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'World Trade Center Cough' Identified

Air 'Thicker Than Pea Soup' Led to Breathing Problems, Acid Reflux

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Sept. 9, 2002 -- Some lingering memories of the World Trade Center collapse might be the plumes of smoke and clouds of dust that billowed over the site for days. The lingering effects of such airborne debris made some New York firefighters sick for months.

A study in the Sept. 12 issue of The New England Journal of Medicine shows that 332 firefighters suffered from what became known as "World Trade Center cough." That's about 3% of the nearly 11,000 who responded to the disaster. World Trade Center cough was characterized as a prolonged, severe cough accompanied by shortness of breath.

Researcher David J. Prezant, MD, and colleagues reported that these firefighters were ill enough to take medical leave of at least four weeks. Less than half went back to work within seven months. About 100 firefighters who were exposed in the first week had throat irritation and respiratory problems that didn't require medical leave. Prezant is with the Bureau of Health Services, Fire Department of New York City.

Researchers say they made an unexpected discovery: The vast majority of cough sufferers also developed heartburn or acid reflux disease. The scientists suspect the reflux was caused by dust that irritated the digestive tract and that it made coughing worse. A NEJM editorial called the incidence of reflux disease "strikingly high."

The New York research team, which included fire department medical staff, found the more intense the exposure to the debris, the more likely firefighters would get sick. So more of those firefighters who got to the scene first -- on Sept. 11 -- developed the cough than those who responded in the following week. Most cases can be traced to exposure in the first three days.

One deputy chief was able to free himself from debris after the collapse said the air he breathed was "darker than a sealed vault and thicker than pea soup." All 332 firefighters with World Trade Center cough said they coughed up dark mucus that contained some "pebbles or particles" within 24 hours of exposure.

Most of the firefighters did not use respirators while on duty, the study shows. Even when they were used, they mostly were just paper dust masks. The NEJM editorial says as a result, firefighters suffered "adverse health effects." It urges "the best possible protection" be provided for rescue workers and healthcare workers, because "disasters on a similar scale are possible in the future."

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