Occupational toxicant inhalation injury: the World Trade Center (WTC) experience

Subsequent to the review and acceptance of this article, two patients suspected to have small airway disease (as described in “Methods” and “Results”), underwent thoracoscopic open lung biopsy, in view of their lack of adequate response to inhaled medications. The histology revealed constrictive bronchiolitis in one of the cases, which would lend support to the preliminary classification presented in this article. This patient (whose end-expiratory chest CT scan showed severe air trapping but no interstitial changes, and his pulmonary function tests borderline decreases in both total lung capacity and diffusion capacity) had, however, mild and patchy but definite focal lymphoid aggregates, areas of alveolar–capillary membrane thickening, and mild subpleural distal air space dilatation, but no honeycombing or fibroblastic foci. In the second case, the chest CT scan showed equally severe air trapping and interstitial changes, but the restriction and decreased diffusion were severe. The histologic features just described for the first case were similar but clearly more severe in the second case. Pending further characterization, the latter findings would add a new category of lung disease or broaden the spectrum or our understanding of the nature of the small airway disease category.

See footnote 1.