NEW YORK -- Many firefighters who raced to save victims of the Sept. 11 World Trade Center attack now are facing their own health problems because of the contaminated air at the disaster site.
Some have asthma. Others have troubles ranging from a persistent cough to diminished lung capacity that can interfere with their physically demanding jobs. A few hundred are on medical leave or working light duty because of respiratory illness.
It's too soon to tell how many firefighters will be permanently disabled and forced to retire because of the respiratory problems, said Fire Department spokesman Frank Gribbon. But so far about 30 firefighters have started the retirement process because of respiratory problems after working at the trade center disaster, which either caused their lung ailments or made prior ones worse, Gribbon said.
Apart from those with current symptoms, medical experts say some firefighters and other ground-zero workers may be at risk of developing cancer decades from now.
One attorney said he has filed legal documents on behalf of more than 700 firefighters with respiratory symptoms to preserve their right to sue the city later on.
Many firefighters who participated in the rescue effort are easily winded, suffer from chronic cough or have developed symptoms of asthma, said Tom Manley, health and safety officer for the Uniformed Firefighters Association.
Some on medical leave may not be able to return to their old jobs, he said.
"You can't be fighting fires with asthma," said Manley, a firefighter for 19 years. "Smoke irritates asthma severely. And when you climb stairs, you are shot by the time you get up there. You're going to be out of wind."
Researchers who are studying the health effects of Sept. 11 say the failure of many rescue workers to wear respirators is a major factor in their health. The firefighter on medical leave said he didn't wear one for the first few days because "there was none around."
Manley said that with so many off-duty firefighters and volunteers pouring in to help, there simply weren't enough to go around early on. Some used surgical masks, he said, but those can't keep all the potentially hazardous materials out of the lungs.
Gribbon said that even when respirators were available, some firefighters chose not to wear them. The equipment is uncomfortable, he said, and makes communication difficult.
Respirator use by workers at ground zero improved after the first few days but "could certainly be better," said Dr. Philip J. Landrigan, chair of the department of community and preventive medicine at the Mount Sinai School of Medicine in New York.
Noting that the trade center disaster is "bigger than anything we've seen before," Landrigan said nobody can predict completely what the long-term consequences will be for worker health.
Among the substances that escaped from the 1.2 million tons of debris at ground zero are asbestos, benzene, dioxin, and polychlorinated biphenyls, known as PCBs. These are linked to cancer, although experts said in many cases the exposures were low enough that the risk appears to be small.
Landrigan said his top concern is asbestos. Some 20 years or more after exposure, it can cause mesothelioma, a rare cancer affecting the sac lining of the chest or abdomen. Most people with the disease have worked in jobs where they breathed asbestos. Asbestos exposure can also cause lung cancer.
It's hard to say how big the mesothelioma threat is, Landrigan said, because nobody knows how many workers were exposed to various levels of asbestos.
And the exposure isn't over yet. Every time a worker picks up a beam that contains asbestos, "that stuff is kicked into the air" and could be inhaled by workers who aren't wearing proper protection, he said.
Still, Dr. Stephen Levin, medical director of Mount Sinai's Irving J. Selikoff Center for Occupational and Environmental Medicine, said he believes the risk of asbestos-related disease in ground zero workers is relatively low. While he doesn't want to trivialize their exposures, he said, they are lower and briefer than the typical lifetime exposures seen in construction workers.
As for dioxins and benzene, Landrigan said they probably pose much less risk than asbestos, and Levin said he suspected the risk from those chemicals and PCBs is small.
A key concern experts cite is dust -- a mix of such things as pulverized concrete and fibrous glass, and mineral dust, mixed with irritating gases. Dust can cause respiratory problems that last a lifetime.
Levin said doctors at his medical center have found more than a dozen people who, in the wake of the disaster, experienced a first episode of asthma. The cause isn't clear.
The problem has appeared in rescue workers and people who were just nearby when the disaster happened. The worst cases have shown up in people caught in the dust cloud that spread from the collapse.
Planned studies of people exposed in the disaster might show whether early treatment -- say, within the first two or three months -- with inhaled steroids really does lower the risk that newly diagnosed asthma or sinusitis will become lifelong conditions, Levin said.