Responders to the World Trade Center attacks who have post-traumatic stress disorder are twice as likely to develop respiratory diseases compared with those without PTSD, according to a study of thousands of responders.
What's more, the study found, they are much less likely to have their symptoms diminish compared with those without PTSD.
Although PTSD is not covered in the Victim Compensation Fund under the James Zadroga 9/11 Health and Compensation Act of 2010, it and respiratory illnesses -- such as asthma, reactive airway disease, chronic obstructive pulmonary disease and pulmonary fibrosis -- remain persistent and not easily treated among responders exposed to the steaming stew of toxins at Ground Zero.
In an unpublished study by Stony Brook Medicine's World Trade Center Health Program, researchers examined 8,466 police officers and 10,430 nontraditional responders such as volunteers between 2002 and 2010 and then 21/2 years later.
Dr. Benjamin Luft, medical director of the program, said that the two conditions together can be thought of as a "signature illness" of 9/11 responders.
"Now more than 10 years after 9/11, the connection between mental and physical illnesses among responders appears stronger," Luft said. "This connection raises important questions about the mechanisms underlying the PTSD and respiratory illness relationship."
At the first visit, 70 percent of responders with PTSD symptoms had respiratory problems, compared with 30 percent of responders without PTSD symptoms, the study found.
After 21/2 years, those with PTSD symptoms who initially didn't have respiratory problems were two times more likely to develop them than those without PTSD. And they were half as likely to see their respiratory problems diminish 21/2 years later, compared with responders who did not have PTSD symptoms, the study found.
"Couldn't stop coughing"
One of those is Ken George, 50, of North Babylon. A worker on 9/11 for the city highway department, he said his persistent cough started in the early morning hours of Sept. 12 when he and his fellow rescuers deeply inhaled a plume of green smoke coming out of the pile.
"We fell to our knees," he said. "We couldn't stop coughing."
Thirteen years later, he said he still has a chronic cough and reactive airway disease -- an increased sensitivity to certain toxins, allergens and other triggers that cause airways to tighten -- and takes about 30 pills a day. In 2005, he had a heart attack and retired a year later.
The trauma of working inside what he called "the gates of hell" also left its mark.
"There were body parts all over the place and the sounds of firefighters' beepers going off," he said. "As we were walking toward the pile, all these family members were applauding and giving us pictures of their loved ones. I took four or five pictures and put them in my hat. When we got there, it was like the gates of hell had opened up. Flames were still exploding. It was tough. It was tough."
His PTSD symptoms started almost immediately, he said. Symptoms of PTSD can include recurring flashbacks, nightmares, panic attacks, memory loss, emotional numbness, sleep and anger problems, and hypervigilance. After one 16-hour shift crawling in "all these little crevices," he found himself having a panic attack sitting in the backseat of a truck. Soon, he said, he wasn't sleeping and when he came home he was locking himself in his room.
More than a decade later, he said, the symptoms persist, but after counseling and the support of other 9/11 responders, "I'm at least able to talk to you. Before that I was not even answering the phone."
Researchers theorize that PTSD sufferers have a hyper-aroused immune system that predisposes them to some diseases, and that being sick may also worsen their PTSD.
This latest study -- under review for publication -- is one of a series by Luft and his colleagues looking at the persistent relationship between respiratory and PTSD symptoms. The center will receive $4 million in grants for the studies from the National Institute of Occupational Safety and Health, including $2 million to continue research looking at the link between genetic changes, PTSD and respiratory illnesses.
Other studies include one that will track in real time -- using a kind of "smart watch" -- how PTSD symptoms impact breathing and other biological functions. Another will see whether a relaxation program reduces PTSD and respiratory symptoms.
Respiratory problems are not the only affliction of 9/11 responders. Gastroesophageal reflux disease is also common.
"There is a very similar association between GERD and PTSD," Luft said. As for the relationship between cancer and PTSD, Luft said, "That is something over time we definitely want to see, whether there is an association in either direction -- whether cancer worsens the psychological issues, or PTSD has an affect on the development of cancer."
As of early August, 3,141 cancers among responders have been certified by the World Trade Center Program. Non-melanoma skin cancer and prostate cancer -- both common cancers -- top the list.
Aim of current research
Roman Kotov, associate professor of psychiatry at Stony Brook University and lead author of the study with 19,000 responders, said the current research is designed to look at all aspects of the interaction between PTSD and respiratory problems and come up with ways to disentangle the two.
"We can find out what's going wrong and try to correct it," he said.
That's what John Coughlin, 55, of Sayville is hoping. He's participating in the trial looking at the effectiveness of the Relaxation Response Resiliency Program. A former NYPD officer in emergency services, he was at Ground Zero on 9/11 and worked on and off at the site until he retired in February 2002.
He suffers from a number of ailments, including PTSD, sleep apnea and diabetes. He had open heart surgery last year and has failed his last three pulmonary tests, he said. He goes out little, he said, and is hoping the program will help him enjoy life more.
"I get flashbacks sometimes. I cry at the drop of a hat," he said. "I'll be driving and all of a sudden something will come up or I'll be sitting in my apartment and I'll start crying."
"I need to relieve my stress," he said. " . . . I hope it will give me some coping mechanisms and help with sleep."