Airway, Digestive, and Mental Health Comorbidities in WTC Responders and Survivors—WD2809

NP is a 58 year-old lieutenant with the New York City Fire Department (FDNY). On 9/11, he was at the towers when they fell. NP lost many friends and colleagues, and was exposed to high levels of dust and debris. In the days following, he had a sore throat as well as a mild cough. A few months after the attack, NP developed a chronic cough. One year after, he started to experience persistent upper and lower respiratory symptoms, as well as gastroesophageal reflux disorder (GERD), and was diagnosed with asthma. A year ago, his respiratory symptoms became so severe that he was required to go on medical leave for 6 weeks. Currently, his respiratory symptoms and GERD are under control with medication, but he still coughs frequently. During today's visit, he mentions that he has been having trouble sleeping. His wife is with him, and she is concerned because he has started "drinking more often," and has been irritable and forgetful. NP appears uncomfortable to be discussing his feelings, but admits to having bad dreams recently as well as feelings of guilt.

• Post Traumatic Stress Disorder (PTSD)
• Adjustment Disorder
• Anxiety
• Substance abuse
• All of the above

MR, a 45 year-old woman, presents at your medical practice with persistent cough, acid reflux, nasal congestion, and sinus fullness. For the past 8 years, she has been taking overthecounter medications to manage these symptoms, including cetirizine, omeprazole, and other antacids. However, she reports that all of these symptoms have recently become worse, noting that she feels the need to cough and clear her throat very frequently. During your discussion, she mentions that she was in her apartment in Brooklyn on 9/11, where a large layer of dust built up about 90 minutes after the first tower fell, and then continued into the next day. She also remembers having a sore throat that day, and states her "entire neighborhood was raining dust and debris." For several months after the attack, she also worked in midtown Manhattan, and could frequently smell an acrid burning odor.

• Minimal exposure to WTC dust and fumes, because she was too far away from the WTC site, and did not work in the nearby area
• Only acute exposure to initial debris and WTC dust clouds
• Both acute and chronic exposure to WTC dust and fumes
• Only chronic exposure to dust and fumes in local streets in months after 9/11

BC is a 55 year-old retired City of New York Police Department (NYPD) officer living in Florida. Two years ago, when he first came to you, he stated that he had worked at the WTC "pile" for 60 hours over 3 months. While searching for the remains of colleagues, some of whom he considered close friends, he had chronic exposure to WTC dust. For the past 2 years, BC has been receiving treatment for asthma, GERD, and rhinitis. He now reports an increased frequency of "asthma attacks" with feelings of chest tightness, hyperventilation, and choking, He worries that his asthma is not being controlled by his medications.

• Review current asthma treatment regimen
• Recommend screening for obstructive sleep apnea
• Refer the patient for allergy testing
• Review current asthma treatment regimen and consider evaluation for panic disorder

• He would not be eligible to participate in a program, as you are already managing his care
• The WTC Health Registry is only available to WTC responders and WTC survivors living in the state of New York
• WTC Responders and WTC Survivors who reside outside of the NY metropolitan area are still eligible to participate in the WTC Health Program
• He would be unable to participate in the program because he is not a firefighter