Chest
Volume 131, Issue 5, May 2007, Pages 1414-1423
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Original Research: World Trade Center-Related Pulmonary Disease
World Trade Center “Sarcoid-Like” Granulomatous Pulmonary Disease in New York City Fire Department Rescue Workers

https://doi.org/10.1378/chest.06-2114Get rights and content

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.

Section snippets

Case Ascertainment

For annual incidence rates, the population at risk was the entire FDNY rescue workforce present at any time during the WTC disaster rescue, recovery, and cleanup operation between September 11, 2001, and July 1, 2002. This number totaled 15,048, composed of 11,193 fire personnel (firefighters and officers), 2,972 EMS personnel (emergency medical technicians, paramedics, and officers), and 883 recent retirees. Employee head counts in each of the 5 years after the WTC disaster were similar to

Results

Between September 9, 2001, and September 11, 2006, 26 WTC dust-exposed FDNY rescue workers were found to have pathologic evidence of sterile granulomatous pulmonary disease consistent with the diagnosis of sarcoidosis or SLGPD (Table 1). Thirteen patients presented in the first year after WTC dust exposure (September 11, 2001, to September 10, 2002), 1 patient presented in the second year (2003), 4 patients presented in the third year (2004), 4 patients presented in the fourth year (2005), and

Discussion

Sarcoidosis is a multisystem noncaseating granulomatous disease affecting young to middle-age adults. It predominantly involves the lungs, lymph nodes, and skin, all of which are portals of entry for many immunologically active occupational and environmental agents. Although the etiology of sarcoidosis is not well understood, occupational and environmental factors have been implicated.7 Occupational clusters, with presumptive toxic or infectious exposures, have been reported for sarcoidosis or

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    The authors have no conflicts of interest to disclose.

    This work was supported by grants from the National Institute for Occupational Safety and Health (OH-08232) and the September Eleventh Recovery Grant of the American Red Cross Liberty Disaster Relief Fund.

    The sponsors had no involvement in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation of the manuscript.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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