MONDAY, May 7 (HealthDay News) -- A number of New York City firefighters who were exposed to the dust of the World Trade Center collapse have developed the troublesome but not especially dangerous lung condition called sarcoidosis, physicians report.
Sarcoidosis involves inflammation that produces tiny lumps of cells called granulomas. They can form in any part of the body, but one of the most common sites is the lungs.
"We don't know what causes it throughout the world, but we have long suspected wood-burning exposures," said Dr. David J. Prezant, chief medical officer of the New York City Fire Department, and a professor of medicine at Albert Einstein College of Medicine. "For that reason, we have been looking at New York firefighters back to 1985. In 1999, we reported their incidence was increased compared to the general New York population.
"What was surprising was the dramatic increase after 9/11," Prezant continued. "We had been averaging two cases a year. One year after 9/11, we had 13 cases. The incidence decreased after that, and now it is down to four cases a year."
Reporting in the May issue of the journal Chest, Prezant and his colleagues noted that a "sarcoid-like" lung condition has been detected in 26 firefighters. "The other surprising thing was not only the increased number but also that almost all the cases we had were symptomatic," he said. "Usually, there are either no or very few symptoms, with the condition being picked up by chest X-rays. In 65 percent of these cases, the firefighters had symptoms of asthma."
Eighteen of the 26 firefighters with sarcoidosis showed symptoms of asthma. Eight of 21 who agreed to have their lungs tested had hyperactivity of the airways, something not seen in sarcoidosis patients before the World Trade Center disaster of Sept. 11, 2001.
The outlook for the firefighters is not dire, Prezant stressed. "We know that in 95 percent of patients, sarcoidosis either never causes problems or causes only minor problems," he said. "It is easily treated with steroids or other medications. These cases do have to be monitored, and that is why we have a very aggressive monitoring program."
Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, isn't so sure that the condition is completely innocuous. "It has always been assumed that there is an increased risk of lung cancer, although there is no data on that," he said. "It has only been six years since 9/11, so we have to wait and see."
The two physicians also differed on the probable causes of the condition in the firefighters. "It is well known that certain things can trigger sarcoidosis," Horovitz said. "It is associated with exposure to heavy metals such as barium and beryllium, so it is not really surprising that, given the heavy metals in the World Trade center dust, sarcoidosis developed."
But Prezant countered: "We have not found heavy metals in the firefighters. We believe the sarcoidosis is related to wood burning and chemical exposure rather than to heavy metals."
Prezant's report covered only the firefighters who were exposed to World Trade Center dust, because that is the group he looks after.
"I wouldn't be surprised that many of the other rescue workers could be at similar medical risk," Horovitz said.
Previous studies have found that dust from the Trade Center collapse took a toll on rescue workers' lungs.
For example, almost 70 percent of rescue personnel and workers who responded to the terrorist attacks suffered from lung problems during and after the recovery efforts. And some of those problems persisted for at least two-and-a-half years after the attacks, according to a report released last September by researchers at Mount Sinai Medical Center in New York City, the largest study to date on the health effects of the disaster.
To learn more about sarcoidosis, visit the U.S. National Heart, Lung, and Blood Institute.
SOURCES: David J. Prezant, M.D., chief medical officer, New York City Fire Department; Len Horovitz, M.D., pulmonary specialist, Lenox Hill Hospital, New York City; May 2007, Chest