Pulmonary function after exposure to the World Trade Center collapse in the New York City Fire Department

Rationale: On September 11, 2001, the World Trade Center collapse created an enormous urban disaster site with high levels of airborne pollutants. First responders, rescue and recovery workers, and residents have since reported respiratory symptoms and developed pulmonary function abnormalities. Objectives: To quantify respiratory health effects of World Trade Center exposure in the New York City Fire Department. Measurements: Longitudinal study of pulmonary function in 12,079 New York City Fire Department rescue workers employed on or before 09/11/2001. Between 01/01/1997 and 09/11/2002, 31,994 spirometries were obtained and the FEV1 and FVC were analyzed for differences according to estimated World Trade Center exposure intensity. Adjusted average FEV1 during the first year after 09/11/2001 was compared with the 5 yr before 09/11/2001. Median time between 09/11/2001 and a worker's first spirometry afterwards was 3 mo; 90% were assessed within 5 mo. Main Results: World Trade Center-exposed workers experienced a substantial reduction in adjusted average FEV1 during the year after 09/11/2001 (372 ml; 95% confidence interval, 364-381 ml; p < 0.001) This exposure-related FEV1 decrement equaled 12 yr of aging-related FEV1 decline. Moreover, exposure intensity assessed by initial arrival time at the World Trade Center site correlated linearly with FEV1 reduction in an exposure intensity-response gradient (p = 0.048). Respiratory symptoms also predicted a further FEV1 decrease (p < 0.001). Similar findings were observed for adjusted average FVC. Conclusions: World Trade Center exposure produced a substantial reduction in pulmonary function in New York City Fire Department rescue workers during the first year after 09/11/2001.