Increased sarcoidosis in WTC rescue workers
NEW YORK (Reuters Health) - There is an increased incidence of sarcoidosis and "sarcoid-like" granulomatous pulmonary disease (SLGPD) among Fire Department of New York (FDNY) members who were rescue workers in the World Trade Center disaster, according to findings published in the medical journal Chest.
Sarcoidosis is an inflammatory disease that first appears as grain-like lumps, or "granulomas," which are mostly seen in the lungs or lymph nodes. They clump together to form larger clumps that eventually attack other organs. The condition may be mild or may be severe, causing lasting damage.
"On September 11, 2001, the attack and collapse of the WTC in New York City released massive amounts of airborne respirable particulate matter and combustion byproducts," Dr. David J. Prezant, of the FDNY, and colleagues write. Since then, there have been reports of granulomatous pneumonitis and cardiopulmonary sarcoidosis in workers exposed to dust.
Prezant and colleagues examined whether exposure to WTC dust during the rescue/recovery effort increased the incidence of sarcoidosis or SLGPD. Subjects in the FDNY WTC monitoring and treatment programs with chest X-rays suggestive of sarcoidosis were evaluated during the 5 years after the WTC disaster. The evaluation included chest CT imaging, pulmonary function, provocative challenge, and biopsy. The team compared the annual incidence rates to the 15 years before the WTC disaster.
Pathologic evidence consistent with sarcoidosis or SLGPD was found in 26 WTC-exposed FDNY rescue workers. Overall, 13 patients were identified in the first year after WTC dust exposure (86 for every 100,000 workers) and another13 came for treatment in the next 4 years (22 for every 100,000). This compared with 15 cases for every100,000 workers identified during the 15 years before WTC dust exposure.
The increase in the annual incidence of sarcoidosis or SLGPD among FDNY rescue workers in the 5 years after WTC dust exposure was statistically significant. All 26 patients were present at the site during the first 72 hours after the collapse, when the respirable dust concentrations were at their highest.
Fifteen percent had airway obstruction, 38 percent had evidence of disease on lung function testing (obstruction, bronchodilator response, and/or airway hyperreactivity), 58 percent had asthma symptoms, and 69 percent had symptoms and/or pulmonary function evidence," Prezant's team explains.
The team reports that all 26 patients had multisystem disease within the chest cavity. Six patients (23 percent) also had disease in other parts of the body.
The new findings have "important public health consequences for disease prevention, early detection, and treatment following environmental/occupational exposures," the team concludes.
SOURCE: Chest, May 2007.
