A man coated with ash and debris from the collapse of the World Trade Center… (Amy Sancetta / Associated…)
Thousands of first responders, workers, volunteers and local residents involved in the rescue and cleanup of the World Trade Center site, along with workers at the Staten Island landfill where wreckage was taken, are left a decade later with a range of physical and psychological ailments.
Respiratory illnesses were among the earliest and most prominent health effects — including the most common one, known as the "World Trade Center cough."
Today, doctors understand World Trade Center cough to be more than just a cough. Best characterized by asthma and/or bronchitis-like symptoms such as persistent coughing, wheezing and breathlessness, it also often includes acid reflux and nasal congestion.
For many people, it has become a chronic respiratory illness that requires long-term treatment to manage.
The name of the disease was first coined by Dr. David Prezant, medical director of the New York City Fire Department, in a Sept. 12, 2002, study in the New England Journal of Medicine. In it, he and his colleagues reported that firefighters who had worked at the World Trade Center site within the first three days of Sept. 11 were most likely to display these symptoms, no doubt from massive exposure to a variety of toxic chemicals. Those who required at least four consecutive weeks of medical leave as a result of the sickness were diagnosed with World Trade Center cough.
One need not look much further than the contents of the dust left behind by the fallen buildings to understand why 90% of New York City firefighters working at the site in the 48 hours after the attack complained of cough symptoms: nearly 24,000 gallons of combusting jet fuel and the burning, pulverized buildings created a massive smoke plume and dust cloud that blanketed the region.
Cement, glass fibers, asbestos and a host of toxic chemicals from the collapsed buildings created a mix of environmental pollutants and carcinogens such as polycyclic aromatic hydrocarbons (PAHs), dioxins and volatile organic compounds. Fires continued to burn below and above ground for months, further exposing workers to noxious chemicals.
Much of the damage to people's airways and lungs has been attributed to the highly alkaline dust, says Dr. Joan Reibman, director of the New York City Health and Hospitals Corp.'s World Trade Center Environmental Health Center. "Early on, we understood that the dust had a very high pH," she says. "If you're inhaling it, that will cause an alkaline burn, which leads to inflammation of the airway."
Later analyses found that 95% of the dust from the World Trade Center was composed of large particulate matter that made its way into the lungs of people at, or near, the site.
"Usually there are defense mechanisms that block you from breathing large particles," Reibman says, but the highly alkaline air likely damaged those defense mechanisms, allowing the particles to pass.
Though it's clear that first responders and cleanup workers — such as firefighters, police officers and construction workers — who faced massive toxic exposure were among the sickest, other groups have been heavily affected as well. In the years since the attack, respiratory illnesses have been widely reported in residents of Lower Manhattan, including children, as well as in people who work there.
A 2005 study of 2,812 residents living near the World Trade Center published in the journal Environmental Health Perspectives found that coughing, wheezing, chest tightness and shortness of breath were reported in three to six times greater numbers among people living within one mile of the World Trade Center site than among those who lived more than five miles away. Reibman says that more recent studies of patients who have sought treatment for Sept. 11-related respiratory illness suggest that years later, they still have a greater risk for abnormal lung function.
But it is hard to know what the real numbers are, experts say. Unlike firefighters — who receive care through the New York City Fire Department and whose health status before and after Sept. 11 has been well-documented — the health of residents and local workers hasn't been well-tracked.
That picture should improve somewhat through data from the New York City Department of Health and Mental Hygiene World Trade Center Health Registry, which enrolled more than 71,000 people between 2003 and 2004 to document illness seen in responders, residents and workers. But the registry wasn't started until several years after the attacks and all information is self-reported, which will make it impossible to say with certainty how many people suffered respiratory ailments, experts say.