This cohort probably experienced less overall exposure than other World Trade Center responder cohorts did. Results suggest that being present when the buildings collapsed was associated with reported symptoms.

Loperamide is an over-the-counter antidiarrheal with opioidreceptor agonist properties. Recommended over-the-counter doses (range = 2-8 mg daily) do not produce opioid effects in the central nervous system because of poor oral bioavailability and P-glycoprotein efflux* of the medication (1); recent reports suggest that large doses (50-300 mg) of loperamide produce euphoria, central nervous system depression, and cardiotoxicity (2-4). Abuse of loperamide for its euphoric effect or for selftreatment of opioid withdrawal is increasing (5). Cases of loperamide abuse reported to the Upstate New York Poison Center and New York City Poison Control Center were analyzed for demographic, exposure, clinical, and laboratory characteristics. Cases of intentional loperamide abuse reported to the National Poison Database System (NPDS) also were analyzed for demographic, dose, formulation, and outcome information.A New York case of loperamide abuse was defined as any call to the Upstate New York Poison Center or New York City Poison Control Center reporting intentional loperamide abuse during January 1, 2008-March 31, 2016. An NPDS loperamide abuse case was defined as any exposure reported to NPDS citing intentional loperamide abuse during January 1, 2008-March 31, 2016.Among the 22 New York loperamide abuse cases identified, 18 patients were male. Median patient age was 30 years (range = 19-48 years). Electrocardiogram abnormalities included QTc prolongation in 15 (68%) patients, QRS prolongation in nine (41%) patients, and ventricular dysrhythmia in eight (36%) patients. The average reported daily dose was 358 mg (range = 34-1,200 mg). Previous opioid abuse was reported by 15 patients, previous treatment with methadone or buprenorphine (a partial opioid agonist used to treat opioid addiction) by eight patients, and chronic abuse by 13 patients. Opioid withdrawal symptoms after cessation of loperamide were reported by nine patients. Serum loperamide concentrations were obtained from four patients and ranged from 77-210 ng/mL, representing 25-875 times the therapeutic range of 0.24-3.1 ng/mL (6).A total of 179 NPDS cases were identified, approximately half of which were reported after January 1, 2014 (Figure). Notes from the FieldAmong the 179 cases, 137 (77%) of the patients were male, the median patient age was 26 years (range = 7-87 years), and 154 (86%) were admitted to or treated in a health care facility. The average loperamide dose was 196.5 mg (range = 2-1,200 mg), and nearly all cases (95%) involved tablets or capsules. Cardiac conduction disturbances were reported in 24 (13%) patients, ventricular tachycardia or fibrillation in 16 (9%) patients, other dysrhythmias in 10 (6%) patients, and other electrocardiogram changes in five (3%) patients. Outcome was reported for 132 patients and was coded as moderate (pronounced or prolonged systemic symptoms, non-life threatening) or major (life-threatening symptoms or residual disability) for 66 patients (50%). Four (3%) deaths were reported.These cases support the reported ass...

This study evaluated whether impulse oscillometry (IOS) testing revealed signs of respiratory disease in New York State (NYS) World Trade Center (WTC) responders in comparison with unexposed NYS employees. It also compared self-reported respiratory symptoms between the two groups, 6 years post-9/11. For this evaluation participants completed a self-administered questionnaire regarding respiratory symptoms. IOS testing included measures of resistance and reactance to assess for peripheral versus central airway effects. Two hundred forty-eight subjects (99 exposed and 149 unexposed) were included in the final analysis. Since September 11, 2001, NYS responders were more likely to report new or worsening cough in the absence of a respiratory infection, cough consistent with chronic bronchitis, current respiratory symptoms, or lower respiratory symptoms in the last 12 months. Significant associations were found between IOS indices and gender, smoking history, and obesity. When comparing exposed and unexposed participants, there were no significant differences in the geometric means of the IOS indices. Responders who used a respirator with canister demonstrated significantly lower respiratory resistance at 5 and 20 Hz (R5 and R20). While this study has provided no evidence of an association between WTC exposure and peripheral airways disease in this cohort of responders, results do suggest that use of a respirator with canister may be protective for central airways in responders exposed to dust and smoke. This emphasizes the importance of stressing proper respirator use in planning responses to future disasters. Our control data also provide useful reference values for future IOS research.

Our findings suggest that even in a moderately exposed responder population, lower respiratory effects were a persistent problem 5 years post-9/11, indicating that some WTC responders require ongoing monitoring.