMT workers conducted by Montefiore Medical Center-Einstein College and the FDNY.

    The respiratory loss "equaled 12 years of aging-related decline," the report said.

    The study compared the health conditions of the FDNY responders who worked on rescue and recovery efforts with their medical test results from the previous five years.

    Each of the responders underwent testing to determine lung and respiratory capacity before and after 9/11. The exam tallies forced expiratory volume (FEV) - or how much a person can exhale during a breath.

    Typically, an adult loses 31 milliliters in FEV per year. But Ground Zero workers lost 372 milliliters - a rate of decline 12 times the normal annual rate.

    "There was a drop in lung function equivalent to 12 years of aging," said co-author Dr. Gisela Banauch, a professor at Montefiore/Einstein College in The Bronx. "It's statistically a very significant loss."

    "This study - together with other studies that have been published - makes a causal connection between WTC exposure and short- to intermediate-term respiratory disease very likely," Banauch told The Post of the findings, published in the American Journal of Respiratory Critical Care Medicine.

    The loss in lung function is "tied to sickness and death," she added.

    The 12-year loss is just an average. Thousands of firefighters who were present during the collapse of the Twin Towers suffered the greatest loss of respiratory capacity (388 milliliters), the study found.

    The FDNY's chief medical officer, Dr. David Prezant, who is a study co-author and Einstein College professor, considered the discrepancy in the rate of illnesses - based on when firefighters and EMTs arrived at the disaster site - the most significant scientific finding. Pollution and debris were most prevalent when the buildings crashed, and dissipated in time.

    "The closer you were to the morning of the collapse," Prezant said, "the worst drop in symptoms and pulmonary function."

    Prezant stressed that the dramatic 12-year loss in breathing functions in one year was a snapshot in time and doesn't necessarily mean a 40-year-old ends up with the lungs of a 52-year-old.

    "It doesn't mean this is irreversible loss. Early diagnosis and aggressive treatment has been restoring a large portion of the lung function. There's been great improvement," he said.

    A follow-up analysis will be conducted to determine whether breathing functions recover or worsen for each FDNY rescue worker.

    Lawyers representing sick Ground Zero rescue workers in a negligence suit filed against the city hailed the report's findings.

    "It shows what a massive impact this disaster had on first responders. Usually it takes years or decades for diseases to show themselves. Here, you have acute health effects shortly thereafter. What does this tell us about the future?" said attorney Andrew Carboy of Sullivan, Papain, Block, McGrath & Cannavo.

    And Carboy said the study also provides crucial evidence showing that government officials in charge of Ground Zero failed to provide safety gear to protect workers from inhaling hazardous air and dust - a major claim of plaintiffs in the case.

    The study noted that more than 400 chemicals were identified in the toxic WTC air.

    "Adequate respiratory protection was not immediately available," the report said, adding that only 22 percent of workers who first arrived to the disaster site wore masks. Among responders who came later, the figure never topped 50 percent.

    Even so, the protective respiratory equipment that was used "had no appreciable effect," the study said. "No doubt, the initial lack of adequate equipment and subsequent compliance problems diminished any protective impact," it said.

    http://cms.firehouse.com/content/art...Id=46&id=49283

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    Some of the people working in the cleanup and recovery effort after Sept. 11 wore masks, but the most effective ones were effective for no more than 20 minutes.

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    Officer James J. Godbee Jr., who died in 2004, had scarred lungs.

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