Persistent hyperreactivity and reactive airway dysfunction in firefighters at the World Trade Center

Am J Respir Crit Care Med. 2003 Jul 1;168(1):54-62. doi: 10.1164/rccm.200211-1329OC. Epub 2003 Feb 25.


New York City Fire Department rescue workers experienced massive exposure to airborne particulates at the World Trade Center site. Aims of this longitudinal study were to (1) determine if bronchial hyperreactivity was present, persistent, and independently associated with exposure intensity, (2) identify objective measures shortly after the collapse that would predict persistent hyperreactivity and a diagnosis of reactive airways dysfunction 6 months post-collapse. A representative sample of 179 rescue workers stratified by exposure intensity (high, moderate, and control) without current smoking or prior respiratory disease was enrolled. Highly exposed workers arrived within 2 hours of collapse, moderately exposed workers arrived later on Days 1-2; control subjects were not exposed. Hyperreactivity at 1, 3, and 6 months post-collapse was associated with exposure intensity, independent of ex-smoking and airflow obstruction. Six months post-collapse, highly exposed workers were 6.8 times more likely than moderately exposed workers and control subjects to be hyperreactive (95% confidence interval, 1.8-25.2; p = 0.004), and hyperreactivity persisted in 55% of those hyperreactive at 1 and/or 3 months. In highly exposed subjects, hyperreactivity 1 or 3 months post-collapse was the sole predictor for reactive airways dysfunction (p = 0.021). In conclusion, development and persistence of hyperreactivity and reactive airways dysfunction were strongly and independently associated with exposure intensity. Hyperreactivity shortly post-collapse predicted reactive airways dysfunction at 6 months in highly exposed workers; this has important implications for disaster management.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Air Pollutants / adverse effects*
  • Air Pollutants / analysis
  • Asthma / diagnosis
  • Asthma / epidemiology
  • Asthma / etiology*
  • Bronchial Hyperreactivity / diagnosis
  • Bronchial Hyperreactivity / epidemiology
  • Bronchial Hyperreactivity / etiology*
  • Bronchial Provocation Tests
  • Case-Control Studies
  • Cough / diagnosis
  • Cough / epidemiology
  • Cough / etiology*
  • Explosions*
  • Female
  • Fires*
  • Forced Expiratory Volume
  • Humans
  • Inhalation Exposure / adverse effects
  • Inhalation Exposure / analysis
  • Male
  • Middle Aged
  • New York City / epidemiology
  • Occupational Diseases / diagnosis
  • Occupational Diseases / epidemiology
  • Occupational Diseases / etiology*
  • Occupational Exposure / adverse effects
  • Occupational Exposure / analysis
  • Predictive Value of Tests
  • Prospective Studies
  • Surveys and Questionnaires
  • Terrorism*
  • Time Factors
  • Vital Capacity


  • Air Pollutants