Sarcoidosis, Firefighters Sarcoidosis, and World Trade Center “Sarcoid-Like” Granulomatous Pulmonary Disease

Chest (Impact Factor: 7.48). 01/2008; 132(6):2053. DOI: 10.1378/chest.07-1259
Source: PubMed

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    • "In most patients, this is a sign of a restrictive defect, but in the population of WTC responders this pattern, combined with the presence of symptoms of airways reactivity, responsiveness to bronchodilators, demonstration of airway hyperreactivity, and air-trapping, are more consistent with an obstructive pathophysiology [Banauch et al., 2003; Weiden et al., 2010]. In the general population of pulmonary patients, and in many patients in the WTC responder population, such findings are often associated with obesity (increasing chest wall impedance) or asthma (air trapping) [Miller, 2007; Hyatt et al., 2009]. "
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    ABSTRACT: On September 11, 2001, events at the World Trade Center (WTC) exposed residents of New York City to WTC dust and products of combustion and pyrolysis. The majority of WTC-exposed fire department rescue workers experienced a substantial decline in airflow over the first 12 months post-9/11, in addition to the normal age-related decline that affected all responders, followed by a persistent plateau in pulmonary function in the 6 years thereafter. The spectrum of the resulting pulmonary diseases consists of chronic inflammation, characterized by airflow obstruction, and expressing itself in different ways in large and small airways. These conditions include irritant induced asthma, non-specific chronic bronchitis, aggravated pre-existing obstructive lung disease (asthma or COPD), and bronchiolitis. Conditions concomitant with airways obstruction, particularly chronic rhinosinusitis and upper airway disease, and gastroesophageal reflux, have been prominent in this population. Less common have been reports of sarcoidosis or interstitial pulmonary fibrosis. Pulmonary fibrosis and bronchiolitis are generally characterized by long latency, relatively slow progression, and a silent period with respect to pulmonary function during its evolution. For these reasons, the incidence of these outcomes may be underestimated and may increase over time. The spectrum of chronic obstructive airways disease is broad in this population and may importantly include involvement at the bronchiolar level, manifested as small airways disease. Protocols that go beyond conventional screening pulmonary function testing and imaging may be necessary to identify these diseases in order to understand the underlying pathologic processes so that treatment can be most effective. Am. J. Ind. Med. 54:649–660, 2011. © 2011 Wiley-Liss, Inc.
    Full-text · Article · Sep 2011 · American Journal of Industrial Medicine
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    ABSTRACT: We report on cases of multiple myeloma (MM) observed in World Trade Center (WTC) responders registered in the WTC Medical Program. Possible cases of MM diagnosed between September 11, 2001, and September 10, 2007, in responders were confirmed if they met the World Health Organization and Mayo Clinic diagnostic criteria. Among 28,252 responders of known sex and age, eight cases of MM were observed (6.8 expected). Four of these cases were observed in responders younger than 45 years at the time of diagnosis (1.2 expected). A slight deficit of MM cases was observed in responders older than 45 years (4 observed, 5.6 expected). In this case series, we observe an unusual number of MM cases in WTC responders under 45 years. This finding underscores the importance of maintaining surveillance for cancer and other emerging diseases in this highly exposed population.
    Full-text · Article · Aug 2009 · Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine
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