Recovery and cleanup workers or residents living at or near the World Trade Center (WTC) disaster area could show up at their doctors'' offices with a number of symptoms, according to a report issued by the Mt. Sinai School of Medicine, Department of Community and Preventive Medicine. The report discusses irritative and respiratory problems in relation to environmental exposures from the WTC disaster.
According to the report, primary short-term health effects of exposure to airborne contaminants at or near the site can include asthma/reactive airways disease (RADS), chemical irritation of the eyes, nasal passages, throat, and upper airways, sinusitis, and persistent cough, and pneumonitis. Ingestional exposures can result in digestive symptoms such as irritation of the upper gastrointestinal tract with gastro-esophageal reflux (GERD). There also have been a number of reports of dermal irritation and rashes on exposed areas of the skin.
Clinical features which can help to distinguish WTC-related respiratory problems from other conditions such as seasonal allergies and viral illnesses include history of a clear temporal and geographical association between presence at or near the site and onset of symptoms such as:
- A history of irritation of the eyes, nose or throat while at or near the site.
- Presence of burning of the nasal passages and/or throat for 10 or more days in the absence of seasonal allergies or an antecedent viral illness
- Physical examination findings consistent with marked inflammation of nasal passages (cherry red mucosa with or without engorged blood vessels) and throat
- Presence of a new or worsening cough, chest tightness, wheezing, decreased exercise tolerance and/or shortness of breath lasting 10 or more days in the absence of seasonal allergies or an antecedent viral illness.
- Presence of new or worsening dyspnea especially with exertion. This may or may not be associated with wheezing and/or chest tightness.
- Presence of new or worsening asthmatic complaints.
- Presence of new or worsening dyspepsia (GERD-related symptoms).
- Presence of new or worsening chest tightness, pleuritic chest pain or chest burning.
The report makes recommendations for the diagnosis and treatment of WTC-related upper and lower respiratory problems. The team from Mt. Sinai suggests that health care professionals report any respiratory diagnosis related to the WTC disaster to the New York State Department of Health''s Occupational Lung Disease Registry. This reporting is legally mandated.
The report cautions physicians to advise workers to use adequate respiratory protection while at the site. For rescue workers or individuals that have returned to work at or in the vicinity of the site and are complaining of some or all of the symptoms mentioned in the report, the Mt. Sinai team suggests limiting or eliminating exposures.
"This would be a prudent course of action given that rescue phase of operations has now ceased and experience has shown that repeated occupational exposure since Sept. 11th has been a contributing factor in both the persistence and severity of symptoms," says the report.
It adds, "Workers hoping to return to work at or near the site who have asthma or established RADS … should not continue to work at the site."
For more information about the report and specific treatment of WTC-related health problems, see www.mssm.edu/cpm/wtc_health/respiratory.shtml.
by Sandy Smith ([email protected])