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| |  CHEST: World Trade Center Cough-Immediate Prophylaxis Was Key By Dan Keller Special to DG News PHILADELPHIA, PA -- November 12, 2001 -- Prophylactic treatment to prevent the respiratory aftereffects of the World Trade Centre attack appear to be working. Images of the tremendous, billowing clouds of pulverized concrete and glass that were the World Trade Center lodged in the memories of anyone who saw them on television. Their particulate matter lodged in the throats, lungs, and stomachs of anyone who was there. David Prezant, MD, Deputy Chief Medical Officer with the New York City Fire Department (NYFD), saw and felt the devastation first-hand. "The sky turned black," he said. "You thought you were in a mine… with particulate matter that was so dark and so concentrated that it appeared to be almost like syrup." Medically, he knew what would follow for anyone on the scene: an inhalation injury that he soon termed "the World Trade Center cough." It is dry and chronic, developing a week or two after exposure, accompanied by nasal drip and possibly gastroesophageal reflux disease (GERD) from the irritation of swallowed matter. With the possible respiratory sequelae in mind, Dr. Prezant said the NYFD Bureau of Health Services offered their people inhaled steroids, "an intervention with minimal risk and potential benefit." The Bureau told the fire fighters that while it had never been done before in the setting of a mass casualty event, "it was worth a try." The medical staff managed to distribute nearly 4,000 inhaled steroid samples to fire fighters and Emergency Medical Services personnel who were developing a cough. (Astra-Zeneca supplied the samples.) The goal was to prevent the onset of a chronic cough syndrome, asthma, and other obstructive airway diseases. Presenting his experiences to the 2001 annual meeting of the American College of Chest Physicians, in Philadelphia, Pennsylvania, Nov. 8, Dr. Prezant noted, "We are the first large scale distribution effort of an inhaled steroid in any mass disaster in the world." The tactic appears to be working, he said. Some people treated with the inhaled steroids have had their coughs resolve (Dr. Prezant himself included). And for the rest, he said that the early, immediate medical attention has opened the door for continuing physician contact to take a longer-term approach to the respiratory problems. In addition to inhaled steroids, Dr. Prezant said emergency personnel are receiving cough medications and drugs for nasal problems and for GERD. And he emphasized that they are being urged to take some control themselves by wearing respirators to limit further exposure to particulate matter, as well as to stop smoking for the 15 to 20 percent of fire fighters who do. The NYFD has had a medical monitoring program in place since 1996. It has maintained records since then, including baseline electrocardiograms and pulmonary function tests, on all its personnel.
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