Article

Vocal Cord dysfunction in former World Trade Center (WTC) rescue and recovery workers and volunteers

Department of Community and Preventive Medicine, and Medicine, The Mount Sinai School of Medicine, New York, New York, USA.
American Journal of Industrial Medicine (Impact Factor: 1.74). 03/2008; 51(3):161-5. DOI: 10.1002/ajim.20541
Source: PubMed

ABSTRACT

Vocal cord dysfunction (VCD) is a condition characterized by paradoxical partial adduction of the vocal cords on inspiration. It has been associated with exposures to irritants, as well as with psychological illnesses and conditions. Workers who participated in the recovery of the WTC disaster site were exposed to a large amount of irritants as well as considerable psychological stressors. We describe the clinical characteristics of 10 symptomatic former WTC workers diagnosed with this condition, as well as the frequency of spirometric findings suggestive of variable extrathoracic obstruction.
Workers who became symptomatic after their WTC work experience have been evaluated clinically by a multidisciplinary team at an academic medical center. The evaluation included history, physical examination, chest radiograph, blood tests, and pre- and post-bronchodilator spirometry in all patients. Additional evaluations and diagnostic tests included otolaryngological evaluation with flexible rhinolaryngoscopy and stroboscopy, gastroenterological and psychiatric evaluations. A randomly selected sample of 172 spirometry results were reviewed for evidence of inspiratory flow limitation.
Variable extrathoracic obstruction was found in 18.6% of the spirometries. Ten patients were diagnosed with VCD. In addition to symptoms suggestive of co-morbid conditions (particularly rhinitis and acid reflux disease), most of the 10 patients had (1) hoarseness, (2) dyspnea that was not associated with bronchial hyperreactivity, or (3) dyspnea associated with asthma, with either mild bronchial hyperreactivity and/or poor response to asthma treatment.
VCD appears to be part of the spectrum of airway disorders caused by occupational exposures at the WTC disaster site. Further study of this association is warranted.

0 Followers
 · 
13 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Chronic cough is a common symptom in a wide range of respiratory conditions, and may also occur as a result of upper airway or gastro-esophageal problems. Whilst chronic cough of any cause may be exacerbated by work, in some cases it has a direct occupational cause, resulting from a harmful acute or chronic workplace exposure. Such occupational conditions may only be suspected by taking a detailed occupational history, and directly asking employed patients whether their cough improves away from work. Early and accurate diagnosis, linked with tailored drug therapy, modification of workplace exposures, and expert compensation advice is likely to offer the best outcome for this group of patients.
    No preview · Article · Feb 2008 · Chronic Respiratory Disease
  • [Show abstract] [Hide abstract]
    ABSTRACT: This article reviews the experience of a unique occupational group of World Trade Center (WTC) workers: immigrant workers. This group is comprised largely of men, laborers, who are first-generation immigrants. The majority of these workers are from Latin America (predominantly from Ecuador and Colombia) or from Eastern Europe (predominantly from Poland). Our data shows that the disease profile observed in these workers was what we have previously reported for WTC working population as a whole. Recent reports have begun to document the disproportionate burden of occupational hazards, injuries, and illnesses experienced by immigrant workers in the United States. The WTC experience of immigrants exemplified this burden but, additionally, highlighted that this burden is exacerbated by limitations in access to appropriate health care, disability and compensation benefits, and vocational rehabilitation services. A clinical program that was designed to address the complex medical and psychosocial needs of these workers in a comprehensive manner was successfully established. Full justice for these workers depends on larger societal changes.
    No preview · Article · Jan 2009 · Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Vocal cord dysfunction (VCD) is defined by paradoxical vocal fold closure during inhalation, and rarely upon exhalation. The precise etiology of VCD is unknown; however, a variety of potential causes may include laryngeal hyperresponsiveness, laryngeal irritants, psychogenic causes, and rarely neurologic diseases. VCD can occur in athletes, particularly females, and the sports medicine professional likely is to care for patients with acute respiratory difficulties caused by this condition. Given its complex nature, a multidisciplinary approach to VCD evaluation and management is necessary and results in optimal outcomes.
    Full-text · Article · Mar 2009 · Current Sports Medicine Reports
Show more