Chest

Chest

Volume 140, Issue 5, November 2011, Pages 1146-1154
Journal home page for Chest

Original Research
Obstructive Lung Diseases
Comorbid Trends in World Trade Center Cough Syndrome and Probable Posttraumatic Stress Disorder in Firefighters

https://doi.org/10.1378/chest.10-2066Get rights and content

Background

We describe the relationship between World Trade Center (WTC) cough syndrome symptoms, pulmonary function, and symptoms consistent with probable posttraumatic stress disorder (PTSD) in WTC-exposed firefighters in the first year post-September 11, 2001 (baseline), and 3 to 4 years later (follow-up).

Methods

Five thousand three hundred sixty-three firefighters completed pulmonary function tests (PFTs) and questionnaires at both times. Relationships among WTC cough syndrome, probable PTSD, and PFTs were analyzed using simple and multivariable models. We also examined the effects of cofactors, including WTC exposure.

Results

WTC cough syndrome was found in 1,561 firefighters (29.1%) at baseline and 1,186 (22.1%) at follow-up, including 559 with delayed onset (present only at follow-up). Probable PTSD was found in 458 firefighters (8.5%) at baseline and 548 (10.2%) at follow-up, including 343 with delayed onset. Baseline PTSD symptom counts and probable PTSD were associated with WTC cough syndrome at baseline, at follow-up, and in those with delayed-onset WTC cough syndrome. Similarly, WTC cough syndrome symptom counts and WTC cough syndrome at baseline were associated with probable PTSD at baseline, at follow-up, and in those with delayed-onset probable PTSD. WTC arrival time and work duration were cofactors of both outcomes. A small but consistent association existed between pulmonary function and WTC cough syndrome, but none with PTSD.

Conclusions

The study showed a moderate association between WTC cough syndrome and probable PTSD. The presence of one contributed to the likelihood of the other, even after adjustment for shared cofactors such as WTC exposure.

Section snippets

Materials and Methods

The FDNY-WTC Medical Monitoring Program performs health evaluations of the FDNY workforce approximately every 18 months. These evaluations include pulmonary function tests and self-administered, computer-based, medical and mental health questionnaires. Study participation requires informed written consent; the study was approved (No. 02-02-041 and No. 07-09-320) by our institutional review board at the Montefiore Medical Center.

Results

The analytic cohort represented 53.2% of the 10,074 eligible WTC-exposed firefighters (n = 5,363) who completed an examination during the study period. Comparing the analytic cohort with those excluded (n = 4,711), the proportion of persons in the earliest arrival group was similar (15.9% vs 16.0%; χ2 = 0.02, degrees of freedom [df] = 1, P = .89). There were small but statistically significant differences in race (94.6% white vs 92.8% white; χ2 = 14.3, df = 1, P < .01), rank (37.6% officers vs

Discussion

To the best of our knowledge, this is the first study of highly exposed WTC firefighters that examined comorbid respiratory and mental health symptoms over time. Using bivariate and multivariable techniques, the concordance between these symptoms at baseline and follow-up was striking, in both cross-sectional and longitudinal analyses. This relationship was consistent whether the analysis was based on individual symptoms, number of symptoms within each WTC cough syndrome category or PTSD

Conclusions

In FDNY WTC-exposed firefighters, a moderate association existed between commonly reported WTC cough syndrome and probable PTSD symptoms, which might warrant screening for one outcome when the other is present. Similarly, consideration should be given to the synergistic impact of treating both conditions (treatment of one condition may affect improvement of the other and conversely, lack of treatment of one may inhibit recovery in the other). Also, clinicians should be alert to the possibility

Acknowledgments

Author contributions: Mr Niles had full access to all of the data in the study and takes full responsibility for the integrity of all of the data and the accuracy of the data analysis.

Mr Niles: contributed to origination of the study, analysis of data, and drafting of the manuscript.

Dr Webber: contributed to origination of the study, analysis of data, and drafting of the manuscript.

Mr Gustave: contributed to data preparation, data analysis, and editing of the manuscript.

Dr Cohen: contributed to

References (35)

  • PP Katz et al.

    The impact of disability on depression among individuals with COPD

    Chest

    (2010)
  • BI O'Toole et al.

    Trauma, PTSD, and physical health: an epidemiological study of Australian Vietnam veterans

    J Psychosom Res

    (2008)
  • PJ Landrigan et al.

    Health and environmental consequences of the world trade center disaster

    Environ Health Perspect

    (2004)
  • DJ Prezant et al.

    Cough and bronchial responsiveness in firefighters at the World Trade Center site

    N Engl J Med

    (2002)
  • R Herbert et al.

    The World Trade Center disaster and the health of workers: five-year assessment of a unique medical screening program

    Environ Health Perspect

    (2006)
  • M Farfel et al.

    An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center Health Registry enrollees

    J Urban Health

    (2008)
  • MP Webber et al.

    Trends in respiratory symptoms of firefighters exposed to the world trade center disaster: 2001-2005

    Environ Health Perspect

    (2009)
  • GI Banauch et al.

    Persistent hyperreactivity and reactive airway dysfunction in firefighters at the World Trade Center

    Am J Respir Crit Care Med

    (2003)
  • GI Banauch et al.

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

    Am J Respir Crit Care Med

    (2006)
  • M Corrigan et al.

    FDNY World Trade Center Firefighters' Mental health – computerized self-administered questionnaire to identify symptoms, PTSD & Counseling Service Use

    Am J Public Health

    (2009)
  • JM Stellman et al.

    Enduring mental health morbidity and social function impairment in world trade center rescue, recovery, and cleanup workers: the psychological dimension of an environmental health disaster

    Environ Health Perspect

    (2008)
  • S Galea et al.

    Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks

    Am J Epidemiol

    (2003)
  • AS Gershon et al.

    Burden of comorbidity in individuals with asthma

    Thorax

    (2010)
  • RM Brackbill et al.

    Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack

    JAMA

    (2009)
  • D Lauterbach et al.

    The relationship between posttraumatic stress disorder and self-reported health problems

    Psychosom Med

    (2005)
  • J Fagan et al.

    Relationship of self-reported asthma severity and urgent health care utilization to psychological sequelae of the September 11, 2001 terrorist attacks on the World Trade Center among New York City area residents

    Psychosom Med

    (2003)
  • JC Beckham et al.

    Health status, somatization, and severity of posttraumatic stress disorder in Vietnam combat veterans with posttraumatic stress disorder

    Am J Psychiatry

    (1998)

    • Cited by (0)

    Funding/Support: This work was supported by the National Institute for Occupational Safety and Health [Grant R01-OH07350].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

    View full text
    Copyright © 2011 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.