Pulmonary disease in rescue workers at the World Trade Center site.

PURPOSE OF REVIEW: The catastrophic collapse of the World Trade Center (WTC) towers on September 11, 2001 created a large-scale disaster site in a densely populated urban environment. Over the ensuing months, tens of thousands of rescue, recovery and cleanup workers, volunteers, and residents of the adjacent community were exposed to a complex mixture of airborne pollutants. This review focuses on currently described respiratory syndromes, symptoms, and physiologic derangements in WTC rescue, recovery, and cleanup workers, discusses potential long-term effects on respiratory health, and draws parallels to community findings.

RECENT FINDINGS: Detailed qualitative and quantitative analyses of airborne pollutants with their changing composition during initial rescue/recovery and subsequent cleanup have been published. Major concerns include persistent aerodigestive tract inflammatory syndromes, such as reactive airways dysfunction syndrome (RADS), reactive upper airways dysfunction syndrome (RUDS), gastroesophageal reflux disease (GERD), and inflammatory pulmonary parenchymal syndromes, as well as respiratory tract and nonrespiratory malignancies. Aerodigestive tract inflammatory syndromes have now been documented in WTC exposed occupational groups, and syndrome incidence has been linked to WTC airborne pollutant exposure intensity. Community based investigations have yielded similar findings.

SUMMARY: While it is too early to ascertain long-term effects of WTC dust exposure, current studies already demonstrate a definite link between exposure to WTC-derived airborne pollutants and respiratory disease, both in the occupational and the community setting. A better understanding of causes and effects of this exposure will help in developing appropriate preventative tools for rescue workers in future disasters.