CT solves puzzling 'WTC' cough

Several workers deployed at the World Trade Center for aid and cleaning tasks after the attacks of September 11 developed a mysterious cough. High-resolution, end-expiratory CT scanning helped researchers elucidate the cause, according to a report presented at the 2004 RSNA meeting.

The researchers enrolled 29 rescue and recovery workers whose symptoms did not fit the indications for asthma or chronic obstructive pulmonary disease and could not be identified using routine pulmonary function tests. The workers underwent both standard and high-resolution end-expiratory CT. The latter revealed that their ailment resembled air trapping, a condition that usually affects smokers and the elderly, causing breath shortness, dry cough, or wheezing. The study followed parameters similar to those of a study of firefighters at the WTC that was published in The New England Journal of Medicine in September 2002.

Major obstructive lung diseases like asthma and emphysema can lead to a chronic stage in which scarring and fibrosis remodels lung parenchyma. Researchers suspect that the small airways are the site of that remodeling. This information could have prognostic implications, said coauthor Dr. Rafael de la Hoz, assistant medical director of the WTC Health Effects Treatment Program at the Mount Sinai Irving Felikoff Center for Occupational and Environmental Medicine in New York City.

In addition to patients with asthma or COPD, high-resolution end-expiratory CT scanning could help the management of sarcoidosis and other, less well understood conditions affecting the lungs, including rheumatoid arthritis, de la Hoz said.