by Anna Gosline, New Scientist
Nov. 30, 2004
Inhaling toxic dust from the World Trade Center disaster on 11 September 2001 has damaged some rescue workers’ lungs more than years of smoking, US scientists reveal. Using an unconventional chest scan for the circumstances, researchers were able to capture visual signs of the severe respiratory problems that doctors could not otherwise have diagnosed.
Hundreds of people have been tested and treated for respiratory problems - or “World Trade Center cough” -- since New York City’s twin towers fell, most of them suffering from asthma-like breathing difficulties. Some people, however, maintained persistent but unidentifiable coughs that could not be picked up using standard chest computed tomography (CT) scans.
“These people had symptoms that just didn’t fit the typical pattern. They weren’t treated at first because there wasn’t any objective evidence of what was wrong,” says lead author David Mendelson at Mount Sinai Hospital in New York City, US.
So Mendelson’s team turned to a technique called end-expiratory CT. In a normal chest scan, patients are asked to take a deep breath and hold it. In end-expiratory scans, patients take in a deep breath and release it slowly. In a healthy individual, the entire chest should be seen on the scan as an even grey color -- the CT representation of moving air.
The doctors scanned 29 rescue and recovery workers with unexplained symptoms. In 25 of these they saw splotchy black patches deep down in the finer, branching tubes of their airways. Black spots mean that air is trapped and stagnating in the lungs, making it difficult for the patients to breathe freely.
In order to gauge the severity of the air-trapping pattern, the authors developed a visual scale that ranged from 0 to 24. Mendelson says that smokers would probably fall somewhere between 0 to 4 on his scale. The World Trade Center rescue workers, however, averaged 10.55.
The extent of air trapping was found to reflect the amount of time each worker was exposed to the dust and debris of the buildings’ collapse.
The most likely culprit behind this type of airway disease is pulverized alkaline cement, says Mendelson, who presented his findings at the Radiological Society of North America’s meeting in Chicago on Tuesday. All of the subjects are now being treated with anti-inflammatory drugs.
Richard Russell, of the British Thoracic Society in London, UK, is not surprised by the degree of lung tissue damage caused by exposure to the fine cement dust, which is capable of penetrating deeply into the lungs and damaging the delicate tissues found there.
But he warns that the rescue workers’ breathing problems might be permanent: “This is a physical problem that’s not going to go away with simple anti-inflammatories,” he says. “We’ll just have to watch and see if the patients get better over time and make sure they’re not smoking.”
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In the aftermath of the Sept. 11, 2001, attack on the World Trade Center, the White House instructed the Environmental Protection Agency to give the public misleading information, telling New Yorkers it was safe to breathe when reliable information on air quality was not available.
That finding is included in a report released Friday by the Office of the Inspector General of the EPA. It noted that some of the agency's news releases in the weeks after the attack were softened before being released to the public: Reassuring information was added, while cautionary information was deleted.
"When the EPA made a September 18 announcement that the air was 'safe' to breathe, it did not have sufficient data and analyses to make such a blanket statement," the report says. "Furthermore, the White House Council on Environmental Quality influenced ... the information that EPA communicated to the public through its early press releases when it convinced EPA to add reassuring statements and delete cautionary ones."
On the morning of Sept. 12, according to the report, the office of then-EPA Administrator Christie Whitman issued a memo: "All statements to the media should be cleared through the NSC (National Security Council in the White House) before they are released." The 165-page report compares excerpts from EPA draft statements to the final versions, including these:
The draft statement contained a warning from EPA scientists that homes and businesses near ground zero should be cleaned by professionals. Instead, the public was told to follow instructions from New York City officials.
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Another draft statement was deleted; it raised concerns about "sensitive populations" such as asthma patients, the elderly and people with underlying respiratory diseases.
A statement about discovery of asbestos at higher than safe levels in dust samples from lower Manhattan was changed to state that "samples confirm previous reports that ambient air quality meets OSHA (Occupational Safety and Health Administration) standards and consequently is not a cause for public concern."
Language in an EPA draft stating that asbestos levels in some areas were three times higher than national standards was changed to "slightly above the 1 percent trigger for defining asbestos material."
This sentence was added to a Sept. 16 news release: "Our tests show that it is safe for New Yorkers to go back to work in New York's financial district." It replaced a statement that initial monitors failed to turn up dangerous samples.
A warning on the importance of safely handling ground zero cleanup, due to lead and asbestos exposure, was changed to say that some contaminants had been noted downtown but "the general public should be very reassured by initial sampling."
The report also notes examples when EPA officials claimed that conditions were safe when no scientific support was available.
... The White House did not respond to requests for comment.
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