Trends in respiratory symptoms of firefighters exposed to the world trade center disaster: 2001-2005

Environ Health Perspect. 2009 Jun;117(6):975-80. doi: 10.1289/ehp.0800291. Epub 2009 Feb 11.


Background: Respiratory symptoms, either newly reported after the World Trade Center (WTC) disaster on 11 September 2001 (9/11) or increased in severity, have been well documented in WTC-exposed workers and New York City residents. However, considerable uncertainty exists over the persistence of symptoms.

Objectives: In this study, our goals were to describe trends in post-9/11 respiratory and gastro-esophageal reflux disease (GERD) symptoms in WTC-exposed firefighters and to examine symptom progression in the cohort that completed both year 1 and year 4 questionnaires.

Methods: We analyzed questionnaire responses from 10,378 firefighters in yearly intervals, from 2 October 2001 to 11 September 2005, defining exposure based on arrival time at the WTC site. For the cohort of 3,722 firefighters who completed the two questionnaires, we also calculated exposure duration summing months of work at the site.

Results: In cross-sectional analyses, the prevalence of dyspnea, wheeze, rhinosinusitis, and GERD remained relatively stable, whereas cough and sore throat declined, especially between 1 and 2 years post-9/11. We found a dose-response relationship between arrival time and symptoms in all years (p < 0.01). Logistic models of symptoms at year 4 in the cohort demonstrated independent effects of earlier arrival and longer work duration: each additional month of work increased the odds of symptoms 8-11%.

Conclusions: Protracted work exposures increased the odds of respiratory and GERD symptoms 4 years later. In most large disasters, exposures may be unavoidable during the rescue phase, but our data strongly suggest the need to minimize additional exposures during recovery and cleanup phases.

Keywords: World Trade Center; disaster medicine; firefighters; gastroesophageal reflux disease (GERD); occupational medicine; rescue workers; respiratory symptoms.

Publication types

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

MeSH terms

  • Cross-Sectional Studies
  • Fires*
  • Gastroesophageal Reflux / chemically induced
  • Gastroesophageal Reflux / epidemiology
  • Gastroesophageal Reflux / pathology
  • Logistic Models
  • Occupational Exposure*
  • Particulate Matter / toxicity*
  • Rescue Work*
  • Respiration Disorders / chemically induced
  • Respiration Disorders / epidemiology*
  • Respiration Disorders / pathology
  • Respiratory System / drug effects*
  • Respiratory System / pathology
  • September 11 Terrorist Attacks*


  • Particulate Matter