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World Trade Center "Sarcoid-Like" Granulomatous Pulmonary Disease in New York City Fire Department Rescue Workers^*

^* From the Pulmonary Division (Drs. Chavko, Banauch, and Aldrich), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Pulmonary Institute (Dr. Izbicki), Shaare Zedek Medical Center, Jerusalem, and Ben Gurion University of the Negev, Be’er Sheva, Israel; Pulmonary Division (Drs. Weiden and Berger), New York University, College of Medicine, New York, NY; New York City Fire Department (Drs. Kelly and Prezant), Brooklyn, NY; and Epidemiology and Population Health (Dr. Hall), Albert Einstein College of Medicine, Bronx, NY.

Correspondence to: David J. Prezant, MD, FCCP, New York City Fire Department, Office of Medical Affairs (Room 4w-1), Brooklyn, NY 11201; e-mail: prezand{at}fdny.nyc.gov

Abstract

Background: Previous reports suggest that sarcoidosis occurs with abnormally high frequency in firefighters. We sought to determine whether exposure to World Trade Center (WTC) "dust" during the collapse and rescue/recovery effort increased the incidence of sarcoidosis or "sarcoid-like" granulomatous pulmonary disease (SLGPD).

Methods: During the 5 years after the WTC disaster, enrollees in the Fire Department of New York (FDNY) WTC monitoring and treatment programs who had chest radiograph findings suggestive of sarcoidosis underwent evaluation, including the following: chest CT imaging, pulmonary function, provocative challenge, and biopsy. Annual incidence rates were compared to the 15 years before the WTC disaster.

Results: After WTC dust exposure, pathologic evidence consistent with new-onset sarcoidosis was found in 26 patients: all 26 patients had intrathoracic adenopathy, and 6 patients (23%) had extrathoracic disease. Thirteen patients were identified during the first year after WTC dust exposure (incidence rate, 86/100,000), and 13 patients were identified during the next 4 years (average annual incidence rate, 22/100,000; as compared to 15/100,000 during the 15 years before the WTC disaster). Eighteen of 26 patients (69%) had findings consistent with asthma. Eight of 21 patients (38%) agreeing to challenge testing had airway hyperreactivity (AHR), findings not seen in FDNY sarcoidosis patients before the WTC disaster.

Conclusion: After the WTC disaster, the incidence of sarcoidosis or SLGPD was increased among FDNY rescue workers. This new information about the early onset of WTC-SLGPD and its association with asthma/AHR has important public health consequences for disease prevention, early detection, and treatment following environmental/occupational exposures.

Key Words: airway hyperreactivity • asthma • emergency medical services workers • firefighters • granulomatous pneumonitis • sarcoidosis • World Trade Center

This article has been cited by other articles:

				A. Miller Sarcoidosis, Firefighters Sarcoidosis, and World Trade Center "Sarcoid-Like" Granulomatous Pulmonary Disease Chest, December 1, 2007; 132(6): 2053 - 2053. [Full Text] [PDF]