Health Beat–The “Smoldering” and “Flying” Hazards, Part 3

By Mary Jane Dittmar, Senior Associate Editor

Part 1
Part 2

Within the past 15 years, a rare type of lung disease-acute eosinophilic pneumonia-has been identified. Only a few cases of this non-bacterial pneumonia have been identified. According to Dr. William N. Rom, a lung specialist at the New York University School of Medicine, this disease may be caused through inhalation and may be more common than it is believed to be. In fact, two cases of firefighters with eosinophilic pneumonia have recently come to light.¹

According to the Gale Encyclopedia of Medicine, eosinophilic pneumonia is a group of diseases in which there is an above-normal number of eosinophils (a type of white blood cells) in the lungs and blood. These cells are part of the non-specific immune system and participate in inflammatory reactions.

There are two types of eosinophilic pneumonia: Leveler’s pneumonia, which clears spontaneously, but slowly, in about a month, and pulmonary infiltrates (cells or body fluids that have passed into a tissue or body cavity) with eosinophilia (PIE), a more serious and potentially fatal disease.

Pneumonia with eosinophils occurs as part of a hypersensitivity reaction–an over-reaction of the immune system to a particular stimulus and generally is not, as already noted, a reaction to an infection. A correlation between asthma and eosinophilic pneumonia has been established.

Eosinophilic pneumonia can also be caused by drugs and by polluted air. Symptoms range from mild (coughing, wheezing, and shortness of breath) to severe and life-threatening (severe shortness of breath and difficulty getting enough oxygen). In a few cases, the disease may rapidly produce life-threatening pneumonia.

The Patients
A 38-year-old firefighter, who had responded to the World Trade Center, was hospitalized with respiratory failure and ultimately was diagnosed with acute eosinophilic pneumonia. Dr. Rom treated the firefighter. In a report published in the American Journal of Respiratory and Critical Care Medicine (September 2002), it was stated that after extensive testing, fly ash, which came from the gypsum wallboard used in building construction, was the most likely cause of the eosinophilic pneumonia. Fiberglass particles, asbestos fibers, and eosinophils were also present in the firefighter’s lungs.

Dr. Rom made the diagnosis based on the results of testing the contents of the firefighter’s lungs through a procedure called a bronchoalveolar lavage (the washing out of the lungs with saline or mucolytic agents).

In another case, a 41-year-old firefighter was reported to have suffered respiratory failure after he was admitted to the hospital for an allergic type of reaction. About a week before his admission, he had responded to a vehicle fire in which the engine and the body of a small sports car were well-involved. The firefighter wore his mask during the fire but removed it after the fire was knocked down, even though the car was still smoldering.

The day after the vehicle fire, the firefighter had responded to an indoor fire during which a television burned. Again, the firefighter took off his mask after the flames had been extinguished, even though, by his own description, the fire was “sooty” and thick smoke was still in the room.

The firefighter reported having a cough that produced black sputum for about four to five days. The cough prompted the firefighter’s superior to remove the firefighter from the dive team. On the day he was admitted to the hospital, the firefighter had developed chest pains and shortness of breath. Diagnostic tests showed patchy infiltrates in his lungs, predominantly in the upper lobe. He did not respond to treatment with broad-spectrum antibiotics, experienced respiratory failure over the following three days, and had to be placed on a respirator for a time. He ultimately responded to treatment with steroids.

As a result of having taking off his protection mask while toxic fumes were present, this firefighter experienced an allergic type of reaction that ultimately progressed into acute respiratory distress.

Another important consideration is that even though you might not consider your present situation to be hazardous, whatever contaminant(s) to which you might be subjected may be the proverbial “straw(s) that broke the camel’s back”: Added to whatever infiltrates that already might be present in your lungs, even a relatively mild exposure can precipitate a major respiratory problem. Also, we really don’t know every substance that is present in our environment or whether some material considered safe or “neutral” today might prove to be hazardous tomorrow.

For additional information pertaining to specific health threats to which you may be exposed in your work environment, consult your heath office or local office of occupational safety and health.

You can’t be too cautious when it comes to your health. Protect yourself against all exposures. Don’t gamble with your health.

Reference

1. “9/11 Firefighter Contracted Rare Pneumonia,” Janice Billingsley, HealthScoutNews Reporter, Health on the Net Foundation, Sept. 18, 2002.

Is there a health issue your department has faced recently? Has your organization adopted a new health policy? Has concern over health matters increased in your department? Let us hear from you. Send your comments to maryjd@pennwell.com.

Mary Jane Dittmar is senior associate editor of Fire Engineering magazine and fireengineering.com. Before joining the magazine in 1991, she served as editor of a trade magazine in the health/nutrition market and held various positions in the educational and medical advertising fields. She has a bachelor’s degree in English/journalism and a master’s degree in communication arts.