Mount Sinai Study Finds One-Quarter of World Trade Center Responders Still Have Impaired Lung Function
The Mount Sinai study is the first to assess lung function in a large group of WTC responders at two different time points since the September 11th attacks.
A new study finds that about one quarter or 24% of World Trade Center (WTC) responders continued to have impairment of their lung function after their second exams at The World Trade Center Medical Monitoring and Treatment Program coordinated by The Mount Sinai Medical Center. This is the first study to assess lung function in a large group of WTC disaster responders at two different time points since the September 11th attacks. The study is published online in Chest, the official journal of the American College of Chest Physicians.
More than 40,000 men and women were exposed to products of combustion and particulate matter following the September 11th attacks. The study, led by Gwen Skloot, MD, Associate Professor of Medicine and Pulmonary, Critical Care and Sleep Medicine at Mount Sinai School of Medicine, analyzed the changes in spirometry results between the first exam and the second exam of WTC responders (September 2004 through December 2007), which occurred an average of 32 months after the first exam. Spirometry, the most widely used measurement of lung function, is a 15-minute breathing test that Mount Sinai has offered to all participants at the first exam and during subsequent exams. "The majority of individuals did not have an excessive decline in lung function between examinations," said Dr. Skloot. "We are now intensively studying the subgroup with excessive change in lung function in order to identify important predictors of change."
Factors associated with more rapid decline in lung function included responding to a typical asthma medication at the first examination and gaining weight between exams, said Dr. Jacqueline Moline, Vice Chair, Department of Community and Preventive Medicine at Mount Sinai School of Medicine, and Director of The World Trade Center Medical Monitoring and Treatment Program Clinical Center at Mount Sinai.
We believe that these persistent abnormalities were due to a combination of persistent asthma, restrictive disorders such as lung scarring or chest wall abnormalities, as well as unknown factors. We think that it is important for us to continue to examine the responders to determine the possible causes, said Paul Enright, MD, Research Professor of Medicine at University of Arizona College of Public Health and Adjunct Professor of Community and Preventive Medicine at Mount Sinai School of Medicine.
The spirometry results from the first exam of WTC responders were summarized in a paper published in December 2006 in the journal Environmental Health Perspectives. This study found that about 28% of the first 8,384 responders had an abnormal spirometry test during their first exam. These spirometry results were compared to predicted values, which were determined from spirometry tests done by thousands of healthy never-smokers who participated in the third National Health and Nutrition Examination (NHANES III). The spirometry test results from the baseline exam were very helpful because they provided an objective measurement of lung function, which provided complementary information to the respiratory symptoms, chest x-rays, and clinical exam findings. All of these sources of information were used by the physicians who made the diagnoses and initiated appropriate treatment.
The results of this study indicate that longer term monitoring and treatment of WTC responders is essential, said Dr. Robin Herbert, Associate Professor of Community and Preventive Medicine at Mount Sinai School of Medicine, and Director of The World Trade Center Medical Monitoring and Treatment Program’s Data and Coordination Center at Mount Sinai.
The World Trade Center Medical Monitoring and Treatment Program’s Mount Sinai-coordinated Consortium of Clinical Centers of Excellence have medically screened over 26,000 WTC rescue and recovery workers and volunteers in all 50 states since the program kicked off in July of 2002. The Program has also provided over 40,000 medical monitoring exams and is federally funded and supported through a grant administered by the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control.
About The World Trade Center Medical Monitoring and Treatment Program
The World Trade Center Medical Monitoring and Treatment Program with funding from the federal government, offers free, confidential medical and mental health evaluation, long-term monitoring and treatment for eligible WTC rescue, recovery and clean-up workers, including volunteers, who responded to the Sept. 11th, 2001 terrorist attacks in NYC. Medical screening and periodic medical monitoring examinations, as well as both out- and in-patient treatment services as may be needed for WTC-related medical and mental health conditions is being offered at a number of NY/NJ metro-area occupational medicine clinical centers and nationwide. Mount Sinai Center for Occupational & Environmental Medicine has taken a lead in developing the program that stands as the federal government’s principal public health response to 9/11, Mount Sinai continues to coordinate a NY-NJ Consortium of occupational medicine providers of program services.
The Program also maintains data through two Data and Coordination Centers, one coordinated by Mount Sinai (School of Medicine) and one by the FDNY, complimenting the latter agency’s matching service program for current and retired NYC Fire Dept. employees. Non-identifying data is periodically pooled and analyzed across the programs to expand the scientific understanding of health impacts resultant from WTC exposures, assure best practices of care for responders in need, and help inform future health response to such emergencies.
To determine eligibility, to enroll and/or for more information, WTC responders nationwide need only call into the programs hotline at 1-888-702-0630. The program maintains a website as well, at wtcexams.org, which also lists participating services providers and clinical center locations, including those maintained by a NY/NJ metro-area Consortium.
About The Mount Sinai Medical Center
The Mount Sinai Medical Center encompasses The Mount Sinai Hospital and Mount Sinai School of Medicine. The Mount Sinai Hospital is one of the nation’s oldest, largest and most-respected voluntary hospitals. Founded in 1852, Mount Sinai today is a 1,171-bed tertiary-care teaching facility that is internationally acclaimed for excellence in clinical care. Last year, nearly 50,000 people were treated at Mount Sinai as inpatients, and there were nearly 450,000 outpatient visits to the Medical Center.
Mount Sinai School of Medicine is internationally recognized as a leader in groundbreaking clinical and basic-science research, as well as having an innovative approach to medical education. With a faculty of more than 3,400 in 38 clinical and basic science departments and centers, Mount Sinai ranks among the top 20 medical schools in receipt of National Institute of Health (NIH) grants.
About the Mount Sinai Health System
The Mount Sinai Health System is New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology/Neurosurgery, and Orthopedics in the 2019-2020 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 12th nationally for Ophthalmology, Mount Sinai St. Lukes and Mount Sinai West are ranked 23rd nationally for Nephrology and 25th for Diabetes/Endocrinology, and Mount Sinai South Nassau is ranked 35th nationally for Urology. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and Mount Sinai South Nassau are ranked regionally.