Special Reports

Breathing problems could force firefighters to retire

NEW YORK - As many as 500 New York City firefighters may have to retire early as a result of "respiratory disability," chronic breathing problems caused by their exposure to dense clouds of dust, smoke and fumes at the World Trade Center, health officials said Monday.

The potential departure of the firefighters comes as the department is still struggling to deal with the loss of 341 firefighters and two paramedics, who were among the 2,801 people killed in the collapse of the twin towers after the terrorist attacks on Sept. 11.

As of Aug. 28, 358 firefighters and five emergency medical workers were still on medical leave or light duty because of respiratory disorders that began after they worked at the trade center. Symptoms include persistent cough, wheezing, shortness of breath and other asthma-like symptoms, sinus inflammation and chronic heartburn.

David Prezant, deputy chief medical officer of the Fire Department of New York, said doctors did not know exactly what the affected workers had been exposed to, or whether they would get better or worse.

Their current problems are thought to have been caused by the inhalation and swallowing of fine particles created by the fires and building collapse.

Workers who had the heaviest exposure to the site - those who were there when the buildings collapsed and in the first days after - had the highest incidence of respiratory trouble.

Very few firefighters used respirators or other types of breathing protection in the early days after the attack, when the air was at its worst.

In addition to the 363 firefighters and rescue workers with respiratory disability, another 213 were on leave with emotional stress resulting from their work at the site and from their grief over the deaths of so many friends and co-workers.

The number of stress-related incidents observed among the workers during the 11 months after the attack was 17 times the number that occurred in the 11 months before the attacks.

Reports on the firefighters' injuries and illnesses are to be published Wednesday by the Centers for Disease Control and Prevention. Another, to be published on Thursday in the New England Journal of Medicine, has already been published on the journal's Web site, www.nejm.com.

Overall, the surviving firefighters have fared both better and worse than doctors expected. Considering that nearly all of the city's more than 11,000 firefighters worked at the site, and that 90 percent developed a cough, the proportion with chronic problems is relatively small.

In the firefighters who do have lingering symptoms, the problems have been more severe and persistent than doctors would have expected, Prezant said.

In the past, among firefighters who had respiratory problems from smoke inhalation, 90 percent recovered. But among the 332 firefighters who had a severe case of "World Trade Center cough," only 48 percent have fully recovered and returned to work.

Prezant said that one of the most important findings of the study was that many of the firefighters with persistent cough and other respiratory problems also had heartburn, or gastroesophageal reflux, a condition in which stomach acid backs up into the esophagus and throat.

"This is critically important for physicians to know," he said, because the cough does not improve unless the reflux is treated.