Giuliani's restrictive airway disease: How toxic air at Ground Zero led to this condition

Rudy Giuliani was hospitalized over the weekend and placed on a ventilator to help him breathe, the latest flare-up in his restrictive airway disease, one of the ailments linked to exposure to toxic air in lower Manhattan in the months after the terrorist attacks of Sept. 11, 2001.

Restrictive airway disease, along with cancers, is one of the conditions that have been disproportionately diagnosed in those who worked, lived or went to school in the vicinity of Ground Zero and spent time there.

Here are questions and answers about restrictive airway diseases and their connection to the toxins in the air at Ground Zero almost a quarter century ago.

What are restrictive airway diseases?

Restrictive airway disease is present "in a small but significant number of patients" who had been at or near Ground Zero back then, said Dr. Benjamin Luft, a professor at Stony Brook University's medical school and director of its 9/11 health program.

It is one of the conditions linked to exposure to the Ground Zero air, John Feal, who runs the nonprofit FealGood Foundation, which advocates for first responders, told Newsday. Others include cancer, including some that are rare and unusual.

There is no cure, and the disease develops over time, sometimes without major symptoms initially beyond cough, said Luft, whose program monitors about 15,000 people, mostly on Long Island, who had been at Ground Zero. The disease can be controlled by medications.

Does the disease get worse over time?

Over time, a patient with restrictive airway disease can develop exercise intolerance, a cough that doesn't produce phlegm and difficulty with everyday tasks. The condition makes one more susceptible to developing pneumonia and other infections. 

"It can be quite insidious," he said of restrictive airway disease, adding: "You don't really know you're having these things, and then, 'boom!'"

"This is a disease that was caused by exposure to the caustic dust, the dust that was down at Ground Zero, it was almost like lye. It was almost that their lungs were burned," he said. 

A study published in 2011 about those exposed to 9/11 toxins as a result of their occupation noted "the slow onset of symptoms and long delay in clinical diagnoses.”

In a statement, Giuliani's spokesman said that his condition adds complications to any respiratory illness, and the virus "quickly overwhelmed his body, requiring mechanical ventilation to maintain adequate oxygen and stabilize his condition."

Why was the air around Ground Zero so toxic? 

When hijacked jetliners crashed into the Twin Towers, causing their collapse later that day, the debris pulverized into a plume of lead, asbestos, smoke, heavy metals, dust and other toxins that blanketed the neighborhoods around lower Manhattan. According to the Centers for Disease Control and Prevention, an estimated 400,000 people were exposed and 80,000 have been sickened. Giuliani was among the officials who assured the public, very early on, that the air was safe. That judgment has come under harsh criticism in later years. 

How is Giuliani’s health now?

The 81-year-old former mayor of New York City remains hospitalized in Florida, where he was brought over the weekend in critical condition after he had trouble breathing. He was put on a ventilator and given last rites, but his condition has improved and he is off the ventilator. In addition to his 9/11 health problems, Giuliani is a prostate cancer survivor, a condition diagnosed prior to 9/11.