Looking at the Respiratory Impacts of the Sept. 11, 2001 Attacks
Update: In July 2019, after passage by both the House and Senate, President Trump signed a bill into law to ensure continued full funding for the 9/11 Victims Compensation Fund. The "Never Forget the Heroes: James Zadroga, Ray Pfeifer, and Luis Alvarez Permanent Authorization of the September 11th Victim Compensation Fund Act" permanently funds benefits to people and families who suffered from health impacts from the Sept. 11 attacks and the ensuing rescue, recovery and cleanup operations.
Fifteen years after Sept.11, 2001, we remember and honor the victims of the tragic attacks that day, and the first responders who risked their own lives to save others. Beyond the terrible destruction and loss of life caused by these attacks, many of the survivors and first responders of the World Trade Center attack suffered from respiratory illness due to their exposure to what many refer to as "World Trade Center Dust." Some of these individuals still suffer from respiratory damage caused by the dust to this day.
To learn more about the respiratory impacts associated with the World Trade Center attack, we spoke with Brian W. Christman, M.D., professor and vice-chair for Clinical Affairs at Vanderbilt University and national volunteer spokesperson for American Lung Association.
Question: There were/are high rates of respiratory illness reported in those affected by the Sept. 11 attacks and in those who helped clean up after the attacks. Can you tell me about the types of respiratory illnesses experienced?
Answer from Dr. Brian Christman: Due to the intense exposure (to pollutants in the air) there have been a number of respiratory diseases associated with the attack on the World Trade Center. People who confronted the early, intense dust plume and burning fumes frequently developed acute rhinitis, sinusitis, sore throat and acute cough. The inhalation of some of the more reactive chemicals, such as acrolein which evolves when certain synthetic materials burn, resulted in injury to the smaller airways. Some patients developed variants of asthma with unusual small airway injuries from the toxic dust and fumes. These unusual injuries made these asthma cases initially hard to diagnose and treat.
Q: What are the factors that we know affected or caused these types of respiratory illnesses?
A: The dangerous inhalants included both pulverized alkaline dust from fragmented building materials and chemical products from explosions and burning of building materials. Alkaline is the opposite of acidic, but can be just as harmful. The alkaline silica dust deposited in small airways causing inflammation, scarring and narrowing. When the toxic dust deposited in the nose and sinuses, similar inflammation developed. The symptoms experienced were generally worse in those with pre-existing illnesses like allergic rhinitis ("hay fever"), chronic sinusitis, asthma, etc.
Q: Who was the most impacted by the "World Trade Center Dust"?
A: In general, those who were caught in or voluntarily entered the dust and debris cloud, or were early arrivers after the disaster. They worked longer at the site, did not use personal protective equipment and were at greater risk of developing respiratory symptoms.
Some firefighters' lungs aged the equivalent of 10-12 years in the first weeks to months following the attack from the dust they breathed. Those who smoked did even worse.
Some of the firefighters who were first responders had the heaviest dust exposure. The NYC Fire Department has performed spirometry (i.e., lung function testing) longitudinally with 13 years of follow up. Some firefighters’ lungs aged the equivalent of 10-12 years in the first weeks to months following the attack from the dust they breathed. Those who smoked did even worse.
Q: What are the three things that you would want the public to know about the respiratory impacts related to the terrorist attacks on the World Trade Center?
1) Most people who had intense early exposure did sustain around a 10 percent reduction in lung function and this reduction was sustained after more than a decade.
2) Some of the effects could have been reduced with widespread use of personal protective respiratory equipment.
3) Persons most affected generally had pre-existing lung problems. Smokers were harder hit than non-smokers.
Q: We certainly hope we never have another event like this. But we will have large scale disasters that affect many people. What lessons do you see that we have learned from 9/11 that we need to use in future disasters to protect lung health?
A: Most of the early responders had minimal equipment to help protect their lungs and upper airways. For future large scale exposures, we should ensure that both professional responders and engaged volunteers are provided with appropriate masks to protect their lungs. Those who are at ground zero soon after an explosion may need more sophisticated gear, such as self-contained breathing apparatus (often referred to as "SCUBA"s).
Some of the effects could have been reduced with widespread use of personal protective respiratory equipment.
Also, because of the ongoing job-associated risks for our rescue professionals, they should have baseline lung function studies to allow determination of an acquired loss of lung function.
I think it would be important for everyone to consider which of our citizens would be at greatest risk for having respiratory problems after an incident like the Sept. 11 attacks. Most of this is common sense, but folks with underlying respiratory disease will be a greatest risk. Examples would include older people with COPD or congestive heart failure, patients with scarring-type lung diseases with reduced lung function, and those with hypersensitive airways like those with asthma. Our youngest patients, babies and toddlers, have geometry working against them due to the small size of their airways. Naturally you would want to keep them away from a high dust/fume site such as Ground Zero if at all possible. Some recent research showed that patients with lung cancer did worse, with shorter survival, when they had chronic exposure to particulate air pollution.
To learn more about the support and treatment efforts for the survivors and responders of the World Trade Center attacks, we spoke with Joan Reibman, M.D., Director of the World Trade Center Environmental Health Center, who told us:
"There were numerous efforts from all arenas after 9/11 to screen for adverse health effects in both the responder and community population. For the responders, these efforts were from organized labor and extant health programs for the New York Fire Department working in conjunction with occupational health programs around New York City. For the community, now called 'Survivors,' these efforts were less organized and developed from advocacy of disparate community groups working with local academic centers. Currently there are Centers of Excellence for the responders as well as for the 'Survivors.' These are now mandated under law from the James Zadroga Health and Compensation Act . These programs provide treatment for World Trade Center related illnesses."
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