Inhaler Eased Lung Problems in 9/11 Workers

WEDNESDAY Oct. 24, 2007 -- Timely use of a month's worth of inhaler medicine may have lessened rescue workers' respiratory symptoms in the wake of the Sept. 11, 2001, World Trade Center attacks, according to new findings announced Wednesday.

Inhaled corticosteroids (ICS) are anti-inflammatory medicines commonly used for the treatment of asthma. No study had ever examined whether administrating ICS before the onset of symptoms could ease those symptoms or prevent the onset of respiratory problems following exposure to inhaled particulates.

The 9/11 attacks jettisoned countless tons of particulate materials into the air above New York City. Many of those who labored to rescue the survivors, collect the remains, and clean up the debris have suffered over the past six years from a host of acute and progressive respiratory problems, including sinusitis, asthmatic symptoms, and the so-called "World Trade Center cough," among other problems.

Beginning one week after 9/11, a team led by Dr. David Prezant, chief medical officer in the Office of Medical Affairs, and co-director of WTC Medical Monitoring and Treatment Programs at the New York City Fire Department, offered the ICS drug budesonide to the approximately 11,000 NYC firefighters involved in cleanup and rescue efforts at the WTC site.

Almost 3,000 firefighters agreed to participate in the trial, during which the drug was inhaled twice a day for four weeks. Only 220 stuck with it for the full study period -- not because of side effects, the authors noted, but mostly from a lack of any immediate effect.

Two years later, the researchers assessed the treatment's effectiveness in relieving respiratory symptoms and improving lung function in those individuals who completed the treatment, relative to untreated control subjects.

Survey results indicated that those workers who received budesonide did see greater improvements in respiratory symptoms compared to their untreated counterparts, despite the fact that the treated group also tended to have greater unprotected exposure to the site. However, clinical tests failed to detect differences in lung function or airway reactivity, according to the study.

That finding suggests the drug targets workers respiratory symptoms but not the underlying cause, said Dr. Len Horovitz, an attending physician in the department of pulmonary medicine at Lenox Hill Hospital in New York who has tended to "a few" WTC patients (mostly volunteers and residents).

"You want to believe when you relieve symptoms, you are ameliorating the disease process, but that's not always the case," Horovitz said. "That's not clear, and, in most of these patients, their pulmonary function continued to decline, so it would appear they didn't halt the process itself."

Prezant could not be reached for comment. But Dr. Alvin Thomas Jr., president of the American College of Chest Physicians, said a subsequent re-analysis of the data by Prezant produced what the authors called a "small but significant improvement in the lung function" of workers who received treatment.

Thus, "inhaled corticosteroids may help prevent respiratory problems ... [and to] help ameliorate [mild] symptoms that develop," said Thomas. He stressed that additional studies will be needed to verify that conclusion, however.

The research was to be presented Wednesday at the annual international scientific assembly of the American College of Chest Physicians, in Chicago.

So, what should rescue workers do the next time they are called upon to work amid the dust of collapsing buildings? First, protect the lungs, said Horovitz. Even a handkerchief or a T-shirt placed over the nose and mouth can block larger particles from the airway.

If at all possible, said Thomas, workers should use a respirator. Unlike a handkerchief, or even the surgeons' masks available at most drugstores, respirators trap the microscopic particles that can get deep into the lungs and cause long-term problems.

And, if there is any chance of exposure to toxic inhalants, he added, start taking ICS as soon as possible.

"Prezant's study suggests that if you don't have a mask that you have complete confidence in, you should still use the inhaler, because particles can still get through and cause symptoms," he said.

Posted: October 2007


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