Inhaled steroids protected 9/11 firefighters-study
By Julie Steenhuysen
CHICAGO, Oct 24 (Reuters) - As New York City firefighters struggled to find survivors in the haze and rubble of the World Trade Center collapse, the fire department's chief doctor was thinking about how to keep them safe from toxins in the air.
Dr. David Prezant devised a plan to offer inhaled corticosteroids -- the kind used to prevent asthma attacks -- to the city's firefighters in the hopes they might prevent lung damage.
The effort appears to have paid off, said Prezant, a lung specialist who presented his findings on Wednesday to a meeting of the American College of Chest Physicians in Chicago.
Prezant knew the best defense against respiratory disease would be to use respirators, but he also knew exposure was inevitable, and many rescue workers had already breathed in potentially toxic particles.
"These people were going to rescue their buddies and recover their buddies no matter what. It was our plan to mitigate their exposure," Prezant told Reuters.
The strategy was unproven. No studies had shown inhaled steroids could protect against long-term lung damage.
Prezant, who had been trapped at the World Trade Center himself and was taking inhaled steroids to protect his own lungs, decided to offer the same treatment to firefighters.
"We thought about this on day two," said Prezant, co-director of the World Trade Center Medical Monitoring and Treatment Programs.
He asked a friend at Montefiore Medical Center to contact a sales representative for AstraZeneca (AZN.N) (AZN.L), maker of the inhaler known as Pulmicort or budesonide.
"I knew there would never be any side-effects. That is why I knew it was worth doing even if there was no evidence it would help," he said.
Within days of the Sept. 11 attack, AstraZeneca had trucks loaded with 10,000 donated inhalers headed for the city.
FEARS OF SIDE-EFFECTS
Prezant had to satisfy the company's lawyer that the medication, which is not labeled for preventive use, would be given by medical personnel and that firefighters would be fully informed -- which he did.
Some 2,700 out of 10,000 firefighters initially agreed to participate, but only 158 actually completed treatment. Many feared the effects of steroid use or saw no immediate benefit. Just 64 participated in the follow-up.
But two years after the attack, those who did complete treatment had significant reductions in respiratory symptoms and better quality of life compared with untreated firefighters, according to Prezant's study.
Treated firefighters, who started out with more symptoms than those with similar exposure who got no treatment, had about 10 times greater improvement in lung function compared with the untreated group.
The results are enough to suggest this approach might be worth another try, he said.
"This occurred in the midst of the largest urban disaster with no planning and no understanding of the challenges that would need to be overcome with patient education," Prezant said.
Dust-laden air from the collapsed World Trade Center towers has been implicated in at least two deaths -- from lung inflammation and scarring -- and linked to the respiratory illnesses of thousands working and living within miles (km) of Ground Zero, according to medical studies.
Mount Sinai Medical Center researchers found 69 percent of the nearly 10,000 first responders they examined had new or worsened lung problems after Sept. 11.
Democrats in Congress have faulted the Environmental Protection Agency for failing to meet its clean-up responsibilities and say the Bush administration knowingly played down the risks posed by the dust, which contained asbestos, lead and other contaminants.
CHICAGO, Oct 24 (Reuters) - As New York City firefighters struggled to find survivors in the haze and rubble of the World Trade Center collapse, the fire department's chief doctor was thinking about how to keep them safe from toxins in the air.
Dr. David Prezant devised a plan to offer inhaled corticosteroids -- the kind used to prevent asthma attacks -- to the city's firefighters in the hopes they might prevent lung damage.
The effort appears to have paid off, said Prezant, a lung specialist who presented his findings on Wednesday to a meeting of the American College of Chest Physicians in Chicago.
Prezant knew the best defense against respiratory disease would be to use respirators, but he also knew exposure was inevitable, and many rescue workers had already breathed in potentially toxic particles.
"These people were going to rescue their buddies and recover their buddies no matter what. It was our plan to mitigate their exposure," Prezant told Reuters.
The strategy was unproven. No studies had shown inhaled steroids could protect against long-term lung damage.
Prezant, who had been trapped at the World Trade Center himself and was taking inhaled steroids to protect his own lungs, decided to offer the same treatment to firefighters.
"We thought about this on day two," said Prezant, co-director of the World Trade Center Medical Monitoring and Treatment Programs.
He asked a friend at Montefiore Medical Center to contact a sales representative for AstraZeneca (AZN.N) (AZN.L), maker of the inhaler known as Pulmicort or budesonide.
"I knew there would never be any side-effects. That is why I knew it was worth doing even if there was no evidence it would help," he said.
Within days of the Sept. 11 attack, AstraZeneca had trucks loaded with 10,000 donated inhalers headed for the city.
FEARS OF SIDE-EFFECTS
Prezant had to satisfy the company's lawyer that the medication, which is not labeled for preventive use, would be given by medical personnel and that firefighters would be fully informed -- which he did.
Some 2,700 out of 10,000 firefighters initially agreed to participate, but only 158 actually completed treatment. Many feared the effects of steroid use or saw no immediate benefit. Just 64 participated in the follow-up.
But two years after the attack, those who did complete treatment had significant reductions in respiratory symptoms and better quality of life compared with untreated firefighters, according to Prezant's study.
Treated firefighters, who started out with more symptoms than those with similar exposure who got no treatment, had about 10 times greater improvement in lung function compared with the untreated group.
The results are enough to suggest this approach might be worth another try, he said.
"This occurred in the midst of the largest urban disaster with no planning and no understanding of the challenges that would need to be overcome with patient education," Prezant said.
Dust-laden air from the collapsed World Trade Center towers has been implicated in at least two deaths -- from lung inflammation and scarring -- and linked to the respiratory illnesses of thousands working and living within miles (km) of Ground Zero, according to medical studies.
Mount Sinai Medical Center researchers found 69 percent of the nearly 10,000 first responders they examined had new or worsened lung problems after Sept. 11.
Democrats in Congress have faulted the Environmental Protection Agency for failing to meet its clean-up responsibilities and say the Bush administration knowingly played down the risks posed by the dust, which contained asbestos, lead and other contaminants.
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