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

¹Pulmonary Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY ² Pulmonary Institute, Shaare Zedek Medical Center, Jerusalem & the Ben Gurion University of the Negev, Be'er Sheva, Israel ³ Pulmonary Division, New York University, College of Medicine, NY, NY ⁴ Fire Department City of New York, Brooklyn, NY and ⁵Biostatistics and Epidemiology, Albert Einstein College of Medicine, Bronx

prezand{at}fdny.nyc.gov

Abstract

BackgroundPrevious reports suggest 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).

MethodsDuring the five years post-WTC, enrollees in the Fire Department of New York's (FDNY) WTC Monitoring and Treatment Programs who had chest radiographs suggestive of sarcoidosis underwent evaluation, including: chest CT imaging, pulmonary functions, provocative challenge and biopsy. Annual incidence rates were compared to the 15 years pre-WTC.

ResultsPost-WTC, pathologic evidence consistent with new-onset sarcoidosis was found in 26 patients -- all with intra-thoracic adenopathy and 6 (23%) with extra-thoracic disease. Thirteen were identified during the first year post-WTC (incidence rate of 86/100,000) and 13 during the next four years (average annual incidence rate of 22/100,000; as compared to 15/100,000 during the 15 years pre-WTC). Eighteen of 26 (69%) had findings consistent with asthma; eight of 21 (38%) agreeing to challenge testing had airway hyperreactivity (AHR), findings not seen in pre-WTC FDNY sarcoidosis patients.

ConclusionPost-WTC 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: Sarcoidosis • Granulomatous Pneumonitis • Asthma • Airway Hyperreactivity • World Trade Center • Firefighters • EMS workers

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]