Mann Jack M, Sha Kenneth K, Kline Gary, Breuer Frank-Uwe, Miller Albert
Weill Medical College of Cornell University, Attending Physicians in the Division of Pulmonary Medicine, New York Hospital Queens, Flushing, New York, USA.
Am J Ind Med. 2005 Sep;48(3):225-9. doi: 10.1002/ajim.20196.
Bronchiolitis obliterans is a severe, often progressive, lung disease characterized by cough, exertional dyspnea, and airflow obstruction. It has been ascribed to specific causes such as lung or bone marrow transplant, medications for rheumatoid disease, and most recently in association with exposure to environmental agents.
A 42-year-old, previously healthy New York City Highway Patrol officer who arrived at the World Trade Center (WTC), "ground zero," early on September 11, 2001 was evaluated. He has been followed for over 2 years with serial chest radiographs, CT scans, and pulmonary function studies. He eventually underwent an open lung biopsy.
His dyspnea started on September 12, 2001 and progressed despite aggressive therapy with inhaled bronchodilator as well as oral and inhaled corticosteroids. At no time did he have any radiographic evidence of pulmonary disease. His forced vital capacity (FVC) decreased from 5.32 L in October 2001 to 2.86 L in January 2003. He underwent an open lung biopsy because of the persistent exertional dyspnea coupled with the loss of over 2 L of lung volume. The pathological findings were chronic bronchiolitis with focal obliterative bronchiolitis and rare non-necrotizing granuloma. Symptoms and pulmonary function improved after therapy with Azithromycin was added to his treatment.
This process is believed to be secondary to his massive exposure to the cloud of dust that followed the collapse of the WTC. It is our conviction that many of those present at the WTC on September 11 who have persistent dyspnea and deterioration of pulmonary function may have a similar pathologic process despite absence of abnormalities on CT of the chest.
In view of the many signs and symptoms seen in first responders we feel that these findings provide important information about the pathophysiology and treatment of progressive disease resulting from this exposure.
闭塞性细支气管炎是一种严重的、通常呈进行性发展的肺部疾病，其特征为咳嗽、劳力性呼吸困难和气流受限。它被归因于特定病因，如肺或骨髓移植、类风湿疾病用药，以及最近与接触环境因素有关。
对一名42岁、既往健康的纽约市高速公路巡警进行评估，他于2001年9月11日一早抵达世界贸易中心（世贸中心）“零地带”。对他进行了超过2年的随访，期间进行了系列胸部X光片、CT扫描和肺功能检查。他最终接受了开胸肺活检。
他的呼吸困难始于2001年9月12日，尽管接受了吸入性支气管扩张剂以及口服和吸入性皮质类固醇的积极治疗，但仍持续进展。他从未有过肺部疾病的影像学证据。他的用力肺活量（FVC）从2001年10月的5.32升降至2003年1月的2.86升。由于持续的劳力性呼吸困难以及肺容积减少超过2升，他接受了开胸肺活检。病理结果为慢性细支气管炎伴局灶性闭塞性细支气管炎和罕见的非坏死性肉芽肿。在治疗中加用阿奇霉素后，症状和肺功能有所改善。
据信这一过程继发于他大量接触世贸中心倒塌后扬起的尘埃云。我们坚信，2001年9月11日在世贸中心现场出现持续呼吸困难和肺功能恶化的许多人，尽管胸部CT未见异常，可能也有类似的病理过程。
鉴于急救人员出现的诸多体征和症状，我们认为这些发现为此次暴露导致的进行性疾病的病理生理学和治疗提供了重要信息。
